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Thread: Temp Basals - when do you use them?

  1. #1
    Join Date
    Apr 2013
    Location
    Glen Ellyn, IL
    Posts
    775

    Default Temp Basals - when do you use them?

    We're new to pumping, so I thought I'd ask. When do you use a temp basal rate and how do you know how long to use it?

    For example, how do you decide when to use a higher temp basal and when to just do a correction?

    On the flip side, when do you decide to do a lower temp basal?
    DD diagnosed March, 2013 at age 10, now 11 years old
    T:slim (Humalog) as of August, 2013
    Dexcom G4 as of November, 2013

  2. #2

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    We're new to pumping, so I thought I'd ask. When do you use a temp basal rate and how do you know how long to use it?
    We use temp basals all the time, and we guess on the times, knowing we can cancel it.

    For example, how do you decide when to use a higher temp basal and when to just do a correction?
    We use a higher temp basal when he's running high and we can't seem to bring him down within a few hours of correction. Or fatty/etc foods, like restaurant meals, or pizza, or burgers. If he's high, we try a correction probably twice. Correction with bg, maybe half a unit an hour later if he's still not dropping, then decide to do a temp. The we always say if he goes under 150, we cancel it. Deciding for food is trial and error, if it's a new food, or we don't know, we say something like "let's try 150%/200% for 5 hours, and we can cancel it if you drop below 150. If after 5 hours you're still over 150, we'll do another temp basal for 3 more hours." Oh, bedtime! Bedtime corrections seem to do next to nothing. So we always do a full correction, then do a temp basal of 200% for a few hours.

    On the flip side, when do you decide to do a lower temp basal?
    Same thing, lots of times. Exercise, we'll start a 0%/25%/50%/75% based on the exercise, starting up to an hour before the exercise, through the end or an hour before it ends. Depends on how high energy it is. Also if he seems to be running under 90, we'll say let's do a 50%/etc for a few hours until he gets over 100, then cancel it. Sometimes when he's low, but is going to eat a meal, we'll bolus over 30 mins, and do a temp basal of 0% for 30 mins just to lower it a bit.
    Mom to ~
    DS 15
    --dx'd Type 1 Nov '07
    --pumping with Minimed w/ Novolog since January '11
    --integrated cgm and MySentry

  3. #3

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    We use them all the time. One of my favorite things about pumping. Always good to know too that you can cancel or adjust at any time. My daughter dances and skis. We use temp basals for both. We find that reducing 30% works best and we start 30 minutes prior to activity and end 30 minutes after. With skiing, it may go a bit longer. We run temps when she is sick and running low, then I do it for 3 hour blocks, or if she's just having a wonky day and running low.

    As for increasing, we will do it when she is sick and high and not budging, or if she just happens to be running high for some unexplained reason. I usually do those 2 hours at a time. If she has a bad set, I will correct via syringe, then run an increased temp basal of 130% for about 2 hours.

    With the CGM, it's suggested if it's double arrows going up or down to decrease/increase by 20%
    Diagnosed June '05
    Pumping since Feb '06
    Animas Ping
    Dexcom Study







    My current position:
    CIO...CHIEF INSULIN OFFICER

    "Life is under no obligation to give us what we expect"...Margaret Mitchell

    "Make it work"...Tim Gunn

  4. #4

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    We use them all the time. We use them when facing stubborn highs or lows. And when the kids are under 80 and asleep and we want to try to avoid waking them to eat. Or when they are quite a bit more active than usual and it's for an unknown amount of time. Traveling is a big one. Sickness. Running a little low before recess or bus. When we are going to a party and will be faced with a running tally of carbs grazed for two kids. Double arrows up or down on the CGM.

    As to how long...it varies. Sometimes we just need 15 minutes to get them to a meal or off the bus. If we are traveling all day, the temp basal is on all day. Nights with stomach aches and little appetite or a tendency to vomiting will get 4-6 hours at a time. They are so easy to set and cancel that we don't worry too much about how accurate we can be but just set it up and monitor.
    Stacy - Mom to
    DD (10, diagnosed at 2) MDI 2006-2009. Medtronic pump 2009-2011. MDI 2011-2013. OmniPod 2013. Dexcom and T:Slim 2013-2014. Added CGM in the Cloud 2014.
    DS (12, diagnosed at 10) MDI for 3 months. OmniPod and Dexcom 2013-2014. Added CGM in the Cloud 2014.

  5. #5

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    DD looks at IOB and when she feels she'll eventually go low based on current bg and IOB, she'll reduce the basal to avoid having to eat something to bring the bg up. So say she's 150 with 2 units of IOB, she'll try to head off the low with a reduced basal. She also uses reduced basals for delayed lows from exercise.
    mom to Molly, 21, dx 7/9/10
    Pumping with Animas Ping 11/10
    Dave, 24, non D
    Wife to Bob...great guy!!

  6. #6
    Join Date
    Jan 2010
    Location
    Chicago, Illinois
    Posts
    1,635

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    Quote Originally Posted by mamattorney View Post
    We're new to pumping, so I thought I'd ask. When do you use a temp basal rate and how do you know how long to use it?

    For example, how do you decide when to use a higher temp basal and when to just do a correction?

    On the flip side, when do you decide to do a lower temp basal?
    It took as a while after initial pump start to begin using temp basals.

    Now, we most frequently use them under two circumstances:

    • DD is over 250 in the first part of the night; we find that in addition to a correction, we need to do a temp basal (+50% for two hours).
    • DD is below nighttime target of 120, but not technically "low", we might do a temp basal (-25% to -50% for two hours). Definitely worth it if we can avoid waking DD in the middle of the night.


