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RE: [IPp] Young pumpers with very low basal rates

Hi Natalie:

My son is also 4 and has been pumping for almost a year.  He's pretty
big for 4 (tall, and weighs in at about 50lbs) and his TDD is from 10-12
units (100U, no dilution) per day, depending on the food intake for the

He gets about 5.5 units per day as basal rate insulin and all of his
food is dosed at 45g per unit.  The truth is that he would undoubtedly
go low if he really didn't eat anything for a long time as we have yet
to find a basal rate that really keeps him "steady" for any period of
time.  We find that any basal rate over an extended period of fasting
will be too much as he seems to get more and more insulin sensitive the
longer he fasts.  Then, as soon as he eats something -- whump!  Huge
insulin resistance!  Makes fasting testing a little pointless at this

Anyway, at 4 years old, there is simply too much volatility in the
variables to even aim for a true basal rate (in our opinion).  However,
what I've found is that less basal for my son means that not only will
he float upwards through the day or night, but as well, as soon as he
eats he shoots up like crazy, and then it takes a TON of insulin to get
him back down again because of the insulin resistance he gets when he is
high (normally he is extremely insulin sensitive).  I wouldn't have that
problem if I could bolus him 20-30 minutes before he eats, but that's
too dangerous when you're dealing with the vagaries of our little 4 year
old personality. So for us, it makes more sense to maintain a little
higher basal and just continue to feed him at very regular intervals.
After all, he's 4, he's growing and he's not adverse to the "snack"
routine.  But then, we didn't go on pump to get away from the MDI
lifestyle.  We went on pump to get away from absolutely uncontrollable
numbers and a HbA1C of 10+.  His HBA1C is in the 7s now.

I hope that helps a bit, however if less than 20% basal is working for
you, who's to tell you different?  The proof is in the HbA1C!


-----Original Message-----
From: email @ redacted
[mailto:email @ redacted] On Behalf Of Natalie G
Sent: December 6, 2003 12:04 PM
To: email @ redacted
Subject: [IPp] Young pumpers with very low basal rates

Hello parents,

Yet another question from the beginner pump parent.  Do those of you
little ones use low, low basal rates.  I know the theory is that basals
should be 40 - 60% of TDD.  Why should it be that way?  My daughter
currently has about 10-17% of her TDD as basal (partly because she has
eaten so much with her new freedom).  Her basal rate is 0.15 u/hr in U25
volume, which is 0.0375 u/hr on U100.  (It was 0.20 u/hr, but she
from 205 to 94 over 4 hours without insulin and with a sneak taste of

Some suggest shooting for basals at 40-60%.  Why?  If I push her basals
up, she is back to eating more set amounts at more set times than we
want.  If I turn her basal up, she will drop low 4-6 hours after eating
if she does not eat again.

I have talked to a couple of other parents of young pumpers.  They
me that their endos encourage / push them to get their basals up to that
target.  If there are valid reasons for shooting for 40-60% basal, I
to hear ALL ABOUT IT!  I want to understand.  But I am wondering if that
target is based on teenagers or adults and if things are just lots
different with young pumpers. 

Your responses are always GREATLY appreciated!

-Natalie Rodgers
Mom to Andrea 4 (dx 1/28/03, pumping Cozmo 10/2/03),
             Alicia 2, and Carlos 6 months
Married to Tom for over 7 fabulous years
Salt Lake City, UT
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