sometimes i can go for months without having to change my pump’s basal rates. sometimes its so easy to make a simple change, say for just 2 hours in the middle of the afternoon, but other times it requires an entire overhaul.
i hate the process, personally, but it does give me a sense of the control i have in managing my D. i test every hour for a major overhaul and see how each change effects my BGs. sometimes i can have 10 different basal rates while at other times only 2. (say, for example, morning/all day and then one for overnight.) sometimes the changes are more dramatic than at other times. dont know why.
just wondering how often you change your basal rates either on the pump or MDI. (although i must admit i wouldnt have a clue how to do MDI changes). what is your process? do you go the “fasting” way skipping one meal at a time? or do you just watch how high you may be climbing at a certain time of day, or plummeting during others?
Couple times a month maybe? I prefer to make tweaks. Often times, I will try something out with a temp basal for a number of days to see how it responds.
When I do change the basal, it is generally a max of 15% change but often times only a 10% change. Let that play out for a period maybe a couple weeks and give it another tweak if needed. I might pull a time of day change forward or back by an hour.
I’m on MDI, but not too long ago circumstances led me to understand that I was taking way too much basal insulin.
When I had finally had it with Lantus/Toujeo and switched to Tresiba, I took the time to slowly titrate the amount of basal I actually needed. It was pretty dramatic, as I essentially went from 75u of Toujeo per day to 44u of Tresiba.
I do a basal test about twice a year now, and 44u seems to be my magic mark.
As @Sam has previously pointed out, there is probably too much of a big deal made out of varying basal rates. How can you expect the exact same exogenous insulin to act differently if you just call it basal or bolus? But that’s a whole separate topic.
I rarely change my basal rates, which is currently 11.4 units per day, 4 rates. Since it is relatively low, any tweaks are very small.
When daytime basal seems off at times, I wait and it is usually back on track without change. So I just make adjustments with food, extra bolus, or temp basal.
However, my weekday schedule is quite predictable, and very similar day to day which probably keeps things steady for me. Weekends tend to be more hectic, but I don’t bother with different patterns.
I did reduce it a bit about 6 months ago, when I started metformin.
Before that, I was at 12.2.
I change mine as infrequently as possible. Maybe adjust it up or down 2 units once a month on average, at most. I firmly believe that over adjusting both basal doses and/ or rates is a dangerous trap
I use temp basal rates every day, often multiple times a day, to compensate for activity (even a walk to the bus stop can make me drop) or to help prevent a low, and sometimes to help bring down a high. I shift my basal rates up or down by a significant amount (about 0.4-0.6 u/hr) at least twice a month for hormones, but when I do this I don’t adjust any individual segments, just adjust the entire thing (I also often have to adjust carb and correction ratios). I’m hoping metformin will help smooth these hormone-related changes out, because it’s really the number one thing standing in the way of non-diabetic level control for me. I make tweaks in between the hormonal shifts, maybe a tiny tweak like a 0.05 u/hr increase or decrease to one segment every four weeks if I notice something seems off. I also have about twice a year (during fall and spring) where my pump settings all change and I need to reconfigure everything (I’m pretty sure this was the cause of my “blood sugar insanity” thread).
this is the type of tweaking i am talking about. no more than that ever seems necessary. up or down. at most, .025 u/hr.
but i have read on this site about those who make changes, rather often, in the I:C ratios. mine have been the same for a long time, with the exception of my early morning (breakfast time) ratios, which as of late have needed significant tweaking. ( from 1:10 to 1:6 )
I have to adjust way more than this for my cycle… If I don’t raise my basal rates by at least 0.4 u/hr, I end up running extremely high for about two weeks. So, when I know I’m running high from hormones (which can be hard to tell at first), then I change basal rates by 0.1 u/hr over a few days until I’m no longer running as high. During this time I also have to make significant changes to my ratios; my carb ratio can drop from 1:14 to 1:8 and my correction factor can drop from 3.0 mmol/L to 1.2 mmol/L. These effects seem to be less extreme since I’ve started using metformin.
I find myself changing my basal program a few times per year — it seems to be seasonal. I don’t do proper fasting basal tests. I just make a change when I notice that my BG seems to be rising all by itself for no reason, and it does the same thing at the same time for three days. Then I’ll increase my basal by 0.025 units per hour a couple hours before the rise starts. Over the following few days I’ll see if I need to add more or go back. Same process for basal decreases when my BG is dropping all by itself.
i have been on the pump for 17 years when i was pre-menopausal. can’t you just set a different “pattern” on your pump for when you have your hormonal changes? i have a Medtronic Pump and it has 3 different settings ( have these basically for exercise days, etc). but i found this very useful when i need the extra insulin without having to use temp nasals, etc.
My wife and I try to sit down each Sunday and review the previous weeks data. If we agree that a specific change is necessary, we make it on that day. We don’t change anything throughout the week as we’re not concerned about “one offs”…we’re more interested in the trends.
UNLESS he gets sick mid-week…then we have to do what we have to do (increase insulin)
If the changes were the same each month, then yes, that would probably work. But they’re not always the same: sometimes they come on suddenly while other times they come on over a few days or a week; sometimes basals need to be upped by only 0.35 u/hr and sometimes by 0.60 u/hr; and usually all my ratios also need changing on top of my basal rates. Also, because I do make tweaks to basal segments, if I set up a “hormone” basal profile that was in the ballpark of what I needed, I’d then need to update that whenever I changed my baseline basal rates. I’ve heard that some pumps allow copying of basal profiles that can then be edited, but Animas isn’t like that, you have to go in and manually edit each section to set it up or change anything, so it’s a pain in the butt!
I’m going to be asking my endocrinologist for a sample of Tresiba at my next appointment. I’m still not sure it would work for me (especially because I bolus up to 12x a day with my pump, often micro-boluses…I would not be willing to do that many injections, and I do use the temp basal feature on my pump almost daily), but virtual elimination of DP definitely makes it seem more promising!
Yeah all of that makes sense! I’m not sure I wouldn’t have better control with a pump—seems entirely possible, just not something I feel adequately motivated to mess with at this point in time (possibly later once the automated systems get even better).
If I were as active as you, I’d probably need one too. I can’t do almost any high intensity exercise though, thanks to my stupid joints, so while that sucks in a lot of respects, it keeps things more stable in terms of not needing variable basal rates to the same extent.
I will go on the record here right now with the suggestion that we likely see an inverse relationship between frequency of basal adjustments and overall control. Such that those making more adjustments are having worse control. I suppose people will just challenge that with “people with more variable blood sugars have to make more adjustments”. Kind of a which comes first the chicken or the egg situation… I’d suggest that at least some of each are true— some people are adjusting more because they have worse control and some people (even the same people) are having worse control because they’re adjusting more
Well, I’ll give Tresiba a try and test this theory out in January or February. Of course, now that I’m using metformin, my body’s physiology is altered so it wouldn’t be a true test of my body’s needs without any additional medication. I’m skeptical, given that I’ve never had a flat basal need in several decades of living with diabetes (there are definitely people out there who have flat basal needs), but I’m curious. Maybe with the addition of metformin it’ll work out better, as @cardamom found.
