I remember when I first started reading blogs in the DOC, people would write about temp basal this and temp basal that. To someone who had no knowledge of pumping (and even after I started to learn), this always mystified me.
How do you know when to do it?
And by how much?
And for how long?
To me it was like trying to solve for x, but you're not given any other numbers to help you.
Well, last night was another pumping first for us... using the temp basal. Elise went to bed at 173, and by 11:00 was 118 (never showing an arrow down on the dex, mind you). So we decided to set a temp basal. But I still could not figure out how much for how long. Because I love to just pull numbers out of my butt, I went with -50% for 1 hour.
By midnight, she was 103. We decided to give her 5g of carbs, and keep the basal at -50% for 2 more hours. When we checked again, she was 143 and we returned to her normal settings.
She woke up at 243, so somewhere, we did something wrong.
So how do you decide when to lower the basal and when to give food? Do both? How do you decide on how much and how long? Or is it some "gut thing" you develop over time?
10 months ago
How funny that I just read your post right after hanging up with the nurse at school and instructing her to set a temp basal because Jacob has been low ALL morning! :)
ReplyDeleteFor us its always a little bit of a shot in the dark. Over time the shots have gotten more accurate as we have gotten a better feel for it. I usually start with a temp basal of 75% if he is slowly dropping... then increase that as needed. I usually set the temp for the length of time that we are in the current basal range. Most of Jacobs basal ranges are 3 hours long. So if we are an hour into a range and he is dropping I will set the basal to 75% for the next two hours.... make sense? :0)
we do temp basals whenever boosting with food is not convienient or possible. (at night... at school...) Otherwise, I will just give him a "free" snack of about 10-15 carbs to get us through that basal range.
Of course, if we have to do this for 3 days in a row, then that is when the basal for that range is permanently changed.
Its been fun reading about your explorations into all the nooks and crannies of pumping!!
Oh the temp basal - I love it - really - and you will too once you get what works for Elise. I use it all the time with highs and with lows. And remember, this is for MY gal - so you will have to find out what works for Elise - and I'm not a doctor (but I should be by now!) so blah, blah blah you know the drill.
ReplyDeleteSo at 118 was too low for her in your mind? So first I see what range you want her in for bed. If that's 150 ish, then a -20% or a -30% for an hour or so might do the trick in an hour or two. But she only went from 118 to 103 in an hour on that -50%, so you know just a tad less than -50%. Maybe next time try -40% and see where that lands you in an hour. And yes, I do both when she falls out of range - give food and temp basal. If she is in range I do not give food. That's what works for us.
See how the temp basal cam and kicked you in the butt though? When we minus too much of the basal, it catches up with the kid. The missed insulin catches up and doesn't keep the blood sugar down, so to me, the 143 was telling you that the -50% was too much, it's letting the sugar climb. Factor in how much 5g raised her too, I'm not sure I know that about her. Returning to 'normal settings' - now you have missed some insulin with all this temp basaling.
I also use temp basals to bring down highs quicker. I use +% amts, but in fairly short time periods, like .5 hours, cause I don't want her to drop too fast.
You will develop a gut feeling for how much % + or - over time. And it totally is based on what you see her numbers do. You will get the hang of it, but it does take time. I know that's hard - patience and trying this % and that %, but when you do hit it - it's wonderful. You will catch on in no time.
Great question and very informative comments. We just started pumping in august and i've been struggling with how and when to use temp basals. Thanks to everyone for sharing!!
ReplyDeleteI don't have a clue so I'm glad you asked so I can learn with you!
ReplyDeleteWe will often use minus 80 percent for a half hour to bump her up to the 150 (we use 150 target when she has been exercising), then minus 20 for rest of the night. That's our exercise basal for moderate exercise. We also use juice or milk to get her up to 150 then do the minus 20. I don't think you were that far off. Takes two hours for a basal to take effect (one hour, I think, for Apidra). and it will remain in effect for two hours once you cancel it. She held at 150 for half the night. I think she may have another basal time period in there from 3am to 8am maybe? Dawn Phenom? Not common in very little ones. But she may need a different basal, using more insulin from the last time you tested until she woke. At some point you will have to test and see. We have one basal 12 to 1:30am, one 1:30 thru 5am, one 5 to 8am. Next time I would use the carbs to bring her to 150 (faster and more reliable, less dangerous also), then try minus 30 percent. See if she holds or drops on that. Remember, by bumping her up to the 150, you are safe while experimenting. We use minus 70 percent only for heavy exercise like swimming for hours on end, hiking, tramp or biking, again for hours. Minus 20 for moderate exercise for us. Gary Scheiner has a chart with Excarbs and basal reductions for various exercises, also depending on moderate, heavy or light exercise; taking into account the duration of the exercise also. Think Like a Pancreas. Worked well for us. But Elise is younger and smaller than our DD was at dx. I think 50 percent minus was a pretty good guess. You are doing well.
