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Re: [IPk] basal rates

The way you start off your basal seems to radically differ depending on
whether you use a minimed or disetronic pump.

With minimed, the nurse calculates how much your total basal should be
(i.e. around half your total insulin, reduced a bit because you'll
probably need less insulin on the pump.  This is then set as a single
rate.  Through basal rate testing, adjusted to reality.

With disetronic, the nurse calculates how much is needed, using a
calculator which assumes that you will have a strong dawn and dusk
phenomenon, and you start off with a basal rate which varies from hour
to hour.  Through basal rate testing, this is adjusted to reality.

I have a minimed pump, and the nurse calculated that needed (I think) 15
units basal a day, which works out at 0.6 per hour.  I said, fine, but I
need more in the morning and 0.6 in the afternoon will flatten me.  I'd
done basal rate testing for five years, in an attempt to persuade
doctors that the basal insulins were unsuitable for me, and lately, that
I needed a pump as they couldn't provide a basal insulin other than
actrapid injected at 4am which gave the right profile to cover my basal

Thankfully, I had an intelligent nurse, who realised that I knew more
about my basal rates than she did - it helped that she had just done her
disetronic training, and thus knew that people could have very different
basal needs.

My patterns are very similar to Abigails - some dawn phenomenon, but
insulin resistant (i.e. needing bigger boluses, as well as more basal)
from 6am to noon.  Then needing virtually no insulin in the late
afternoon, before zooming up again (and a little more insulin resistant)
from 6 to 9.  

So I started off with a basal of, I think, 0.7, but dropping to 0.2 for
the afternoon.  

For the first few weeks, your target blood glucose levels are set at a
very high level, as the aim is not to have perfect levels, but to
a) avoid hypos (because hypos screw up your insulin absorption for 24
hrs, so you can't do your basal testing).
b) get your basals sorted out so that you have a nice flat line - be
that a nice flat line at 12 or whatever
c) get your boluses sorted out so that you don't rise more than a couple
of points, whenever, whatever you eat
d) then gradually lower your targets, to the point where you start to
get hypos again.
e) spend the rest of your life trying to work out ways to get your hba1c
lower without incurring hypos, predicting how stress, exercise,
menstruation, flying transatlantic, and having a life in general will
impact on your insulin needs, so you can programme the pump beforehand
rather than doing correction boluses or eating glucose tablets

Best wishes to all,

dm 30+, 508 1+

In message <000e01c23080$71aceaa0$email @ redacted>, Abigail King
<email @ redacted> writes
>I was started off on 14, or was it 16 units. That calculator  from disetronic
>was used which assumed  everyone has a steep rise and fall in requirements due
>to dawn and dusk phenomenon. I've mad so many alterations in the past 2 years.
>In reality my profile is much flatter ie I stay on the same rate for several
>hours and seem to need most between 8 am and mid day and 7 to 10 pm
>for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
>help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml

Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml