Changing basals 🤔

When do you all change basal rates? Not tweaking one section, but changing the entire amount up or down?

In the past I’ve always been told that if I’m running high (or low) all day fore more than two days that I should change them. But, it seems that I change basals a lot, as in almost constantly. I’m not sure if this is just the way my body works or if I’m doing something wrong.

This past week is a perfect example. I’ve been simultaneously at a conference but feeling unwell (without getting into too much detail: stomach issues) for the past few days. The two days before I left I was running low non-stop, at least six or more times per day, extended lows that would last for hours, and so on. So I lowered basal rates, and the lows continued and continued, and so I continued to lower basal rates. Until today. Last night I treated a low, shot up to 13 mmol/L, and have pretty much been flatlined there for the past 24 hours, despite many, many corrections. I raised my basal rate a bit this morning, BUT I’m reluctant to raise it too far so soon after lowering it.

This just seems crazy to me that I’ve adjusted basal rates every day for the past week, and yet I truly do not know how else I could respond to running low and high for virtually 100% of the time. Does anyone else experience this? Would you lower basals or try something else (and if so, what)?

Only when a clear, overwhelming and consistent pattern develops over the course of weeks… and since I use tresiba there are only two possible underlying trends— drifting downward generally outside of meals or drifting upwards generally outside of meals. Of course in the moment and over the course of the day it can always seem a lot more complicated than that, but that’s what it really boils down to.

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But it doesn’t sound like you ever have times where you are running outside your target range literally 100% of the time? Is there a reason for letting a pattern develop for weeks? Even back in the R and NPH days, when insulin wasn’t really adjusted that much, we were always told three days of a pattern warranted a change.

I’m okay with tweaking, such as if I’m only having mild highs or lows, that’s pretty easy. It’s more these periods where I end up persistently running way outside my target range despite my in-the-moment efforts to correct throughout the day that I find challenging. I would not want to let myself go weeks running at 11-13 mmol/L (200-240 mg/dl) nor treating six lows, some of them really deep, per day.

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No I never spend 100% of the time outside of my target range… I think adjusting after 2 days is generally too fast unless it’s a situation you know… like with women on their period they might know from years of experience “day 1 increase basal by 8 units” or whatever the case may be…

I don’t require adjustments that often, when I do it’s pretty self explanatory… that’s the problem with pumps IMO… infinitely adjustable means infinitely small chance of getting it adjusted just right (that and rapid insulin behaves so poorly)

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Typically when I talk about “adjusting basal” on the pump, though, I’m talking about adjusting all the basal rates up or down at once. I don’t often fiddle with one little three-hour chunk or anything like that, unless there’s a persistent pattern of highs or lows at that time for many days (weeks). So, what I’m talking about here is essentially the same as adjusting a long-acting insulin up or down by so many units.

I’ve had these sorts of issues of needing dose adjustments my entire diabetes life, since I was a kid and way before the pump (I spent 15 years on injections before going on the pump). My control is far better on the pump than it was on any injection regimens I tried.

I’ll be seeing my endocrinologist next week and asking for a sample of Tresiba. It’s things like this and the fact that Tresiba can’t be adjusted quickly to respond to exercise/illness/hormones/stress (and other things that seem to drastically impact my insulin needs) that make me seriously wonder if it will work for me, though I’ll still give it a try. I’m going to ask him for a sample pen and a three-month prescription.


Ah! Congratulations I’ll be really looking forward to seeing how it works for you. Women aren’t as susceptible to the “pumpers dilemma” as men are apparently ;). Can’t wait to see how it works for you

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The biggest thing I’ll miss is being able to micro-bonus at any time. I’m seriously worried my BG will go completely nuts and I’ll lose all semblance of control (I spent 20+ years of my diabetes life in that state, no desire to go back). But I’m also curious about all I’ve heard about it and don’t like any of the grand total of two pumps currently on the Canadian market, so I may as well give it a try.

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You won’t miss it if it’s not necessary. Dunno if that’s too much to hope for or not. Give it a try, if it’s not good just go back to the pump,… really not a big deal to go back. Nothing ventured nothing gained

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Yeah, if I don’t have to do micro-dosing then I wouldn’t miss it. The last time I was on shots I was having to do 8+ injections a day (and night) just to maintain an A1c around 7.5%. If I could actually do MDI and ONLY have to do four shots a day (which has never been the case, except when I was on NPH) that would be fantastic.

