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temp basals and how to use them

Discussion in 'Parents of Children with Type 1' started by shannong, Jun 8, 2013.

  1. shannong

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    We are new to pumping and I'm a little confused about how and when to use temp basals.

    So, if my son has a random high number - do I stick with just a correction, or do a correction and run a higher temp basal?

    If my son has just a slightly high number, do I forget the correction and just run him a higher temp basal?

    If he is spontaneously running around playing tag with his friends, do I lower his temp basal, or is it just too late at that point and should I just feed him carbs?

    If he is having a low, after I treat with carbs, should I lower temp basal too?

    I also have no idea how much to lower or raise a temp basal for these situations.

    Can people just give me some examples of how they successfully use temp. basals so I can get some sense of how people are using it?

    Thanks!
     
  2. Mish

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    well, I'll start by saying it's a very individual thing. The important thing is that a basal tweak won't do anything for a few hours, but knowing that, you can still make use of it.
    ___
    So, if my son has a random high number - do I stick with just a correction, or do a correction and run a higher temp basal?
    I do a correction in almost every case. I'm more apt to use a temp basal after a really high fatty meal which is continuing to raise BG over a period of time. I never did it wtihout a CGM but I can easily ramp him up to 200% and watch the CGM.

    If my son has just a slightly high number, do I forget the correction and just run him a higher temp basal?
    correction again for us.

    If he is spontaneously running around playing tag with his friends, do I lower his temp basal, or is it just too late at that point and should I just feed him carbs?
    If it's just a regular running in the yard thing, I just snack that. I tend to lower basal and keep my eye on it if I know it's going to be an all day thing. . The increased activity really kicks in later anyway, so a temp basal makes sense if there is no immediate low. Sometimes I do have to do both (snack and temp). Temp amount will depend on the activity. 50% if he's on a trampoline..

    If he is having a low, after I treat with carbs, should I lower temp basal too?
    Only if you want a big spike later. LOL. Ok, sometimes. But not for a regular low. I'll do it for a super major low around 30 or 40 during the day (I'll go way down to 10 or 20%) At night if I have a fussy low that's really slow to come up I will set a temp basal for 30 -60 min just so I don't have to keep juicing and interrupting his sleep.

    I also have no idea how much to lower or raise a temp basal for these situations.

    Can people just give me some examples of how they successfully use temp. basals so I can get some sense of how people are using it?


    For us, we really find it useful when we know basals are set incorrectly. We're currently finding that basal needs (despite what ever 'expert' says) change a lot more in our child than seems to be the norm. So I have to have his basals slightly higher to compensate for dinner and I find it easier to just turn it down when he eats less.
     
  3. cdninct

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    Here's our take on things!

     
  4. quiltinmom

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    Those are EXCELLENT questions for your endo/CDE. For the most part the reasons and methods will vary from one person to the next. Like most everything with diabetes, you figure out what works for you through trial and error. We don't use temp basals all that often but there are some who use them quite often.


    Good luck! I hope you love pumping as much as we do. :)
     
  5. hawkeyegirl

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    I have very, very little success with reduced temp basals. VERY little. Usually it doesn't work fast enough to head off what I'm trying to head off, and kicks in just when BG is fine, only to skyrocket him. Kudos to anyone who successfully uses reduced temp basals, because I just can't.

    We use increased temp basals all the time. If I see on the CGM that he is high and still heading up, I do a full correction and an increased temp basal. If I do a regular correction and the first one does nothing, the next correction gets an increased temp basal. If he's "stuck" high, increased temp basals. Love them.
     
  6. MyHandsAreFulll

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    We do temp basals for active play (trampoline, swimming, bike riding), decreasing 30-75% we do increased basals for illness or meds that go with illness like antibiotics or steroids.
    We use a cgm and if she is going to bed at a stable lower number than we would like, say 100, we do a temp basal for an hour or two to bring her up without food.
    Good luck!
     
  7. Lenoremm

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    We find increased temp basals helpful to ease down stubborn highs. A correction might need to be aggressive and may cause a crash but a temp basal will nudge it down.

    We use temp basal down for long or heavy exercise but be careful how you use it our you may have a spike later. Ydmv
     
  8. MomofSweetOne

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    I turned my daughter all the way down to 10% for two hours last night because she was vomiting, BG at 74. She went up to 140 and then I resumed her normal basal.

    We use increased temp basal all the time with puberty. I watch how she tracks at night and adjust her profile accordingly. I focus on keeping her in range per the CGM rather than worrying about whether it's been 3 days since I made a correction (in puberty, 3 days is ancient history). It works for us.

