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How often do you adjust the pump?

Discussion in 'Parents of Children with Type 1' started by Portabella, Sep 23, 2014.

  1. Nancy in VA

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    I've done 2-3 basal tests around breakfast since we went on the t:slim about a month ago. I just did another one yesterday because she had been flat at about 85 since we had treated a low at midnight. So, we started at 85 at 8am and by 11am, she was 256. Did some major basal changes and probably need some MORE basal but I want to give it a few days and then do another basal test next week.
     
  2. MomofSweetOne

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    As I've been reading this thread, I found myself thinking back to diagnosis where we were given the impression that we would get insulin levels adjusted and then it wouldn't be so confusing or hard. But our CDE later admitted to me that if they told us what it were really like, everyone would be scared to take their child home (as if we weren't already!). Now I'm holding out for the thought that adults have lots less adjusting, so that this will not be my daughter's normal!

    Our morning started with a CGM alerting us to broken tubing, so that Medtronic call used up the amount of diabetes time I was led to believe we'd spend each day.
     
  3. StacyMM

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    I don't think of it as a toddler thing as much as a diabetes thing. Or maybe puberty and toddlerhood have frequent changes in common because we are fine-tuning all of the time! We download the Dexcoms every night.For DS, little changes every day or two handle the regular stuff and bigger changes only happen at growth spurts or changes in sports schedules. DD is much less steady. I make changes every day to some part of her day and some are pretty aggressive - keeping up with hormones can be crazy sometimes.
     
  4. rgcainmd

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    Although my daughter and I have not been playing the T1D game for nearly as long as you and your daughter have, I can so relate to what you are saying. I used to think that there was this elusive combination of pump settings that would allow my daughter to float through every day between the high 90s and low 100s with postprandial BGs no higher than 130. All I had to do was try hard enough. It's still sinking in that this homeostatic never-never land doesn't exist and that every single day will be a balancing act. All we can do is our best and hope that this is good enough.
     
  5. Sarah Maddie's Mom

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    I'll just offer a different view.

    I only make basal rate changes every few months and that's usually spurred on by a dramatic change in schedule and activity level. Even then, I usually only change a single time slot or two. We do do a lot of temp rates but for us, changing basal rates every few days or weekly would make a hash of things. This works for her and her A1cs are consistently at or below 7.
     
  6. mwstock

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    It could be a combination of both fine-tuning and having a toddler in your case if you recently started the pump. I really believe you have to look at patterns and not isolated incidents. Also it is important not to make too many changes at once. It is important to test the changes you make. Basal rates are for keeping the blood sugar stable without activity or food. It easiest to isolate them during the night or fasting before breakfast in the morning. During the day it is hard to test these and often times it becomes a question of basal or bolus that needs adjusted. If it is within three hours of the last meal...it could be related to the carb ratio. We only make adjustments to react to a series of lows or highs. Each parents effort on here may be different. Each child's pump settings and dosage differs also.
     
    Last edited: Sep 28, 2014
  7. shannong

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    So true! 2 years later and I am still working on accepting this.
     
  8. Charliesmom

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    At that age we were changing things weekly.
     
  9. susanlindstrom16

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    I'd say we make basal changes about every month or so. Just since school has started, we've upped her morning basal rates because she'd still be in the high 100s-low 200s at lunch time. We haven't changed the carb ratios in 2 years- I was thinking about doing it this past couple of weeks, but our issue seems to be solved (for now) by the increase in basal and also making sure i dose for every single thing that goes into her mouth in the mornings. Previously she'd be ok with having a little extra milk or whatever without the extra insulin.
     
