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Permalink Reply by Capin101 on March 9, 2012 at 8:33am

Hi Dee,

I currently have 15 basal rates in my Minimed pump. About half of them are during the overnight hours to fight my large dawn phenomena. I believe the most important thing in any diabetes is achieving normal (or near nomal) BG levels. I also find that every week or some of my basals need a slight tweek for reasons I have given up trying to comprehend.

The way I change my basals and Walsh's "Pumping Insulin" recomends is like this: To change your basals on your pump you must first know when your insulin peak activity is. My humalog peaks at just under 2 hours, so I use two hours. Make adjustments to your basals going back the amount of time of you insulin's peak activitiy (2 hours). Therefore, if you notice that you are going high at noon, then you would want to adjust your basals at 10. Unless your basals are way off, only make the smallest adjustment possible as it can have a larger impact then you might guess. Follow the results for the next 3 days-ish to see if the basal adjustment is sufficient to keep you in your target range.

I think you still need to fast and double check your basal rates in the morning just to be sure that your I:C ratio has not changed as well. Hope this helps.

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Permalink Reply by Dee Meloche on March 9, 2012 at 8:55am

I will retest my morning basal rate just to make sure it is okay,but so far it looks good.My sugar didn't go high like it did at 10 am before.I am 8.2 right now before starting a lunch basal test.Thanks,I guess I'll try not to let my doctor get to me so much anymore.

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Permalink Reply by Zoe on March 9, 2012 at 11:32am

According to John Walsh, the majority of pumpers use multiple basal rates. Part of the reason a pump works so well is because it allows us to vary our rates to match our needs which vary throughout the day! Yeah, smile politely at your doctor.

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Permalink Reply by acidrock23 on March 9, 2012 at 12:38pm

I have a few. I used to have more but I noticed that some of the "bumps" were around mealtimes and just adjusted the ratios for those times instead and it seems to work just as well.

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Permalink Reply by Dee Meloche on March 24, 2012 at 3:49pm

That new basal rate I added I realized I didn't need that extra insulin.So now I have 6 basal rates.

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Permalink Reply by Zoe on March 24, 2012 at 4:04pm

Oops, I didn't see the other posts, including my own..lol

Just one comment. I believe you said you were going high at 10 AM and that you changed your 10AM basal. If you want to alter numbers at 10am you should change the basal at around 8AM.

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Permalink Reply by Zoe on March 24, 2012 at 3:59pm

Not at all. According to John Walsh, "Among experienced pumpers, only 9% use one basal rate for the day and another 14% are on two basal rates a day. Most pumpers are on three or more basal rates a day". Your doctor, like most, probably doesn't have too many experienced pumpers on his caseload? Our insulin needs definitely vary during the night and day due to many factors. I have 9 which I got after a lot of tweaking. Whatever works!

As for whether to change bolus or basal. You say the change comes about 3 hours after bolusing which is kind of borderline. If there is a fair amount of fat, or the meal is high carb plus high fat, you could be spiking at that point.

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