Think Like a Pancreas: Chapter 6, Your Cheat Guide!
Fine Tuning Pump Basal Rates
When you go on the insulin pump, whatever you do, don’t assume the initial basal settings are correct.
Testing, adjusting, and retesting basal rates can be exhausting but worth it.
During your basal test, the only thing raising blood glucose should be the liver, and the only thing lowering it should be basal insulin. All other influences (food, bolus insulin, exercise activity, major stress, hormonal changes) need to be eliminated.
How do you figure out if your basal is set properly?!
- Wait approximately 4 hours after your last bolus/meal—this will give the carbs time to finish digesting and the bolus time to finish working. No food should be digesting.
- No bolus insulin should be working.
- Your body should be producing its normal amount of glucose. If your on your period, have unusual stress, or if you had a recent low blood sugar (in the past 4 hours), do not run the test.
- Allow basal insulin to be delivered at its normal rate
- Maintain your normal level of physical activity
Testing Schedule Example: Table 6-4
During the test, If your blood sugar drops more than 30mg, the basal rate is probably too high, if your blood sugar rises more than 30mg, the basal rate is probably too low.
Tip: Make basal changes before blood glucose starts to rise or fall. If you are experiencing a high from 1am-4am, an adjustment for 12am-3am would be best. Basal rates needs to be changed prior to observed changes. Gary also recommends to make setting changes on the hour, i.e. 1:00am instead of 1:30am—he sees it as more practical and manageable.
Tip: Adjust in appropriate increments. The amount of the basal change needs to reflect both the magnitude of the observed blood glucose change and the individual’s sensitivity to insulin. If you are on larger doses, larger adjustments may be needed to see a the needed change, if you are on low doses, then it would be the contrary.
Tip: Stick to mimicking your body’s natural rhythms. A basal program that includes multiple peaks and valleys is almost always incorrect……you are likely compensating for some other aspect of the insulin program that is not set up properly (too much or too little bolus insulin, or over eating to compensate incorrect dosing).
Remember: You are your best pancreas. You know your body. You know your stress. You are the ultimate decision maker regarding your blood sugar plan. To allow for happier blood sugars, schedule a day (what about next Friday?), to check to see if your Basal is set correctly. Sometimes it takes a few fasting adventures before your fine-tuning is mastered, but trying it once could shed much light on the reason behind some of your highs and lows!
Should you adjust your usual pre-meal bolus dose? Find out next week in Chapter 7, Bolus Calculations!