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Re: Fw: [IPk] Adjusting Basal rates



>I am also very keen on this subject as would you believe the day this
first message was posted I had been up all night with high blood sugar
and reading this book to help me find out what to do and I was equally
confused.
Many thanks
Gillian


 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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