ReplyDeleteOh man. Reading the other Moms talk about figuring temp basals makes my brain hurt! We use temp basals mostly at night. I just give juice to bump up the low (because juice will stop a drop quicker than just a temp basal for Maddi AND she sips a straw while asleep) then I set a temp basal of zero for 30 minutes. Once she is bumped up she usually stays...
ReplyDeleteother times for lows I reduce by 20% or 30% and it seems to work miracles...I for one, have NEVER in 5 years mastered temp basals for food coverage though! :( UGH!
We've been pumping about 18 months now and I'm still working on the temp basals. I have only gone -10% or -20% when she's running low, and then I treat with food as well. However I do find that for things like Pizza (our nemisis) or long car rides, that bumping up her basals +10-30% helps a lot! For Pizza I bump it up 20% for about 4 hours, for the car ride which is usually when we travel to Phoenix, a 4 hour drive, I bump it up around 15 or 20% for the 4 hour drive, but of course we're still checking her BG the whole time.
ReplyDeleteTwo things that have helped me. And I actually learned the first thing from the second thing - that will make sense in a second.
ReplyDeleteRemember that if you want to change someone's blood glucose result at (let's say) 3 pm, it would actually be the basal at 12 or 1 that you would change. Since the action of insulin isn't immediate, neither are the amounts in a basal rate.
I pumped for a few years not really understanding what I was doing. Then I found the book "Pumping Insulin" - not available in bookstores but you can get it on Amazon. There are charts and graphs and tables in there that completely revolutionized my pumping life. I highly, highly recommend it to anyone with an insulin pump.
We've been using the pod for a year and a half now...I can tell you on one hand how many times we've tried the temp basals! One of the comments was right on with the timing! When you adjust a basal it usually doesn't take affect until 1-2 hours after the change (we use apidra so one hour for us). Then when you turn it back on...you have to wait for the insulin to catch up. I've only turned her pump "off" once the first summer when she was swimming and wouldn't come up, I got scared and just shut it off...she came up alright! Whoo! Way up! The book Pumping Insulin by John Walsh is a good buy. Soooo, I have no temp basal advice, but do know...if you get pissed at it and decide to not use it, we've managed pretty well without using it hardly at all! So don't pressure yourself too much to do the fancy pants stuff...you've been rocking it without a pump long enough, go with your gut babe! =) Loves and Hugs!!!
ReplyDeletefirst we utilize the premise that for Isaac 1 unit brings him down by 300...so depending on where he's at we do a little math to figure out how much less insulin he needs and then program in that reduction in for two hours, why two hours because one always seems to be too little for him...also we recheck at 1 hr just to be certain he hasn't dropped more then let him go until our "normally" scheduled 2am check. I've also found we can't do both, we can't give glucose and reduce his basal UNLESS he has double arrows going down. Then and only then do we do both, and if we do both we usually only reduce his basal for one hour to 0.025 along with about 8grams of carbs. Confusing, yet?
ReplyDeleteI think that it really just takes time to see how Elise responds to the reduced basals, Isaac's body responds quickly to insulin changes but slowly to glucose intake at night. I've also loved using temp basals for things like gymnastics, I'll turn his basal down about half an hour before class to about half of his normal and have it stay that way for an hour after his class...works really well (right now!)
I think you're doing well with having been pumping for such a short amount of time.
I'm a HUGE fan of the temp basal. However, I detest the percentage setting. We have Bean's set to calculate temp basals in 0.05u. It's just way easier for me to see that if her basal is set for 0.20u and I know she needs a little bump, I can go to 0.25 instead of having to think 'what percentage should I do?'
ReplyDeleteMaybe that will help... :)