Basal Adjustments

I was asked on FaceBook to explain how I made the adjustment to Arden's overnight basal rates that resulted in the graph above. I'm sorry that it took me so long to write about my (less than technical) process. Here's how I did it...

Somewhere around the second week of overnight lows it became obvious to me that I was dealing with a trend and not an anomaly. Something had changed about her physiology and I was going to have to adjust - basal adjust.

I'm not going to lie, I didn't do any basal testing. I have the procedure around here somewhere, the page or so of directions from Arden's endo that explains how to do basal testing - but I tried a more, let's say, personal approach. Luckily CGM technology lends a distinct advantage and unless we are averting a low, Arden doesn't eat at this time of night so trend graphs are a perfect way to understand where we have too much basal insulin.

I broke out the stupid PC laptop that we had to buy, because the damn device manufacturers refuse to port their software over to OS X (Apple), then I downloaded Arden's DexCom data. It only took a moment to see what time of night that her blood glucose was drifting lower.

Arden's overnight basal rate was .30 per hour, all I did was dial it back to .20 starting one hour prior to when her BG was beginning to fall, not terribly scientific I know. The possibility that this adjustment would be too little or too much wasn't a huge concern, because let's face it, I'm awake anyway.

As you can see in the image above, the slow drift that was beginning around 4 am leveled off nicely. The picture you see here shows that there was room for a little more basal insulin. I waited two more nights to verify that this graph was accurate and then I moved the basal to .25 an hour. That adjustment caused a slight dip and so the next night I staggered the hourly rates .20, .25, .20, things have been golden since.

The reasons that I like handling basal adjustments myself are simple. Waiting until Arden's next endo appointment to discuss this doesn't feel like an option - too long. Continuing to live with lows would have not only taken the rest of the precious little energy that I have left, but also it would leave Arden in danger - not doing that. People living with diabetes will always need to make adjustments like this. Their bodies, like everyone else's, are constantly going through ebbs and flows. My pancreas doesn't secrete the exact same amount of insulin every hour and it makes sense that Arden's pump shouldn't either. Arden's body has needs, ever changing needs - I have to keep up with them.

We all have to be comfortable making decisions like this autonomously at some point. As parents we don't always have the time to call for an army of help and our children's bodies shouldn't have to wait days or weeks for balanced control. Don't get me wrong, I wouldn't make a grand change to Arden's care without our doctor and I don't chase every night that doesn't go perfectly, but basal adjustments when they obviously are needed... We can do that!

If you are going to make basal adjustments please don't forget to write down your old numbers in case you have to switch back. Actually, if you don't already have that information recorded somewhere, take a moment to do that. Write down basal rates, IC ratios, alarm thresholds and all of the other personally inputted data that your pump and glucose monitors retain, just to be safe.

Later this week I'll be talking about Pre-Bolusing, Arden's latest A1c and more... stop back, like Arden's Day on FaceBook or follow the RSS feed to stay in the loop.

Good luck getting those basal rates where they need to be and then enjoy the huge difference in your BGs!

Comments

[Penny]

Interesting to see how everyone handles basal adjustments. Even with a CGM, I do Grace's every 2 hours at night, 4 hours after her last meal or bolus, and never within a low or high above 200. Basal test is off if we dip below 70 or rise above 220. Then I mark it against her current basal, retreating like you do, one hour from when I see the + or - of more than 30 points in her BG. I go in .05 increments unless the swing is + or - more than 60 points, then I do .10 increments, a swing of more than 90 would be .15 increments.
Have you seen Gary Scheiner's chart in TLAP, that details average basals and their curve on a graph? I refer to it all the time. It shows what natural, successful basal patterns look like at certain ages. More insulin from 9pm - 1 am, etc, then leveling off, then swinging up towards late morning. It has helped me understand natural curves of basal patterns.
It is one of my favorite things to do, basal testing. Sick, I know. I love the science and the math behind it. I do also believe that it's the foundation of everything else. It's the house upon which the D is built, so to speak.
And I just realized I wrote like 3 paragraphs, when all I wanted to say was 'good post.' :0)

[Scott Benner]

Thanks Penny! :)

I'm going to find Gary's chart.

[Penny]

In the new TLAP (2nd edition) it's on page 105, Figure 5-2.

[Scott Benner]

Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin--Completely Revised and Updated

TLAP

[Stacey D.]

I can't believe I'm admitting this but I have never done a basal test the conventional way. Except possibly when I first went on the pump 6+ years ago (can't remember with certainty) I am by no means in the group with Penny who loves to do them, that's for sure! lol You have rasied some good points when it comes to adjusting basal. And I'm so glad you're seeing the improvement you aimed for :)