My only other worry is that I’ve heard about a lot of people having allergic reaction issues with Tresiba, which only worries me because I already have half a billion allergies to begin with.

We’ll see how it goes. I’ll probably update here because I’ll have no idea what dose to start at or how to adjust things. My endocrinologist will think I’m crazy, but he’s familiar with my desire to experiment with mew treatments (and also the pump situation in Canada), so I think he’ll humour me. My pump will always be sitting there waiting if I hate Tresiba after a few months and want to go back.

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Really? I hadn’t heard that

Re adjusting there’s really not much to it… give it a few days if you’re getting a lot of increasing bg for no reason, add a few units, if you’re getting a lot of dropping bg for no reason, take a little less. Main thing is to just not adjust it too frequently and end up chasing your tail around…

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Despite trying Tresiba, I’m still curious about when people (MDI or pampers) adjust basal rates, per my original post. :slight_smile:

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It’s all anecdotal, but in some Facebook groups I’m in some people have tried Tresiba and had to switch to other insulins due to allergy issues. I’ve read the same about people being unable to use Fiasp due to allergy issues. I’ve had few problems with Fiasp, so I’m guessing Tresiba will be the same. Maybe people are reacting to one of the preservatives Novo Nordisk uses in their insulins.

I have MM pump, which lets me set up 3 patterns for basal. Standard, A,B. I switch between them as needed, but not very often. I made a recent switch to higher basal pattern, as typically occurs for me, with the change in season and less outdoor activity.

I feel like this is what I’m already doing. Usually the first day or two of running high or low I’ll try temporary basal rates to see if it helps. If it does, I’ll move into permanent changes. But maybe where I’m going wrong is that then if I continue running high or low, I continue changing basals (on the pump, at least, because basal changes kick in after a few hours). With Tresiba, it’s going to be very hard for me to wait three days while 100% of my readings are out of range to make a tiny change, then three days more… I did that on Lantus (waiting three days, adjust a unit or two, wait three more days…) and I think that’s why my endo literally said he’d be happy if we could keep 50% of my readings in range, because at the time I was hitting about 25% of readings in range (and at the time my range was up to 10 mmol/L / 180 mg/dl, so much wider than my range is now).

I think you’ll be pleasantly surprised how much of your time, outside of meals, will be spent in range… and I think once that’s under control it’ll be a lot easier to dial in meals also. I agree the initial getting it dialed in might take a little patience, but if you just start with your average pump basal per 24 hours it should get you somewhere in the ballpark and I’d only expect minor adjustments after that, but we’ll have to see. I’m excited for you. How soon are you going to get started? I hope you love it

I wonder if I should start with my “low” basal average of 28 units or my “high” basal average of 55 units? This is how much my basal varies from female hormones throughout the month (and more at times). Maybe I’ll just start with the average of those two numbers… Or maybe I’ll start with my average over the past week… I probably won’t start Tresiba next week, but the week after when I’m off on holidays and can keep a close eye on my CGM and devote my full attention to avoiding a blood sugar emergency…

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If we seem to need a general basal rate change, I will often times test it out with a temp basal. I have no issue with running a +15% temp basal (or similar) for a few days to test it out.

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Well we’ll figure it out… that’s another stupid thing about pumps, obviously if your basal rates varied that much with a pump… and your blood sugars were that erratic, pretty clearly the basal rates were driving your blood sugars up and or down… which is not what basals are supposed to do, and it’s super hard to untangle basal and bolus (impossible really) when they’re both coming through the same tube from the same reservoir… now that we have long acting basals that actually work I think you’ll be amazed how clear this will all become rather quickly… you may still have to take a lot of shots to manage tightly… can’t fix that, but I think you’ll be delighted with what happens to your time in range

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Does the t:slim allow you to run a 72 hour temp basal? The Cozmo used to do this, and I thought it was really useful. The Ping only allows me to run a temp basal up to 24 hours. I do that sometimes to test out a new rate, but to keep it up for days it means I need to remember to reprogram the temp basal every day, so I just make a permanent change if the 24 hours of temp basal seemed to be working.

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I have to check. We often use 36 hrs. I want to decide each day whether to put it back in but rather than use 24 hrs and miss it by a little bit, I figure if I use 36 hrs than I have hours to “get around to it” and decide whether to “renew” the temp basal.

I just checked the manual. Yes - 72 hrs max for a temp basal.

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