    I seldom do a temp basal in lieu of a correction, but might to one to augment a correction when a prior correction does not seem to be working. We also reduce basal as part of persistent lows, etc. It has been trial and error for us.

    I think it is important to understand how your pump delivers the basal rate, what the current basal rate is and will be over the period of the temp basal, and what effect the reduction or increase will have (for example, understanding how the pump might round up or round down numbers. With DD's Omnipod, one can calculate the temp basal in units or as a %age. We originally did it in units, as DD had very low basal rates. Now we've switched to percentages.
    virgo39
    DD dx at 5 yrs, 3 months (11/09)
    Omnipod w/Novolog (7/10)

  7. #7

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    I like lower temp basals in 4 cases:

    1. Exercise. I don't like eating before exercising and by turning my basal down to 10-20% of normal I can avoid having carbs before moderate exercise. I do the same for strenuous exercise but usually need to sip gatorade when working out. The basal reduction though, avoids the need for fast carbs (that might make me feel sick) like tabs or gel for me.

    2. Mild night lows. If I have something like a high 60 or low 70 at night I will just turn my basal down for a few hours to bump that up to 80-100. It avoids having to eat carbs after brushing my teeth which I hate!

    3. Overbolusing a meal. I sometimes overestimate the carbs in a meal and then have a ton of active insulin while already back in range. So I will do a temp basal of .05 for an hour or so.

    4. Major lows. For anything under 50 or so I will cut basal down to .05 for about an hour and in addition to carbs that usually brings the low up very quickly and prevents me from going low again in the near future.

    ETA: I usually do temp basals in units because my basal rates are pretty low and I want to avoid a 0 basal rate. If I want to do a percent of basal I just check the rate and then calculate it in my head and put it in, in units. Units vs. % is just a personal preference. Over the years we have gone back and forth on what I use.
    Meg
    College Senior, Age 20
    Pancreatectomy 2/17/2003
    Pumping 2/19/2003, Currently w/ Minimed Revel and Omnipod
    CGM: MM 2006-2013, Dexcom G4 2013-Present
    Symlin since 4/2013

  8. #8
    Join Date
    Sep 2012
    Location
    Toronto, Canada
    Posts
    500

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    Quote Originally Posted by Megnyc View Post
    I like lower temp basals in 4 cases:

    1. Exercise. I don't like eating before exercising and by turning my basal down to 10-20% of normal I can avoid having carbs before moderate exercise. I do the same for strenuous exercise but usually need to sip gatorade when working out. The basal reduction though, avoids the need for fast carbs (that might make me feel sick) like tabs or gel for me.

    2. Mild night lows. If I have something like a high 60 or low 70 at night I will just turn my basal down for a few hours to bump that up to 80-100. It avoids having to eat carbs after brushing my teeth which I hate!

    3. Overbolusing a meal. I sometimes overestimate the carbs in a meal and then have a ton of active insulin while already back in range. So I will do a temp basal of .05 for an hour or so.

    4. Major lows. For anything under 50 or so I will cut basal down to .05 for about an hour and in addition to carbs that usually brings the low up very quickly and prevents me from going low again in the near future.

    ETA: I usually do temp basals in units because my basal rates are pretty low and I want to avoid a 0 basal rate. If I want to do a percent of basal I just check the rate and then calculate it in my head and put it in, in units. Units vs. % is just a personal preference. Over the years we have gone back and forth on what I use.
    Meg, I had no idea you could enter in units or precentages - do you know if you can do this on the animas pump? Also how much in advance of exercise do you turn basal down?

    I have yet to master the reduced temp basal without it resulting in my son being sky high later on. This has happened so many times, that I just stopped using reduced temp basals (I still use increased ones though). I'd love it if I could reduce temp rather than always feed the insulin. Maybe I'm turning it down too much for too long (I was turning it down by 30%, at least an hour before exercise).

    Thanks for your sharing your experiences.
    Mom to T, 8yrs dx: Aug/2012
    and son 11 yrs, non-d.
    Animas pump June/13
    Dexcom G4 Dec/13

  9. #9

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    I've been using them daily to adjust for the puberty hormone craziness. I try to watch how she's tracking at night and adjust the basal profile accordingly. It's rare she's actually on her "profile", but we manage to keep her in range far more than if we didn't temp basal the profile.

    As you use them more and more, you'll gain more experience with what works for your daughter and in time it will become almost intuitive.

    Temp basals are the BEST part of pump therapy IMO.
    8/2010 - 9/2011 MDI, Lantus & Humalog
    9/2011- Medtronic Revel 723 & CGM
    11/2012 - Dexcom G4

    "Life is not waiting for the storms to pass, but learning to DANCE in the rain."

  10. #10
    Join Date
    Apr 2013
    Location
    Glen Ellyn, IL
    Posts
    775

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    Be careful what you wish for (or ask for help on), I guess. My daughter came down with a cold yesterday and it's her first cold since diagnosis.

    She was running high from 8:30pm on.

    Not 400's high but not in range well after dinner. The correction I gave her at 8:30 only brought her down 20 pts two hours later (from 299 to 271), so I gave her another correction at midnight and set a 130% temp basal for three hours. I checked her again at 3:00 a.m. (241), corrected again and increased the temp basal to 140% lasting until 8:00 a.m., and she was 190 at 5:00 a.m. and 125 at 8:00 a.m.

    Because she's supposed to go to the nurse's office when she gives herself insulin (as opposed to treating a low which she does in class), we continued the temp basal through school today, with instructions to cancel or reduce it if she goes low. I emailed the nurse this morning, so I'm not trying to sneak around or anything - we'll both keep an eye on her via text today; hopefully all will go well.
    DD diagnosed March, 2013 at age 10, now 11 years old
    T:slim (Humalog) as of August, 2013
    Dexcom G4 as of November, 2013

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