    I was scared to try the temp basal initially but quickly learned out of necessity. It's one of those pump features that you soon wouldn't want to give up, but you don't have to master it it right away.
     
  9. Jacob'sDad

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    For us temp basals are the logical thing to do for highs over about 250. This is because insulin resistance occurs with high BGs and that means resistance to BOTH basal and bolus insulin. Neither will be as effective. So a temp basal raises the basal to compensate for the resistance. I also think temp basals work well to bring down highs because basal is delivered in very small, easily absorbed increments.

    Of course along with the temp basal, I do a correction bolus for highs and if the high is over 300, I will likely have to correct again. This is because the insulin resistance causes the normal correction based on his ISF to be too weak. I could increase the correction amount, but I would rather have to correct twice than to drop him like a rock. The severe drop can make him feel sick and very low and I could also overshoot causing a real low. Trying to bring up a low when his BG is in free fall is a real bad thing.
     
  10. shannong

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    Thanks so much everyone. Your responses are a great help.
     
  11. shannong

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  12. Sarah Maddie's Mom

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    What did he eat within the 4 hours prior to going to bed?
     
  13. Debdebdebby13

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    I haven't read the responses so bear that in mind with my answer.

    We pretty much only use temp basals after pod changes to combat pod change highs and when DD is drifting downward, but still has some active insulin so she'll end up low eventually. In the first situation we run about +25% (125% I believe for those on other pumps) for 4-6 hours, plus a .5-1.0u bolus up front and in the second situation we run a -15-25% for 2-3 hours. That is usually only at night, during the day I'd probably just give her a couple of crackers or something. We have, on a rare occasion used a minus temp basal when she's really active, like a soccer tournament or something when we know she's going to go down.

    We certainly might not be using temp basals to their full potential, but that's where we are right now.
     
  14. Jacob'sDad

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    That could be a delayed fat spike. It can happen several hours after a fatty meal like pizza. It can sometimes require a extreme basal increase like doubling the basal or even more which isn't too difficult to deal with providing you have a CGM to watch the results of the basal increase. We use Apidra and the BG response to basal increases is pretty fast. Since he did eventually come down it is very likely that the basal increase either was not enough or his BG was rising so fast that the response to the basal increase was delayed. There's always the possibility of air in the tubing but more than likely that wasn't the case. Sometimes it just takes several hours for a fast climbing BG to come down. The body is only going to react so fast to the correction and/or the basal increase and throwing more insulin at it right off the bat isn't necessarily going to make him come down faster. It can just lead to a delayed low later when he does come down.
     
    Last edited: Jun 9, 2013
  15. shannong

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    He had Naan bread and actually had a low after dinner. I weighed and calculated the carbs of the Naan bread, but I am convinced that the package was calculating a higher carb count than Naan bread actually is. It said that one piece is 64 carbs. I'm not sure how the Naan bread and/or the low may have affected him.

    Last night, I had a repeat of the night before where I fought highs for the first part of the night. He had pasta for dinner, but rather than a low after dinner, he was high. Fought the high with three corrections again until he stabilized once again about 1:30am.

    The only pattern I am seeing here is the first part of the night being high, but whether his I:C ratio at dinner is off, I don't know because I see no pattern here. I have changed his ISF for the early part of the night to be a little more aggressive. Last night, I also increased his temp basal by 100% - but still numbers didn't come in range until the same time as the previous night. Tonight he plays hockey, so he always runs lower afterwards and usually shows no spike in the night after hockey, so it will change everything tonight again.
     
  16. Helenmomofsporty13yearold

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    I would just correct the high rather than use a higher temp basal in this situation. We only use them for hormonal or sick highs.

    ***DD needs less insulin for corrections between 12am and 3am than any other time of day, so we give less than what the pump suggests for a correction. I am wondering if your son is the same and that is why you had that crash.

    We use lower temp basals when she has exercised.
     
  17. missmakaliasmomma

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    This is a normal issue when t1ds eat bread or other food high in carbs like waffles, pasta, etc. It can keep them high a good amount of time, then they come down quick. I know on the occasion I let my daughter have little muffins for breakfast, I have to resist the urge to correct her during the 4 hours. She always comes down at 4 hours but I hate her being high in between. Also, my dd's dr recommends seeing a pattern for 3 days before adjusting basals, I:C, ISF, etc. Some days can just be a fluke.
     

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