Nice. I am working on our basals trying to reduce our per hour change.
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I think that is what he is arguing for. The good old KISS principle applied to diabetes management.
He isn’t arguing for a one-size-fits-all treatment, but a guideline. “it’s not meant to be dismissive or demeaning in any way, simply something for you to reflect on.” Truisms like “he should recommend the correct number of basal rates” aren’t great guidelines. How do you find the correct numbers of rates? Well, it makes sense to start with a low number of basal rates and then build from there. But be careful when adding new basal rates, make sure you really need them. You shouldn’t start chasing your own tail.
Ponder is warning against falling into the trap of constantly adding basal rates based on a perceived need that in reality isn’t there:
A little tweak here, another there. It can quickly get out of hand, and does.
All too often this doesn’t improve control:.
It’s not uncommon that I encounter pump using PWD’s and CWD’s wearing insulin pumps with up to a dozen basal rates, sometimes more. At the same time, I note their overall control may still be struggling (based on high A1C results).
With this in mind, I don’t think it’s unreasonable that he writes “When possible,” [that’s not one-size-fits-all] “I aim to reduce, not increase, the number of rates.” If 6 rates achieve the same result as 10, I would choose 6. Don’t go for the Rube Goldberg option, keep it simple.
One final quote about one-size-fits-all:
Outcomes are what we want. I prefer to ask the pumper the following question: if your BG trendline maintains stability in the absence of any known influences which would deviate it significantly up or down (30 mg/dL or ~ 2 mmol/L) then I feel your basal settings (however many you use), probably work for you. But I’m not just talking about every now and then, I mean consistently keep you steady.
That is reasonable. However I have heard objections (outside this thread) to the number of basal settings without any discussion of why fewer would be preferred. Having somebody complain about too many basal settings before they look at any CGM data pretty much makes me discount anything further they might say.
My take-away from such a conversation is that it is too much work for the provider to copy down into their records our basal settings and it would be easier for them if we had fewer settings. Or (if not a provider) it is too much mental work to think about the settings.
That doesn’t work so much for me.
On the other hand if a provider were to look at the CGM data and show how 10 settings could be reduced to 6 while not making anything worse or perhaps even an overall improvement - sure - that would be great.
KISS stands for “Keep is Simple Stupid”.
I don’t consider myself stupid. I don’t consider anyone on this forum stupid. We have people running their own closed loop, people doing xdrip. People managing diabetes for toddlers, which is harder than anything.
The problem I have with Ponder is that he seems to think people are not smart enough to deal with it. That’s seems to be the general mindset of doctors, they are just so much smarter than us ignorant diabetic peasants, so they dumb it down for us.
And my dad always told me it was Keep it Safe and Simple.
Maybe that was the PG version…
lol
There are all kinds of variations. The other I heard from way-back was “Knights in Satan’s Service” 
Absent other reasoning, I actually am a big fan of the KISS principle. This often ends up being incredibly effective (for me) from a professional (non-diabetic) point of view.
IMHO multiple basal rates can easily fall into the KISS principle. If the CGM says a different basal rate is required then we put a different basal rate into the program. Pretty simple to me. If there is a simpler approach which is also effective then I would be all ears.
But if the advice is to drop to 2 basal rates because it is better then 14 basal rates (period) then I give that about as much mental attention as the advice to change the total daily basal so as to fit the 50%/50% basal/bolus ratio. Which is the minimum mental energy required to determine when the the mouth of the speaker has finished moving so we can move on to a serious conversation.
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In general, the human body moves in gradual steps. You don’t instantly become famished. You start off a little hungry, and progressively get more and more hungry. You aren’t instantly exhausted at 10pm, you get more and more tired as the evening progresses.
Everything is gradual steps.
If you need more basal insulin at a particular time, which do you think the non-diabetic body looks more like? It doesn’t instantly jump from one basal rate to another at precisely 4am. It gradually gets there over several hours.
That’s why I think more basal rates are more natural.
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I agree. For example, I have two time periods that I tested basal for which are significantly different. The cliff between the two makes no sense. So without doing additional testing, I added a basal rate between the two periods of the average.
Some time periods are simply not as convenient to test as others. So adding an extra rate here or there which is interpolated from neighboring rates (of substantial difference) which ARE tested for makes sense to me.
When it seems convenient we can test that time period to either validate or refute this.
