Importance of Basal Settings

After nearly giving up on my pump, I found the very popular book by Gary Scheiner, Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin. (Amazon) РI think this is a must-have book for people who want tight control of their glucose numbers.

At this point, I had uncontrolled, severe hypoglycemia. With a new-born baby, this was not just a drag on my life but it was a bit dangerous. I do not know how many gallons of orange juice I drank to counter lows.

I had also not paid attention to the importance of fine-tuning my basals. I was using a single basal which gave me big lows at night and when I was doing practically anything that needed me to expend a little energy.

Since many new pumpers are coming from a combination of short-acting and long-acting insulin injections, the idea of basals is a little foreign as compared to bolusing.

I think educators need to spend a little more time talking about how basals are the foundation of successful pump therapy.

Obviously, for the MiniMed 670G, Auto Mode takes care of setting basals but at one point or the other you might find yourself needing to use manual mode (e.g. in case of an infection, etc.) At this point, your basal setting comes into play. (I also believe that having accurate basal settings will make one’s transition to Auto Mode easier. If your basal setting are far off it might take a little longer for Auto Mode to hone in on your BG targets.)

See this article on how to systematically adjust your basals.

Lessons I have Learned

Here are a couple of lessons I learn on basals that might be of help to those who are new to pump therapy.

  • Chances are that you will need more than one basal setting to take care of variations throughout your day. Having multiple basal is especially important for those who are active or experience physiological changes such as Dawn Phenomenon or the Symogi Effect.
  • Some people are more susceptible to subtle changes in basals administered. For example, even an increase in basal rate by 0.025 mg/dL is always enough to wreak havoc to my glucose readings.
  • BASALS ARE KING: Even if you have your carb ratio and sensitivity fined tuned and your basals are off, you will always experience highs or lows after meals, exercise, strenuous work, etc.
  • Temp Basal (in manual mode) work really well when one is sick. Normally I set it at 24 hours and continue doing so until am over the sickness or infection. Do not be surprised when you end up having to crank up your basals quite a lot when you have an infection or are sick.
  • Depriving myself of basal insulin will leave me fatigued. Although I think it will vary from person-to-person, I find myself more active now when my bolus: basal ratio is closer to 50:50.