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Re: [IP] Basal Rate Adjustments



On Sun, 16 Nov 1997 email @ redacted wrote:

> To those of you with kids who have been on pumps for a while,
> 
>   How often do you find that you need to adjust your child's basal rate?  Is
> there anything in particular you look for that lets you know it needs to be
> done, or do you just base changes on basal rate checks?

Watch for a consistent pattern of either lows or highs at a particular 
time of day over 2-3 weeks.  This can be fasting or with meals.

there are two things that may need adjusting, each of which can be tested 
independently.

1) Insulin to carb ratio.

2) basal rate requirement change.

- ----- 1 ------

This can generally be tracked by looking at the history of carb intake 
for ALL meals vs the need of high blood sugar bolus or hypoglycemia.

If there is a repetitive pattern that is NOT related to miscalculation, 
an adjustment to the carb ratio can be determined.  Warning -- approach 
this with incremental changes.

- -------- 2 --------

After separating out (1) above, the remaining variations are usually 
attributable to basal variations.  Usually only a 0.1 adjustment is 
needed to fix this type of problem.  However, adolescents man under go 
one or more large changes in basal rate requirements and may have two 
stable states on and off while making the step change.  These variations 
may require very aggressive changes in basal rates.  It is necessary to 
verify these kinds of changes with fasting basal profiles.  I have only 
found it necessary to profile Lily on a 6 to 18 month schedule. i.e. she 
has made large changes, but they have remained stable.  The biggest 
problems are the day to day ones having to do with adequate rest, 
exercise, pizza, etc...  see my post of yesterday.....

Hope this helps,

email @ redacted