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Re: Fw: [IPk] Adjusting Basal rates



I'm glad I am not the only person confused!
----- Original Message ----- 
From: <email @ redacted>
To: <email @ redacted>
Sent: Saturday, April 19, 2008 9:45 PM
Subject: 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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