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Temp Basal Tips?

Discussion in 'Parents of Children with Type 1' started by DavidN, Oct 7, 2014.

  1. DavidN

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    Over the last several weeks I've read in unrelated threads about parents of CWD using temp basals "all the time". Some daily. I just don't get this and want to learn more because I feel like I'm missing an important tool.

    I understand temp basals and we use them for ....
    - A very active day (pool, beach type stuff)
    - Long drives in the car
    - Following a high fat/carb meal (burger/fries, pizza, Mexican, BBQ)
    - Sickness
    - Treat a stubborn high of 240+
    - A low of 60 or below maybe we'll suspend for an hour or so
    - He's hovering at 78 at night I'll cut insulin for an hour rather than wake for a juice
    - Sleepovers
    - We have had little luck cutting basal for sports. We instead give uncovered carbs.

    But this list hardly constitutes "all the time". Other than the above, we don't use temps. If he is low, we treat with juice. It's quick and easy to quantify. If he is high, we bolus. Cutting or reducing basal while low doesn't work well for us as he inevitably shoots high later. As for treating highs with an increased temp, why (other than a stubborn high)? A bolus will work faster so why bother with a temp and what I perceive to be a gradual reduction?

    But then I read of lots of seasoned vets using temps "all the time" and I've read that the algorithms associated with the AP uses lots and lots of temps. But I'm having trouble understanding how to implement. Any feedback would be appreciated.

    David
     
  2. MomofSweetOne

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    Puberty. Different pump. The Medtronic pump only has 3 basal patterns, whereas you have 7 with the pod. Medtronic's temp basals last 24 hours; the pods last 12. Those two factors alone make a huge difference in approach. I've used both.

    My daughter overshot the growth charts during puberty (moving from the 25%tile to the 75%tile), and the only pattern I found was that she stair-stepped her basals up almost daily for about 2 weeks, give or take by a week or more, then plummeted and started all over. I didn't have consecutive days at a consistent basal for over 2 years, but by using profiles that I became familiar with, I adjusted her basal needs through temp basals daily. Unfortunately, it meant we had a harder time temp basaling for exercise, etc., but we managed.

    When she began using the pod for the summers, we kept forgetting that the temp basals turn off after 12 hours, so we saw some highs until we remembered. I then programmed the pump for her profile and percents of that profile. Rather than using temp basals, I switched basal profiles and then was able to temp basal within the profiles. I miss the multiple basals now that she's on Medtronic, but her growth has slowed way down, so I see more stability than we've experienced since diagnosis.

    For sports, the basal drop usually needs to start an hour or two before or you might as well just carb up.
     
  3. rgcainmd

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    (The bolding is mine.) We use temp basals for pretty much the same things. This feels like "all the time" to me... Not literally, of course, but it sure feels like it a lot of the time.
     
  4. Sarah Maddie's Mom

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    Your list might not be everyday for you… yet :tongue:

    I "do them all the time" as in every other day, generally speaking. Teenager, athlete, independent manager 12 hrs in the day, bolusing good, bad and ugly temp rates save the day.

    They are especially nice for a 16 year old girl who would rather not ingest a couple hundred empty calories just so she can work out or make-up for that rage bolus correction.
     
  5. Megnyc

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    I use them at least a few times a day to attempt to stop highs and lows before they happen. So, if I look at the dex and it says anything 110-150ish with a slanted up arrow I will increase basal by 10-20% for a few hours. Anything higher or with a full up arrow would get a .1-.5 u bolus and a temp basal. This is outside of any recent meals or corrections, of course. It is very rare for me to give a correction without also increasing basal for a few hours. I tend to assume that any blood sugar over 200 will create some degree of insulin resistance and the temp basal is to deal with that; as well as, whatever caused the actual high.

    I'm trying to think of a good analogy here. I think to me, treating highs is like being in a boat with a hole in the hull. You can just keep bailing the boat out but you are never going to be able to completely get rid of the water if you don't plug the hole. The temp basal for me when used in combination with a correction is generally not to address the actual high but rather to deal with whatever created the high in the first place. Hopefully that makes some sense.... I think it may be different with girls than boys since often it is something hormonal causing the shift in basal needs...

    For lows, during the day I usually just eat something and drop basal by 10%. But at night I will almost always treat anything 60-70 with just an aggressive temp basal. Again, I find that just giving carbs will bring me up but whatever is bringing me down is going to keep doing so unless I drop basal for a bit.

    ETA: temp basal=plugging hole in the boat. correction=bailing boat out.
     
  6. Ali

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    For what it is worth while I may program a temp basal for 24 hours I check every four hours at least and adjust. When exercising it is set from 30 minutes to 90 and then a different set for after exercise. You could do all the same with the Omnipod, the 12 hours to me would be irrelevant. On the MM you can go from 30 minutes to 24 hours, Sounds like the Omnipod has a max of 12 hours but you would just reset at some point. I may be misunderstanding something with the Omnipod so someone please correct me. As a big very mature grown up I use temps regularly also. Changes in general activity levels, absorption at pump sites, hormones, sleep, stress, travel etc tend to happen regularly but not on a set schedule so medium basal pattern that I adjust with temp basal on a daily basis is what works best, it just reduces the lows one needs to feed and all the wait times to eat while BG levels come down. Helps smooth stuff out. :)Ali
     
  7. Beach bum

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    We use temp basals frequently. Usually 5 our of 7 days a week.
    For example, yesterday my daughter was starting to dip down for no particular reason. Instead of treating the low with food, we ran a temp basal for about 1.5 hours.
    We decrease basal on nights she dances, leading up to the event by 30%. Then, later in the evening she tends to dip so we reduce again, but not as much. Sometimes when her hormones are raging. Having the Dexcom is a beautiful thing because we can see where she has been and where she is going. It really helps in guiding us on our decisions.
     
