Basal Rate madness?

[Sugarbum]

I went to see the Prof this week for my review and I have hit a brick wall. He told me that my basal rates are "madness"

I have 7 different basal rates in 24 hours. He says I need to reduce my basal rates for better effect down to about three a day as I am causing too much "lagg" of insulin. He said also that with 7 rates my body will enevitably struggle to keep up.

Ive not been told this before, perhaps even taken a bit of pride on how 'fine-tuned' I consider myslef to have been....but perhaps Im barking up the wrong tree. I think too describe my rates as "madness" was a bit harsh!

Do I have too many basal rate changes?

What does everyone else have?

Thanks🙂

 

[Liz!]

Well - how is your control? If it's ok, what's the problem? What does he mean by eventually? Next year? How could that be affected by what you are doing now?

I have loads of different rates. My Consultant has had no probelm with it and as even addded couple. In fact the day before yesterday they suggested NO insulin between 12am amd 4am - and i woke up this morning with a blood sugar of 5, first time not rebounded for ages!

You need to do what it right for you. i had probelms mid afternoon as well, also when I needed no insulin for an hour or so.

 

[Sugarbum]

Thanks Liz.

I would describe my control as reasonable- Im a "could do better" person. Im quite disheartened actually, at the moment. I think I try quite hard but I dont have the results to prove it so I have to go back to the drawing board with something- but reducing my basals down to only 3 blew me out of the water.

If I was to reduce my reguime down to only 3 changes I wouldnt know where to start?

 

[randomange]

I have twelve different rates over 24 hours, and my doctor is happy with this. He says it's obvious I'm a fiddler, but that's fine because he would be the same! 😛 As long as I'm comfortable, and I've basal tested and my BGs are ok, then he's happy for me to continue. I couldn't do three rates a day - I would end up on a rollercoaster of highs and lows. What's the point of having a pump if you can't use the ability to fine tune your basal rates as best you can?

I'm not sure what he means by your body struggling to keep up - surely in a non-diabetic insulin levels can change as required, and in some people that will mean very little change, and in others there will be quite a lot of change? Sorry, I'm not an expert (obviously!) but I think I have to disagree with your prof!

 

[randomange]

Also, in response to your last post, have you tried reading through something like Pumping Insulin to give you somewhere to start? I'm a bit in the same boat as you at the moment - I'm trying to refigure out my basals in response to the new steroid/liver drugs treatment now that I'm on a more settled regime, and I've found it's helped me to 'get back to basics'. 🙂

 

[Sugarbum]

haha! thanks Ange,

Thats interesting that you have 12, thats very specific- you must have burned the midnight oil on your basal testing reguime!

Im hesitiant to go against the grain as it were, but I agree with you. I thought that the tool was only as good as the person operating it, so perhaps he thinks I need to go back to basics 😉 I always worry that if I do anything millitant he will revoke my pump as I am not showing any improvement....and you know Id rather leave the country than hand this over!

Im also confused by the "lagg" statement. I was under the impression this wasnt an issue with the shorter acting insulins that we use for pumping?

 

[Sugarbum]

Also, in response to your last post, have you tried reading through something like Pumping Insulin to give you somewhere to start? I'm a bit in the same boat as you at the moment - I'm trying to refigure out my basals in response to the new steroid/liver drugs treatment now that I'm on a more settled regime, and I've found it's helped me to 'get back to basics'. 🙂

Its funny you have put this- The Proff I see is mentioned in "Pumping Insulin"!!!!! He is the king-pin of pumping, inventing it in the 70's I think it was and then took the idea to the US. I cant tell you as Im not at home but I think he is on page 4 🙂

Perhaps its time to consult that mantra....

 

[randomange]

I have twelve because it's the maximum I can have on the Animas!

I can't really see why lag would be an issue if you've tested your basal rates. I can sort of see why you could have some lag of one into another if you had a really high one, which may have a slightly longer tail off, but most people's basals rates aren't that high (well, mine probably are, but that's a whole other kettle of fish 😛)

I'll have to have a look in Pumping Insulin when I get home I also like Think like a Pancreas, which has a lot of pumping stuff in in as well as stuff for MDI, and some of the ideas are a bit different. I tend to have a look at both of them and then go with what works for me!

 

[Adrienne]

For goodness sake that is one of the most ridiculous things I've heard a consultant say and I've heard plenty of tosh over the last 10 years.

If it is not good that you have more than three basal rates then why do pumps allow it.

If it not good that you have more than three basal rates why don't you just jack in all the hassle and go back to MDI with a split dose levemir and novorapid, maybe that will be better for your consultant, only two basal rates then.

I mean that is what he is really saying isn't he. Levemir is a background insulin and if you split it then normally you give different amounts morning and night so like a basal on a pump (I know it doesn't dribble out hourly).

Stupid man.

We have 9, sometimes 10 basal rates for my daughter. You have to do what works. If you are ok and it is working then great. It is not about the number of basals. If three basals worked for one person and 10 for another then that is what has to happen. There are no fixed rules there.

Rather than feeling despondent I think you should jump for joy and be very happy, you are doing great and I think you have definitely reached a point where you know more than your consultant who could do with some training it seems.

🙂

 

[Pumper_Sue]

I have 15 😱 but it works for me.
Someone cooked up the idea that 4 is all you need so it's now gospel. 🙄

As randomange say's go back to basics and start again. Do some intensive testing and see what is happening.
My basal kept changing every 3 or 4 days somes would last 6 days's without needed changing.
So dective work started and with the help of John Hughes at advanced therapeutics we worked out it was the cannula length causing the problems.
I have now gone down to a 6mm cannula. Problem solved fairly stable now with a slight tweak needed at lunch time.