  10. nebby3

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    We're not currently pumpers but I thought I would chime in on the ages/stages issue. My dd was diagnosed as a toddler and is now 12 and in the throes of puberty. She pumped starting at age 2 for 5 years. We changed basals frequently during that time. I would say her needs were rarely the same for more than 3 days in a row in those years. At age 7 she refused to pump anymore and has been on MDI since. Her A1Cs went down on MDI and there were definitely a few easier years in there before pre-puberty kicked in. I have wondered if the reason she was easier to manage was in part due to the fact that I could no longer change dosages too easily or too often. Fast forward to now, age 12, and I think things are a little easier again than they were the last couple of years (and with lower A1Cs). There are two possible reasons I see for this:
    -when she hit full blown puberty, I think her body actually settled into more of a routine (monthly, you know) and while there are still off times there is an eensy bit more of a pattern to them
    -we got the Dexcom. The main advantage of this I think is that I have been able to see when a lowish # like say 70 or 80 is holding steady or creeping up on its own so I have been more comfortable not treating things and letting them ride out. In other words, just as when she stopped pumping, me doing less has led to better numbers. I think before I was creating a lot of the roller coaster because I didn't have as much info.
    Now this is all specific to us. It may be that I am more the sort to overreact to #s and others will not experience the same thing, but I thought I would share our experience in case it helps anyone.
     
  11. Sarah Maddie's Mom

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    I wonder how you can ever spot "patterns" if one is making basal rate changes every few days? For us it seems that there are always extenuating circumstances, i.e., "oh that was the PE and practice and 30 min on Lily's trampoline day", or " didn't you bolus for a sandwich but ended up getting the salad" day, or getting one's period, or catching a sniffle and so on and so on. I think if I made changed so often I'd just be chasing my tail and driving myself insane (not to mention driving her nuts).
     
  12. KatieSue

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    I agree with this. Most of the time there's always something "off". We don't change ours much unless we are seeing a real problem and can actually discern what it is, which is pretty rare.
     
  13. Michelle'sMom

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    Exactly! We use a lot of Temps but basal changes are rare.
     
  14. Portabella

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    I call it a pattern when I see 200s before dinner every day for a week with the same pump settings and same lifestyle. I don't make any conclusions from unusual days with trips, picnics, etc
     
  15. shannong

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    Thanks for the post. I gave it some consideration and thought perhaps I am always chasing my tail. Decided to use temp. basals a lot more (rather than just changing basal settings) over the past few days and it IS making things easier and I believe giving my son better numbers. I've never been a big fan of temp. basals (for various reasons, one of which is that I often just forget that I set one), but I think so far that is better. Thanks!
     
  16. hawkeyegirl

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    We make basal rate changes as needed, which is usually at least a couple of times a week. My son's "patterns" tend to only last a few days at a time, so if we don't adjust quickly, we're chasing the prior "pattern" as opposed to adjusting for the current one.
     
  17. MomofSweetOne

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    When we took the T1U classes, Gary Scheiner said that the basic profile usually doesn't change that much, but that more may be needed at various times. We got through 2 years of blow-away-the-charts growth through puberty using temp basals on the Medtronic to adjust her entire profile. Reseting the temp basal was simply part of our nightly routine. When she started wearing the pod in the summer, we had a few days of highs because we were forgetting to reset the temp basal after 12 hours, so I programmed the many (which is a much nicer feature on the pod) basals as percents of the standard profile we were constantly adjusting. When I had to type in the amounts, it really shocked me how much 150%, etc was increasing by between her highest and lowest periods...but it WORKED. I am so thankful to him for that bit of wisdom because in my experience through that stage, there were only exceeding rare blips of periods of days that she was at the same basal two days in a row to even attempt to basal test. It was insane, but we seem to be seeing lots of calm without readjusting these days.
     
  18. jenm999

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    Bumping this thread to share that I finally go up the nerve to start adjusting the pump myself - and had our first day without going over 200 or under 70 yesterday - no visits to the nurse except a quickie lunch bolus, yay! I think I'm finally getting the hang of this.

    I had a question/observation. When he was on MDI, my son's Lantus dose was very low and based on the time of day with the lowest basal need. He was getting most of his basal needs via meal boluses or corrections. Now that I can adjust basals, his mealtime ratios are converging! Anyone else notice this?

    Also curious how many time segments most of you are using. We have 7.
     
  19. TripleThreat

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    If I see a trend 3 days I make a chage
     

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