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Re: Fw: [IPk] Adjusting Basal rates



> I'm glad I am not the only person confused!

With insulin-analogs, we've found that changing the basal about 30 
minutes prior is about right and for regular insulin about an hour.

There is a simulator at: 

	http://www.insulin-pumpers.org/howto/basal.cgi

It is a bit finicky about the numbers plugged in but works OK if they 
are formatted in proper order.

Michael


> ----- 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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