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re: [IPp] nighttime lows, basals and question

>>>>>>From: "Allison _" <email @ redacted>
Jeremy is not on the pump yet, but we have this question...

I would like to know what to do with nighttime basal rates when there is a 
low in the middle of the night.  I know to treat the low first.  But when 
you discover the low, what do you do with your basal insulin? Suspend only 
while treating the low? Reduce for the rest of the night?  Leave alone?

I know this is probably a YMMV thing.....<<<<<<<<<<<<<<<<<

Allison, I'm sure that this is yet another YMMV thing in treating
diabetes, especially as I read through the other responses so far.    
What works for us is this:  
        -  we never suspend anymore. After reading through "Pumping Insulin" 
          & as pointed out by Michael,  the basal rate NOW is not going to 
          affect blood sugar to any great extent for 30 min - 2 hrs.  We
          would just disconnect for a hard low but thankfully haven't
          had one in quite some time (knock on wood).

        - We also don't adjust the basal rate for the rest of the night.

        - We treat w/ glucose tabs (typically 2-3 works for Luke) & then
          give him 1/4 cup of milk mixed w/ 1 teaspoon of real choc.
          syrup - that's about 8 gr. carb.  We no longer test in between 
          the glucose & the milk based on plenty of prior testing showing that
          this treatment works well for Luke.  When he was first pumping
          we tested 15 min. after the glucose & 15 min. after the milk.
          Fortunately, Luke sleeps through finger pokes, eating glucose
          tabs & drinking choc. milk.

For now [until the next growth spurt], Luke's nighttime basals
are set well so that he can stay stable across the whole night, so
lows are much rarer & I actually get to sleep through the night
typically 5-6 nights a week as opposed to what we were doing when he
first was pumping - between us we checked him every night for the
first 3 months of pumping, and then 3-4 nights/week for the next
3 months.

And we do give correction boluses during the night if Luke is
above 200, but I must say it took us some time to get past the
fear of giving him insulin during the night on the pump.   

Good luck on your future pumping!
Shelly V, mom to Luke, 7, dx'd 10/99, pumping 3/01

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