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Fw: [IPk] Adjusting Basal rates



Hi Melissa

Have you had a chance to contact John Walsh yet?

Many thanks

Nigel
----- Original Message ----- 
From: "Nigel Hammond" <email @ redacted>
To: <email @ redacted>
Sent: Thursday, April 10, 2008 8:29 PM
Subject: Re: [IPk] Adjusting Basal rates
>
> Hi Melissa
>
> Thanks for the helpful reply.   It's a shame to hear there are so many 
> variables as to when to set the basal - it would make it much easier if it 
> was a fixed period of time!
>
> I have got the 4th Edition.  Here is what it says:
>
> (Pg 135 - 136); "When to change basal rate - The timing of basal changes 
> is often as important as how much it is changed.  Basal delivery is far 
> 'slower' than boluses even though the same insulin is being used.  Boluses 
> given in units are delivered over a minute or so, wheras basals are 
> usually increased by only about a tenth of a unit an hour, and the first 
> tenth unit is not completely delivered until the end of the  hour.  For 
> this reason, basal rate changes have to be made 4 to 8 hourse before you 
> will see their effect"
>
> However the book goes on to say under the heading 'Basal testing with a 
> continuous monitor' (pg 136);  "If the blood sugar is at first flat but at 
> some point begins to rise or fall, raise or lower your basal rate at least 
> 2 to 4 hours before the change begins."
>
> I do find this a bit confusing so if you could contact John Walsh for some 
> clarification that would be really helpful.
>
> Thanks
>
> Nigel, Dad of Poppy (age 9).  Poppy has a Medtronic 522 pump with 
> continuous monitor.  Lives in Milton Keynes but goes to UCLH to get proper 
> diabetes support.  Poppy was diagnosed in 2001.  Wife: Dawn.  Son; Jake 
> (Aged 12)
> ----- Original Message ----- 
> From: "Melissa Ford" <email @ redacted>
> To: <email @ redacted>
> Sent: Thursday, April 10, 2008 11:39 AM
> Subject: Re: [IPk] Adjusting Basal rates
>>
>> Hi Nigel,
>>
>> Which edition of Pumping Insulin says 4-8 hours? If it's the most
>> recent one (4th ed) I'd be surprised, but I can have a chat to John
>> Walsh about it and get back to you if that's the case. I would
>> personally change a basal rate 1 hour ahead of the time I want the
>> change to affect my bgs. I have always used Humalog in my pump.
>>
>> On a general basis, the "rules" for dose timing of Humalog and
>> NovoRapid are the same as both are classed as rapid-acting insulin
>> analogues.
>>
>> The very precise way of figuring out when to change basal rates is
>> trial-and-error I'm afraid! At one time of day - say during dawn
>> phenomenon - Poppy's bg may rise so fast that it's necessary to have a
>> high basal rate kick in quite a bit ahead of time to prevent the liver
>> releasing excess glucose. Meanwhile, she might need to reduce her
>> basal by 20 or 30% (temp basal) just 30 minutes before a school gym
>> class later in the same day. It all depends on her body and the
>> circumstances it's in.
>>
>> Melissa
>> Type 1 15 years; MiniMed pumper 7.5 years; Animas pumper 4.5 years
>>
>> On Wed, Apr 9, 2008 at 10:45 PM, Nigel Hammond <email @ redacted> 
>> wrote:
>>> When adjusting basal rate settings on the pump, we have always made
>>>  adjustments two hours back  - e.g. say blood glucose rises between 
>>> 10:00 and
>>>  11:00 am, we would increase the basal rate between 8 and 9 am.
>>>
>> > I was reading 'Pumping Insulin' and the book suggests making 
>> > adjustments 4 to
>>>  8 hours back.  Poppy's Pediatric Diabetes Nurse once told me that this 
>>> was
>>>  based on slower acting insulins.
>>>
>> > It all seems so vague to me. Does anyone know if there is a more 
>> > precise way
>>>  of working out how far to go back in time to adjust basal insulin 
>>> levels to
>>>  get the desired effect.  Poppy's pump delivers novorapid insulin.
>>>
>>>  Thanks
>>>
>>>  Nigel, Dad of Poppy (age 9).  Poppy has a Medtronic 522 pump with 
>>> continuous
>>>  monitor.  Lives in Milton Keynes but goes to UCLH to get proper 
>>> diabetes
>>>  support.  Poppy was diagnosed in 2001.  Wife: Dawn.  Son; Jake (Aged 
>>> 12)
>>>  .
>> .
> .
.
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