Saturday, April 2, 2011

Pump Adjustments - Part 1 (Basals)

So I have decided to give the pump a serious trial despite the multiple variables listed in my last post.

Question is: Where do I start? 

I have decided to start from scratch, from the beginning, like a Newbie.

Why you ask;  well I've been off my pump more then on it in the last 12 months and I have gained a few pounds.  I think starting with the fundamentals(clean slate), will be good for re-training, sharing, and it will force me to look at all variables effecting my current glucose control. If you want to perfect something, go back to the basics. Otherwise old habits will ensue.

My Last A1C was 8 % so clearly I am not controlling my blood glucose levels adequately.

So I figured I would share my plan and experience with adjusting my basals.

First thing I did was review the recommended ways to adjust basals by reviewing a document written by Dr Robin Conway and Colleagues  based out of Smith Falls, Ontario, Canada. The Professionals Guide to Insulin Pump Therapy

I have used this resource in the past and consider it compulsory reading for any pumper.  This clinic's website The Diabetes Clinic is very patient centred, and easy to navigate. It has everything, and I have found it to be the most useful in managing my pump therapy and others I deal with.  I have no affiliation with them other then finding them on the web.

So I flipped through the first 6 pages and came to page 7.  Titled: "Estimates for Starting Insulin Pump Parameters"  It is a chart giving you an estimation on where to start your basal levels at based on your TDD(Total daily dose of Insulin)  Cool. I scroll down, my TDD using MDI was around 44 units per day.
Based on the chart I should do the following:

Basal: 0.7 units per hour
Meal Bolus 1 unit for 11 grams of CHO(Carbohydrate)
Correction Factor 1 unit for 1.8 mmol(multiply by 18 for US)

Neat, very easy to follow. As I remembered.  I have another hand-out from an Endo that adds another factor to consider. If your A1C is above target, Multiply the TDD by 1.1-1.3 and go from there. I will do that since I am not at target. So 44 times 1.2 =  52.8. SO back to the chart and this is what I get.

Basal: 0.8 units per hour
Meal Bolus 1 unit for 10 grams of CHO(Carbohydrate)
Correction Factor 1 unit for 1.5  mmol(multiply by 18 for US)

Okay. I am now programming my pump based on these new settings. However, I would be unwise, since I know my rhythms. I know I need less insulin from bedtime until 0300 AM. I also know I need more insulin after waking. So what to do?

Keep reading.

On page 8, they list 4 Basal rates, but recommend most people begin with one. I am not most people, I know I said I am going to start from scratch but what I will do is this:

I know from the past I need more in the AM, less in the post sleeping so my plan is this:

Basal Plan # 1:

0000 = 0.04 (1/2 the recommended) 
0300 = 0.8
0800 = 1.6
1000 = 0.8
2300 = 0.4

Trust me this is an increase from my current programing. So we shall see how it goes. I suspect some lows.

How do I test the above:  To quote Dr Conway's recommendation below:

 Adjusting the Basal Rate:
The goal is for the blood glucose to remain within 1.7 mmol/L of the target blood glucose value in the fasting state.
Change the basal rate by .1 to .2  units per hour over the period of time the blood glucose is too high or too low
For example, if the blood glucose rises after 3 AM and drops after 9 AM, raise the basal rate by .1 unit per hour from 3 - 9 AM and evaluate the effect each night.

All right then, this is the plan. The document also has good work-sheets to use for recording and analysing numbers starting on page 13, adjusting the overnight basal. Which is the most important one to start with.

As all PWD and those who care for PWD it is much easier when you start the day out with a good number.

Stay tuned, and I hope these new settings, bring the fasting down a little.



PS: I know a lot of my readers are well versed in pumping, and I want you to know I am open to new ideas and/or alternate resources.