- advertisement -

Hourly basal rate changes

Discussion in 'Parents of Children with Type 1' started by StillMamamia, Apr 3, 2010.

  1. StillMamamia

    StillMamamia Approved members

    Joined:
    Nov 21, 2007
    Messages:
    13,195
    I think some of you do have hourly basal rates, right?
    What's the thinking behind this? Does the body's basal needs really change that much or do you do this to "compensate" for any food spikes/extra activity/any other variable?
    I hope I made sense.

    We don't have hourly basal rates. We have "time frames", so from 8am to 10am, 10am to noon, noon to 2pm, 2pm to 4pm, 4pm to 6pm (or 8pm, can't remember now), then from that to midnight, midnight to 3am, 3am to 5am, 5am to 8am.

    I'm thinking about trying this hourly change. We had a more "detailed" basal schedule but one of our endos suggested to "simplify" things, LOL (still a bit too much to be really simple).

    I'm thinking doing this would help actually see the basal needs without doing an actual basal test. Did this make sense?:eek:

    Anyway, would love to hear your perspectives.

    ETA - this is not about changing the basals everyday, but to establish an hourly basal schedule.
     
  2. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    I think of it more in segments, and adjust the segments. An hourly rate is just a lot of segments.

    I originally thought, after reading Pumping Insulin, that we'd do a lot of basal testing and use the hourly rates, but Alex is not predictable enough for that to be useful. Occasionally I will fine-tune the hourlies, but nearly all of the basal changes are gross changes to get his total basal somewhat close.
     
  3. StillMamamia

    StillMamamia Approved members

    Joined:
    Nov 21, 2007
    Messages:
    13,195
    Scott, I didn't really understand.:eek: Can you give an example?
     
  4. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    We have segments that are roughly 12am - 3am, 3am - 7am, 7am - 7pm, 7pm - 12am. That's wee hours, overnight, day, and evening basals. That seems to be where his changes lines up the most.

    Very occasionally I will adjust these slots a bit, both by time and by amount. Maybe changes 7am to 8am if he gets up later in the summer or vacation, etc.

    But, most of our changes are gross changes. I'm going to oversimplify the programs so that I type less.

    Program A: .35 (8am-12am), .3 (12am-8am)
    Program B: .40 (8am-12am), .35 (12am-8am)
    Program C: .45 (8am-12am), .4 (12am-8am)
    Program D: .50 (8am-12am), .45 (12am-8am)

    Nearly all our basal changes are switching between programs, which is exactly 1.2u per day. When I see fasting numbers that go up, I go to a higher program. When they go down, I "downshift into a lower gear" and go to a lower program.

    My theory is this - if your total basal is far too high or too low, then you'll get into a negative feedback loop. You are continuously getting too much or too little insulin, with the result being stuck high or stuck low.

    If the total basal is close, you will see some bumps during the day, but you won't be trapped high or low. You won't be in the feedback loop. I aim to get the gross changes right before I deal with the fine changes.
     
  5. badshoe

    badshoe Approved members

    Joined:
    Jun 28, 2006
    Messages:
    2,153
    I did hourly changes when Delaney was little. The goal was an average rate that was in between two settings - one hour up, one down. Over night. If it was just up she went low. If it was just down her bg climbed.

    That went on for about 6 months. Then things changed again.
     
  6. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623
    Here are ours, they are more grouped together than they use to be.. I do however, have hourly rates in the pump, so I can easily change them, otherwise I have to redo everything if an hour needs to be changed.
    12a .40
    2a .30
    4a .35
    6a .30
    8a .50
    5p .55
    7p .65
    8p .70
    11p .60
     
  7. chammond

    chammond Approved members

    Joined:
    Jan 5, 2009
    Messages:
    575
    This is the same reason we use these from time to time. Right now logan's basal from 8p-12a is 0.125, and at 12a it changes to 0.1, then up and down a few times hourly. I don't know if this is true, but I wonder if this is more common with younger children or kids with high ISF. Even the most minute amount of insulin affects them more. That is my only guess.
     
  8. kiwikid

    kiwikid Approved members

    Joined:
    Dec 29, 2005
    Messages:
    3,011
    We used to have 8 basal segments. Now we have 3 :) That is definitely simpler!
    When Rachel was on Prednisone her Bg's went ballistic. We started again at .45 all day. Then added .85 in the evening and I've only just added a 3 hr increase (.65) in the early am.

    Going back to the one rate showed us where the changes really needed to be made :cwds:

    So I didn't answer your question at all :(
     
  9. Snowbound

    Snowbound Approved members

    Joined:
    Jan 14, 2009
    Messages:
    869
    We do 5 basal periods
     
  10. Darryl

    Darryl Approved members

    Joined:
    May 8, 2008
    Messages:
    4,313
    We have 4 or 5 "segments" that cover the general situation that she needs very little basal (currently 0.2) between 11 AM and 3 PM,
    and more basal at other times, for example 1.5u/hr from 1 AM to 4 AM. We adjust the segments when we see a few days of a pattern.
    I'd say we adjust the segments every couple of days.