  8. DavidN

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    Thanks for the feedback. Yes, I get what your saying, but my thinking has been "give a bolus" which will begin working in 30-45 minutes vs a temp basal which, yes it also starts working in 30-45 minutes, but to a much smaller extent. But I suspect your experience with this is what leads to your next point below ...

    Yes I understand what you're saying.

    Part of the problem is you're a black belt and I'm an orange belt trying to skip blue, purple, red and brown. And, continuing the analogy, I can't even get my son to go to karate class. I should just be happy when he bolus's when I'm not around, which he does a pretty good job of.

    I suspect the nuances will come over time.

    Thanks again for the insight.
     
  9. hawkeyegirl

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    Well, we've been at this for almost 7 years, and I have zero luck with reduced temp basals for a duration of any longer than a half hour. I also have zero luck with increased temp basals for any longer than one hour. I simply cannot predict what BG will be doing a few hours out, and you need to be able to anticipate that well in advance so that you can end the temp basal about 2 hours before you want it to stop affecting things, and I simply can't do that.

    So we use short term, "extreme" temp basals frequently. (Zero percent for a half hour, or 200% for an hour, for example.) But have no luck with longer term (more than an hour) temp basals.
     
  10. Joseph

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    Same for us. We have been with the pump for more than 2 years and no luck so far. Maybe better for highs but with lows nothing, for the time being only lucky giving him some food.
     
  11. mamattorney

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    We're less than two years in, so may have more stability than others. We use temp basals most often at night, when she is unpredictably predictable. She has an inceased need for insulin that starts around 9pm and disappears around 1:00 a.m. I've tried to set her basal to counteract that rise. I use temporary basals to either counteract an angle arrow up (when she needs more insulin that night) or an angle arrow down (when she needs less that night) and have them run until midnight. If she's flat, but higher than I want her to be, I use a correction. Clear as mud, right?
     
  12. rgcainmd

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    I thought my daughter was the only one who had this pattern! I hear repeatedly about the dawn phenomena and somogyi effect, but my daughter has always flat-lined (I'm referring to having a steady, level line anywhere between the high 80s to low 100s on the Dex) from about 1:30 a.m. onwards. I'm still trying to knock down that 10:30 p.m. to 1:15 a.m.-ish spike with higher basals. Some nights it works but other nights, not so much...
     
  13. MomofSweetOne

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    It's because growth hormone is released during sleep, so once they sleep, their BGs can climb very rapidly if they are in a growth spurt. I saw over 100 pts. in 30 minutes once that started as soon as my daughter fell asleep.
     
  14. mamattorney

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    Try a temp basal for this - it works a lot better than a correction. As soon as you see an arrow on the dexcom, bump the basal up 20% or so (or down 20%) and see if you get a straight line shortly. If you don't catch it fast enough, you might get a straight line at a higher number than you want, then correct that. But it's hard to correct a rise because you don't know when it will peak.
     
  15. bamaboyd82

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    Trying this now! My son has a huge rise every night immediately after falling asleep. I was watching his CGM on Nightscout while reading your comment, and the arrow turned to 120 NE. Hopped up immediately and put in the temp basal. How long would you say it takes to see the flat line?
     
  16. jenm999

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    Aargh! I wish my CDE had explained this. This is *exactly* what has been happening to us the last 2 weeks, out of the blue. 9pm to midnight or so, he goes through the roof (300+), hasn't eaten since 6:30 pm, no IOB. I correct him when I go to bed at 11 but sometimes this is not enough and he spikes again, and the Dex wakes me around 1 am for another correction, or the correction isn't quite sufficient and he spends the night at 180 (which I don't like because I think our low-ish steady nights last quarter made up for a lot of daytime highs and therefore yielded a good A1c). I thought maybe it was a stealth virus (slight sniffles).

    I assume you set the temp basal to conclude at the time you've seen things level off on prior nights?

    The trial and error aspect of this disease is really unsettling for me. How do I know when to stop the temp basals? I don't to wait to see hypos when the growth spurt/illness is over and insulin needs are reduced.

    Oh, and are sleepovers on the OP's list because you tend to run the kids a bit higher to avoid the chance of hypos when you aren't there? (No sleepovers for us yet)
     
  17. mamattorney

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    I'd say around 30 minutes or so. If there was still an arrow after 45 minutes, I'd probably up them temp basal and maybe do a correction too so she wouldn't get too insulin resistant.
     
  18. mamattorney

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    I set it to turn off about an hour before things generally level off.
     
  19. DavidN

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    Yes. I see you have Nightscout. This is where that device maximizes its value. But with sleepovers, he's still across town with adults who know nothing about D so we run a slight temp basal just to be sure, particularly if he's been really active. The parents keep their cell phones bedside in case I have to call for them to wake him to drink juice or correct. He won't wake for lows, his phone or Dex alarm.
     
  20. sugarmonkey

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    We mainly started using temp basals when DS hit puberty. We started finding that a correction on its own wasn't enough to bring down highs, but add in a temp increase of 30% and it would work a lot better. Even adding extra to the correction didn't work as well as the temp. We usually set it for four hours and I'd test a lot more while it was on. Never had any luck with temp decreases for lows. He'd always end up sky high later.
     

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