I have no idea why the rates are so different based on time of day. To a certain degree I don’t care. Sure - it is of academic interest but I wouldn’t get hung up in it. The bottom line is I want what works. Why it works is of secondary interest.
There isn’t anything about Diabetes that is KISS. Period.
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We are on the same page, T!
The same way you figure everything else out with Diabetes…you TEST, EXPERIMENT and TRY DIFFERENT THINGS.
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I agree with this so much. It’s “too much work” for the Endo staff. Because they would have an easier time understanding, or copying information, it is often considered too much. I say if you have a good A1C with 1 basal program, good for you! If you have a good A1C with 50 basal programs, good for you! At the end of the day, it’s not about how many, or how few, basal (or any other) programs you have programmed into your devices. It’s how well you are coping with diabetes; how well you are managing your BG levels, and how unlimited in life can you be while dealing with a disease that is anything BUT simple.
I’ve gotten to the point that I understand enough about Diabetes that, between @ErinElizabeth and I, we won’t just “blindly agree” to mandates thrown out by our Endo team any longer. WE live this disease daily…WE know what works best for Liam. No way someone we visit or talk too once every 3 months will ever dictate our “direction” any longer. If we need 50 basal programs, it’s because we’ve exhaustively tested and know it’s what we need. Our reasons matter to us, and we honestly won’t give two craps about our Endo’s opinion. They have their place, but that place isn’t to tell us how to manage our son’s day to day diabetes treatment. Why? Because their recommendations are CRAP. They can provide a good BASE, but that’s it…that base (for toddlers) will tend to leave your child in the upper 200’s to the mid 300’s. THAT, to any informed parent (or PWD) just won’t do; therefore, it’s required that we take things upon ourselves to tweak until we find that right mix of basal/bolus that gives your child a good A1C while not having significant lows and/or highs. Oh, and while trying as best as possible to not “feed the insulin”.
Endo’s to us, from now on, will be our guides. They will test Liam and ensure he doesn’t encounter any diabetes related sicknesses that people with diabetes sometimes get. WE will ensure that he doesn’t have significant mental impairment from excessive lows. WE will ensure that he doesn’t have complications in his 20’s or later due to excessive highs. These are things that Endos could honestly care less about. They are focused on liability…that is their number 1 concern. What do I have to tell these parents to do to prevent killing their son so that they won’t sue us. We know that if we tell them to stay high, Liam won’t die NOW from Hypoglycemia…nevermind that he may die in his 20’s or 30’s due to excessive highs wreaking havoc on his organs, eyes, limbs, etc.,
Everyone on this forums, I believe, (with the exception of me probably) could write their own book and probably provide as good, if not better, advice than some of the authors.
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Wow, did I offend people?
OMG - I can’t believe you asked that !!! Now I have to read back through all this to see if you offended me.
AAGGGHHHH !!!
ha ha ha ha
I am so glad you tried! It’s wonderful to see the success!
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You can’t offend me.
Not me. Not sure about anyone else. 
I’m just stating why I disagree with Ponders assertions. I agree that you should have as few as possible…but that’s totally subjective and varies from patient to patient. I gather from his comments that he assumes people don’t exhaustively test before making changes that impact their own lives. I get it…if you’re an idiot just KISS. Listen to the preacher preach. But if you live it and you care (and if you’re obsessive about it like some of us…but NOT me! :: whistles innocently ::), then you will be testing constantly, and the “rates” that you select (be it 1 or 100) are a product of thorough research and testing.
His comments just struck me as if he’s dissuading people from using more than a couple rates and I think that’s just silly as someone who has had fewer basal rates for my toddler which has led to excessive high BG’s, or low BG’s with the couple programs that I did have programmed.
I believe the more you KNOW, the more you’ll tweak. Your tweaks may not make sense to anyone else, but that doesn’t matter…they’re not in your shoes, living your life. As long as you have valid rationale that YOU understand, and makes sense to you, and as long as your managing well, other people’s opinions are irrelevant to your life, and your management.
And I’m like @Eric - I can’t be offended, but IF I AM, I’ll let you know. I’m not shy. 
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It takes time to figure it all out, but eventually…ultimately…the only reason you will see an endo is just to get prescriptions. You become totally self-sufficient.
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Yep, I forgot about that, but that is their main purpose for us now…please write up our prescriptions. lol.