Replies to This Discussion

Permalink Reply by Janice L Cotton on April 23, 2010 at 10:19am

This is a very good basic explaination....http://en.wikipedia.org/wiki/Insulin_pump#Basal_rate_determination When I first started pumping I was instructed to check blood glucose levels first thing upon waking...before each meal and 2hrs after each meal..at bedtime..midnight and 3am.

Permalink Reply by Steve D on April 23, 2010 at 10:36am

I rhink if you have not ye been trained, you should give Insulet a call and see if they can hook you up with a rep out your way...and a session with the rep along with your endo or nurse/educator would be a good idea.

Permalink Reply by Janice L Cotton on April 23, 2010 at 11:08am

You should be able to have an Insulet rep to train you along with the "numbers" from the endo/educator to plug into your PDM. I got stuck with a $650 education bill from my edo's office. The OmniPod rep came there to train/educate me AND the nurse/educator. I have been fighting the unfairness of this cost for quite some time.

Permalink Reply by Rachel1986 on April 24, 2010 at 12:53pm

I got a $400+ "education" bill too. I had even called my insurance prior to taking the class to make sure it was covered and they said yes. I appealed it and all of a sudden my bill was magically $26 (which was also waived because I work at the hospital where I took the class). So...$400+ to $0. Sometimes I think insurance companies are trying to pull a fast one on us to see if we catch the mistake and call them on it. Sorry your appeal is not panning out as well. :(

Permalink Reply by Denise Ventura on April 23, 2010 at 11:15am

To me, it's all experimentation. The average 1 unit of insulin covers 15grams of carb, therefore 1:15; and the average hourly basal rate is about .5 units/hour. So, start with those numbers and check your bloodsugars ever 2 hours to see if u need to make adjustments here in there. Right now, I'm at a ratio of 1:10 and .65 basal rate as my insulin needs have increased since becoming pregnant.

I never got training w/ Omnipod because I told them that my experience using the Minimed pump would cover whatever they needed to tell me about Omnipod re calculating boluses and basals.

Permalink Reply by Steve D on April 23, 2010 at 11:23am

I agree with denise, it does require experimantation. To get to the optimal nuimbers, yes, however it is VERY risky to just plug in any numbers and try that way, my endo told me that a person my size should require 1 unit per hour as a starting basal, so that's where I started, and found out even that rate was a little heavy given my tendency to exercise alot daily. best to start with the endo's estimates, and then experiment from there. Also, have you been taking a long acting insulin like Lispro? How much do you take? There, again, the endo will help by translating that number into a basal rate.

Permalink Reply by Domo! on April 23, 2010 at 11:48am

i take 30 u of lantus, but it says on the pretraining packets that it has a duration? How would you figure that out to? Hopefully i get answers soon :)

Permalink Reply by Mike on April 23, 2010 at 3:13pm

Hi Domo!,

Lantus is a long-lasting insulin designed to cover one's basal metabolic needs. When you start pumping, the lantus is replaced with a fast-acting insulin such as humalog, novalog, or apidra.

If you were on 30 units of lantus per day, then in theory, you need to replace that with 30 units of humalog/novalog/apidra per day. Take the 30 units and divide by 24 hours in the day, which results in 1.25 units per hour. That can be your starting rate. Some/most educators/endocrinologists will have you reduce this at first, to avoid potential hypo events. You might want to start at 1.0 units per hour, and see how that goes.

Then you need to start testing your fasting blood glucose levels throughout the day, to see if your rate of insulin per hour needs to be adjusted. You have to not eat for segments of the day, and test your blood glucose (BG) levels often (hourly) to see if your BG is rising, falling, or staying steady at your current basal rate. Then you adjust the rate up or down, depending on what is going on with your BG. If your BG is rising, that means you need to raise your insulin rate because you aren't getting enough insulin to compensate your body's resting, metabolic functions. If you BG is dropping, that means you have too much insulin, so you'll need to reduce your basal insulin rate.

From what I've heard, most people tend to need less basal, overall, when they are pumping compared to what they used a long-acting basal insulin, such as lantus. For example, I took around 20-25 units of lantus back in the day, and my basal insulin needs have dropped to about 14 units/day now that I'm pumping.

For setting and adjusting basal rates, I highly recommend you read Walsh and Robert's Pumping Insulin. It is our pumpers' bible. Trying to tackle basal rates and adjusting insulin:carb ratios is tricky business, and should always be approached with caution and education. I would recommended you read Pumping Insulin from cover to cover before making any substantial changes to your current insulin regime. Any questions you have, of course, should be discussed with your doctor or educator.

Best of luck and cheers,
Mike

p.s. -- Pumping Insulin is awesome and an absolute must read. It's so well done, that even a punter like me can understand it!

Permalink Reply by Steve D on April 23, 2010 at 12:54pm

I was also taking 30 units of Lantus when I swithed to the Pod....so, mabe you should start at a basal of 1 unit per hour, and take it from there. i would rjun that by your endo and the Insulet rep before you try it...ans when you do finally start, be sure to take a bg I would say every hour (if possible) for at least one day, for a few hours until you feel comfortable that you are not cruising into hypo.

Permalink Reply by Domo! on April 23, 2010 at 12:55pm

what is the duration, would i mess with that or just let .05 per hour

Permalink Reply by Steve D on April 23, 2010 at 1:10pm

You have nothing to lose to go ahead with .05phour at first, but still stay on top with frequent bg's for at least the first day! Good luck with everything, and keep us posted!

Permalink Reply by MelissaBL on April 23, 2010 at 2:34pm

According to Chapter 10 of John Walsh's "Pumping Insulin," you first need to know your TDD. (He's got all these fabulous tables and I'm going to lift info from them and summarize a whole chapter into one tiny post here.) A New Start Type 1 who is 140 lbs might take 19-26units per day for a TDD. Once your TDD is figured, then you adjust your basal to be approx. 50% (or 40 or 45 or 55 or 60 - depends on where your endo would like you to start) of that throughout the day. So if your TDD was 22 units, your basal would be 11 units per day, or an average of 0.46 u/hr.

Of course, if you're like most of us, you're eventually going to have multiple basal rates each day, so you might have 1.00 here and .30 there, etc... I've had as many as 7 rates and as few as 4. I generally shoot to have 45% of my TDD come from basal and 55% come from bolusing.

The duration of a basal rate can vary from 1 hour to 24 hours. It all depends on when you need to make a change. Doctors typically suggest that your basal rate should change 2 hours before you see a spike or dip in your blood sugars. Some say 1 hour, others say 3 hours. A basal rate affects you later, you might say. So if you have a severe dawn phenomenon at 5 or 6am, you might start a new basal rate at 3am to affect the rise.

For instance, these are my current basal rates (which need some tweaking b/c I keep getting this stupid 2am spike...):

12am-2:30am - 0.80
2:30am-6:30am - 0.85
6:30am-8:00pm - 1.00
8:00pm-12:00am - 0.80

So since I'm seeing a spike at 2:30, I would say that either I need to adjust and add a higher rate around 11:30pm or adjust my 12-2:30am. I think I'll go do that now... Sorry for the novel!

Oh, btw, I'm currently a 175lb breastfeeding mom, so don't go by numbers. Between the extra poundage and extra calories (requiring more insulin) and the decreased insulin needs (from the breastfeeding), my numbers will not be yours!