Endo of day though if you are getting good results, then don't fix what ain't broke.
You are quite right the pump is only as good as the user so if you doing ok then you is good as is the pump lol.

Do delve into pumping insulin if you haven't already.

 

[everydayupsanddowns]

Feel a bit odd posting here as an MDI luddite, but the only thing I would consider with multi-rate patterns is the delay for the insulin to actually get going.

Even with rapid-acting analogues there is an inevitable delay between delivery and effect. It's one of the things that makes driving the diabetes juggernaut such a lark. Turn the steering wheel and the thing might respond in 45 minutes to an hour. Actually having thought of it that way perhaps it's a bit more like an oil tanker.

I also seem to find that the response time varies through the day (slower in the morning>lunch, more rapid after evening meal) though this may, in part, be due to being on the relatively flat basal profile of MDI.

 

[Pumper_Sue]

Hi Mike,
With a pump depending on which insulin you use in it, we have the ability to set the basal change for when it's needed.
IE., if we had a rise or drop in blood sugar at 10 AM we would set the basal change to start at either 8 AM or 9 AM.
This is why pumpers do or should do regular basal testing 🙂

 

[shiv]

Lou, who is your professor? I think I might have an idea but could you PM me?

Mike, Sue is bang on - I suffer from DP so I have set my basals quite high (for me, anyway) in the early hours to counteract that. That's the great thing about pumping - be able to do these changes!

 

[Sugarbum]

Thansk everyone for your comments. Its kind of a relief to know that actually it would appear I have the fewest changes out of everyone who commented!

I dont use patterns anymore which as a shift worker I thought was brilliant at first. However, with a different shift each day I was always on a pattern, forgeting to change to the other and making a bit of a hash of it all. So I have a few changes in my daily basal and I thought that was working.

I was told I need to go back to the DSN to 'sort my basals out'. Im 33 for goodness sake- felt like Id been sent to detension!

Can I just get some idea from you guys roughly what amounts your changes are between each rate? Big or small?

Thanks guys.

 

[Liz!]

Midnight till 4 = NOTHING, then 0.2, 1.5, 2.0, 1.25, 0.8, 0.5, Midday = 0.2, 0.3, and then 0.6 till midnight again. Much more stable in the evening.

 

[shiv]

00:00 0.55
02:30 0.85
05:00 0.80
10:30 0.55
12:30 0.75
17:00 0.55

But when I was working at the hospital, I would jump from 0.85 overnight to 0.15 at 05:30 because I needed tiny, tiny amounts due to nature of the job!

 

[Pumper_Sue]

My biggest jump is by 1.25 units.
Even though my basal is only 14 units/day. It's known as the wonder of steroids

 

[everydayupsanddowns]

Sue & Shiv

Yes I do envy you the almost infinitely tweakable basal patterns. Would certainly have helped me this week. Then again a few weeks ago it was fine. And next week who knows!?!

What I was meaning really is that if you set different rates at only 30 or 60 minute intervals the variability in lag (even just day to day) might make it problematic to properly understand a pattern of results.

If (when?) I start pumping I think I'll have to be pretty much basal testing constantly the way things seem to ebb and flow for me.

M

 

[Sugarbum]

[/COLOR]

Midnight till 4 = NOTHING, then 0.2, 1.5, 2.0, 1.25, 0.8, 0.5, Midday = 0.2, 0.3, and then 0.6 till midnight again. Much more stable in the evening.

That's a very interesting pattern you have! There cant be many who go without for 4 hours and then a very low rate. Great that you are not needing loads of insulin. You also have a greater variant in your basal changes than I do.

00:00 0.55
02:30 0.85
05:00 0.80
10:30 0.55
12:30 0.75
17:00 0.55

But when I was working at the hospital, I would jump from 0.85 overnight to 0.15 at 05:30 because I needed tiny, tiny amounts due to nature of the job!

Yes working nights is so difficult. I quite often temp basal nothing for a period of time when things get busy it can be the same as a workout!

My biggest jump is by 1.25 units.
Even though my basal is only 14 units/day. It's known as the wonder of steroids

Randomange mentioned earlier about starting steroids, sounds like it has quite an effect...

Im still abit stumped what to do....


These are my basal rates at the mo (or the "madness" as my doc likes to call them!)

00:00 1.1
04:00 1.2
05:00 1.25
06:30 0.95
15:30 0.7
20:00 0.925
23:00 1.0

Perhaps he feels my small increments arent worth it.

Think I have got some number crunching to do!

Thanks for your help, all x

 

[Pumper_Sue]

[/COLOR]

That's a very interesting pattern you have! There cant be many who go without for 4 hours and then a very low rate. Great that you are not needing loads of insulin. You also have a greater variant in your basal changes than I do.



Yes working nights is so difficult. I quite often temp basal nothing for a period of time when things get busy it can be the same as a workout!



Randomange mentioned earlier about starting steroids, sounds like it has quite an effect...

Im still abit stumped what to do....


These are my basal rates at the mo (or the "madness" as my doc likes to call them!)

00:00 1.1
04:00 1.2
05:00 1.25
06:30 0.95
15:30 0.7
20:00 0.925
23:00 1.0

Perhaps he feels my small increments arent worth it.

Think I have got some number crunching to do!

Thanks for your help, all x

SB,
What are your blood sugar readings like on that basal?
If they are as you want them, there is nothing wrong with your basal
When my consultant told me my basal pattern was complicated and far to many, I said so what it works so who's complaining besides you? It works for me.