    The segments have to fine tuned using temp basals just about every hour, though, to match her basal needs. The basal rates change
    randomly in timeframes of a few hours at a time, but the actual timing varies so much day to day that the "segments" are nothing more
    than a starting point. Sometimes the temp basals are small adjustments, other times they are major increases.

    The basic rule we use for temp basals is we look at the rise or fall in the past 20 minutes, then triple that to get the hourly rate of
    rise/fall. Let's say basal is 1u/hr, it's been a while since the last meal, and BG is rising 30 points/hr. Her ISF is 150 so that means
    she needs an additional 0.2/hr so she (or I if overnight) will adjust her basal to 1.20/hr for 3 hours (3 hours is the typical lifetime
    of variations in her basal needs). Along with the basal increase we'll correct for the high, so if the BG was 130 we'd bolus 0.2 and
    also increase basal by 0.2. Often this process needs to be repeated and "escalated" each hour to get BG back into range.
     
  11. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    I have three segments: 3AM to midday; midday to 9PM and 9PM to 3AM.

    The way I generally alter basals isn't by changing each particular segment, because I tend to find that I either run constantly high or constantly low; it's not usually that only one segment needs to be changed (although obviously that is sometimes the case).

    So I have three patterns set:
    Pattern A:
    3AM - midday: 0.6u/h
    midday - 9PM: 0.75u/h
    9PM - 3AM: 0.55u/h

    Pattern B:
    3AM - midday: 0.7u/h
    midday - 9PM: 0.85u/h
    9PM - 3AM: 0.65u/h

    Pattern C:
    3AM - midday: 0.5u/h
    midday - 9PM: 0.65u/h
    9PM - 3AM: 0.45u/h

    So, pattern B works out as 2.4 units more insulin than pattern A over the course of 24 hours, and pattern C as 2.4 units less insulin. Pattern A is my most usual pattern, closely followed by pattern B (the "high" pattern). I do also spend a fair amount of time with temp basals of as low as 0.05u/h and as high as 4u/h, but the patterns provide a basic framework which I can use for mildly high days and mildly low days.
     
  12. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    Emm, that's exactly what we do, except you have larger increments between the patterns.
     
  13. StillMamamia

    StillMamamia Approved members

    Joined:
    Nov 21, 2007
    Messages:
    13,195
    Thanks for the replies. I haven't read them fully yet.:eek: But basically my question was if your basal settings were hourly or not. Now I see some have diff. basal profiles. Not really what I was pondering to do, but probably what would work better.:confused: Hmmm...I'll have to think about this.

    I was thinking along the lines of actually having the basal setting set up hourly, not by segment (as we have now), kwim? But I probably would be setting myself up to too much fine tuning and miss the bigger picture.:rolleyes:

    I'll come back to this later.
     
  14. StillMamamia

    StillMamamia Approved members

    Joined:
    Nov 21, 2007
    Messages:
    13,195

    Emma, in which cases do you use each pattern, if I may ask?
     
  15. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    On high exercise days I sometimes go to pattern C, although I regularly need even less than that. Generally I just change based on what my BGs have been.. If I wake up over 120 I'll put pattern B on, or if I wake up below 80 I'll put on pattern C.. If I seem to be seeing a few 200s I'll put pattern C on, or if I have more than a couple of lows I'll put B on. It's not an exact science.. (Like any of D is.. :rolleyes:)
     
  16. StillMamamia

    StillMamamia Approved members

    Joined:
    Nov 21, 2007
    Messages:
    13,195
    Ah ha! Thanks for your input.

    I still have so much to learn.:(
     
  17. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    You've certainly taught me a lot, Paula. :cwds: You never stop learning with D though, right? ;)
     
  18. TimO

    TimO Approved members

    Joined:
    Jul 27, 2006
    Messages:
    222
    We've had hourly basal rates since "day 1." If we consistently see lows or high at say 3 a.m. we adjust the 1 a.m. basal. This helps us achieve a consistent (if there's such a word with D) reading. We've been fighting lows at 6 p.m. with springtime activity, so we're trying to adjust earlier in the afternoon to compensate. I'm a big believer in hourly basal rates.
     
  19. Rachel

    Rachel Approved members

    Joined:
    Oct 16, 2006
    Messages:
    834
    We do hourly too ... have for years. We started this when our guy was so little that we had to alternate 0.0 and .05 basals every other hour to get the little basal he needed. Even though that is not longer the issue, I like being able to fine tune. We may end up having blocks that are the same, similar to what other people have posted ... but for us, those blocks aren't always defined by the same time frames. So sometimes 1-5 am and 6-9 may be the same but other times it it is 1-3, 3-8, 9 that have the same settings.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice