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[IPk] changes in basal rates

I mailed the group several months ago about the apparent changes in insulin
requirements at different times of the day.  There was no response, so I
assumed that you knew it all already - but that doesn't seem to be the case
(or you wouldn't have asked!). As a pumper who's also a medic (and yes, there
are some good guys out there who understand), I feel reasonably qualified to
respond to those queries.

Each of us has an individually tailored circadian rhythm, and our requirement
for various hormones differs according to our lifesyles and sleep patterns.
In general this means that each person will need more insulin at certain times
of day and less at others.  Your basal rates should reflect this, but you are
unique and only you can determine what's right for you, by carrying out
experiments where you don't eat, don't exercise and aren't stressed.  You then
have to add in the various factors affecting life, and personally I agree that
it's learning that counts, not loads of graphs (but each to his/her own). What
doesn't seem to be common knowledge is that your bolus insulin:carb ratio may
differ according to the time of day.  For example, you may have 50g C at
breakfast with 2 IU insulin, but for the same amount of carb you may need more
(or less) insulin at lunch-time.  I personally need almost double the ratio
used at breakfast for midday meals - the stress factor seems to come into play
here!  Shift work also messes up the body clock; I used to and my husband
still does work shifts, so our bodies are seldom attuned to a set pattern.  It
takes about a week to adjust properly from a night shift to a day shift, much
the same as adjusting to jet lag, and I have to set my basal rates to cope
with this.  Fortunately, the Minimed 508 which I use allows up to three basal
rate patterns to be set in advance.

Hope this helps more than puzzles!

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