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Temp Basals

Discussion in 'Parents of Children with Type 1' started by Hstntxag, Jan 25, 2014.

  1. Hstntxag

    Hstntxag Approved members

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    My son has been pumping for about 5 months and although I feel ok with changing the basal rates at times, I still don't 100% understand the ins and outs.

    We were trained by Medtronic but our original trainer went MIA, so we didn't have great support for some time. I do have a new contact but am not feeling the love... and my because my son's endo just went out on her own, we don't have a CDE to consult. I do own the book Pumping Insulin but haven't had a chance to read it thoroughly.

    I have 2 questions:

    #1. How much lag effect do you account for when changing basal rates? For example..if you are seeing highs first thing in the morning and you know it's not dawn phenomenon..which basal do you change? I have seen some success with changing the 10 pm but was curious as to what others do. His basal rates are:

    Midnight .750
    6 am .625
    10 pm .675

    #2. Is there a cliff notes version of how to set a temp basal? When my son has athletic practice after school or at night, his waking numbers are in range. When activity is lower, waking numbers are high. I'd like to set a temp basal on non-practice nights rather than changing the basals each time. Is there a rule of thumb for percentage of increase and for how long?

    Thank you in advance for your input! This board is invaluable!
     
  2. hawkeyegirl

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    We change basals two hours before we want it to take effect. You'll have to experiment a bit, but I think starting with 2 hours is pretty safe.

    We have absolutely NO luck with any sort of long-term reduced temp basal. Either it has no effect or it sends him sky high. We have much better luck setting basals for non-activity days and using uncovered snacks for active ones.
     
  3. Megnyc

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    I usually change basal 2.5 hours before I want the change to take effect.

    Not sure if you know this but you can have different basal programs for different types of days. There are three on the revel and I have them all set up. It is super easy to switch back and forth between them and you can still set temp basals. I think the pumping insulin book has some good advice on temp basals if I recall correctly. I usually set a temp basal of 20-40% right before activity and extending about 2 hours past and then 80% the night after a long day of swimming, skiing or similar. My basal rates are set though to assume that I will be pretty active. If I am just hanging around the house I have to set a temp basal of 120% or I will be high.
     
  4. Dad_in_Canada

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    Very interesting discussion. We're not pumping yet, but my 8 y/o DS is due to start in May, so I'm trying to learn what I can beforehand.

    I thought a temp basal could be used to ward off an overnight low (ie. set a temp basal, instead of waking DS to eat something to correct the low). But with a lag of 2 hours, I'm not sure that would work very well. Let's say Dex alarmed at 4.4, with a diagonal down arrow, would setting a temp basal of 0% be effective to ward off the low? I think that would mimick Medtronic's low glucose suspend, but I'm not sure how effective it would be.
     
  5. mom24grlz

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    i change basals 2 hours before i went the change. So if Ashleigh was running high at say 4am, then i'd change her basal at 2am. I do the same for temp basals, start them up 2 hours before the activity. I'd like to see a cliff note version on temp basals! But i think it's just trial and error. I know that if Ashleigh is running in the low 300s she needs at least a 150% basal increase, so we kind of work from there. During activity the amount I decrease her by (she drops low) depends on her starting blood sugar. But normally I run her basal at 60%-70%.
     
  6. Hstntxag

    Hstntxag Approved members

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    I have heard of the various settings options but I am guessing our original trainer believed that was 'advanced' and when she went MIA, we never got trained on how to set up those settings. We just received the new 530G pump...I think I'll ask to be trained on that aspect of the pump when we switch over in a few weeks. Much easier than messing with temp basals, it appears.

    And thank you for those who chimed in with the 2-2.5 hour lag. I had heard this number before but wanted to hear from others who are in our shoes. The only thing I can guess about why our 10 pm basal increase helps the 6:30 am wake up number is because he is super sensitive to insulin changes and perhaps 2 hours of increased basal is just enough to make a difference.
     
  7. Sarah Maddie's Mom

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    An 80 with arrow down and a temp rate could go either way. I generally look at IoB first, then try to figure out why she's low or trending low. I also almost never 0 basal. But if it's been a very active day and maybe she had a fairly low carb dinner and I see an 80 at bed I'll roll her basal back to 75% or 60% for a few hours and see what happens. Conversely, if I see a stuck high from a high fat and or high carb dinner I'll try a correction and a temp rate for a few hours at 150 or 175%

    It's really just trail and error with the emphasis on error ;-)
     
  8. shannong

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    For my son, I would need to give some juice, because even turning basal off would not catch it in time before going low.

    I only do temp basals 1 hour out, however the effects of a temp. basal last for about 2 hours after it is turned off.
     
  9. ecs1516

    ecs1516 Approved members

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    We do temp basals during the day and at night sometimes for lows. If the number is stable on CGM and just slower trending down with no down arrow, I will do a temp rate of 30 minutes to 1 hours Off. If a fast dropping one I will do glucose tablets or juice and may add the temp rate off for 30 minutes.
     
  10. Junosmom

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    I'd like to second the recommendation for Scheiner's book Pumping Insulin. It is $22 on Amazon but worth it. It has a whole section on exercise, suggested basals, etc. I'm experimenting with it now as my son tends to go low on nights after his tae kwon do class.

    Monday, I was sitting in the parents' area reading, after suspending all basal as son didn't want to eat before class. I'm reading "don't ever suspend all basal"! Crud! Luckily, the PDM could pick him up that time (most times I have to scan him like Star Trek, right up next to him) and turned it back on. PA at dr office said they do it all the time - suspend all basal. I told her the book says that can cause ketosis, liver getting into the act, etc. Book recommends reducing basal for certain exercise, for example I shouldn't for a 1 hour class, but should for the two hour class and by how much (usually no more than 50%).

    He also tells the ExCarbs or carbs + insulin reduction you should have by type of exercise. Very instructive. We did better last night - he started going low at bedtime, which is when it happens. For exercise, I didn't reduce basal, gave 15 carbs. At beditime, I saw that he still had 1.6 IOB so I gave him 16 carbs milk and peanut butter. This took him to about 122 by 2:30 a.m. and then by morning he had risen a little, to 132, likely morning rise.

    Interesting point: my son LOVES is that he recommends chocolate milk after exercise. Son was too high after the exercise to have more carbs, but he had it with dinner.
     

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