I just knew that working with expert CDE Gary Scheiner was going to be eye-opening. After all, I’ve barely touched the settings on my pump since I started using it three years ago. What a sense of empowerment to start altering so many Pump Settings — which have frankly intimidated the heck out of me until now.
Based on those yucky basal testing exercises, we have completely revamped my basal settings, with no less than seven different segments throughout the day — wow! I’m apparently one of the very few PWDs who needs a tighter insulin-carb ratio mid-day; most people get “tighter” towards dinner. Who knew?
Photo: Adaptive Path
And now for the latest Revelation I learned from working with Gary: you can use temp basal changes to cover food! In our latest session, we reviewed advanced pump features, which mostly had to do with setting temp basals to cover sick days, “predictable stress,” and “prolonged inactivity” (like when you know you’ll be sitting on an airplane for many long hours). This was all pretty familiar ground for me.
What I did not know — and I’m sure never would have thought of on my own — is that it’s useful to employ a temp basal in combination with your bolus dose to cover high-fat foods (or even foods that aren’t obviously high-fat, like many Chinese dishes). Gary suggested I try +60% basal for eight hours after eating a meal like that, or a rich dessert, for example.
I’d been using “extended bolus” for chocolate and other items I consider high-fat, with mixed results. “Just bolus for the amount of carb you think is in there, and then raise your basal in the background,” Gary said.
But for 8 whole hours?! That sounded like overkill. Until I tried it last night, on a Chinese dinner that included egg rolls and chicken and beef dishes with that yummy, sticky-sweet Asian sauce we all love. And guess what? I was 140 at bedtime, took a small correction, and clocked in at 118 at my 2am check. Nice!
Gary also suggested adjusting basals to cover alcohol: a temp basal of -40% for two hours following each drink. Yipes! I drink a fair amount of white wine most evenings, but always along with ingesting my dinner. I’ll have to do a bit of trial and error with that one.
Weird to think that you can mix and match basal changes with bolus doses. But as Gary says, learning to master these advanced pump features “can make the difference between good BG control and great BG control” — our collective aspiration, no? And as Hannah said so eloquently yesterday, “intensely accurate dosing is vital to everyone’s diabetes management,” and it is always a work in progress.
What you are doing is replicating the dual wave bolus feature, which I believe is standard programming in most pumps. Certainly on the Omnipod, in the bolus menu it will ask if you want to extend your bolus, how much of it to deliver upfront, and how many hours over which to spread the remaining insulin. If you really get into pump settings (ahem, I don’t), be weary that with the temp basal method the insulin that is covering the slower-absorbed part of the meal is being attributed to total basal insulin.
Funny…. I was doing temp basals for fatty foods instead of extended boluses for years because on my old Deltec Cozmo you could only do one extended bolus at a time until the first finished. Eat a slice of pizza, do an extended bolus, decide you want another…..the temp basal and regular bolus just made more sense to me.
I’m really really excited to say that the temp bolus thing was something I figured out on my own. Score one for me!! I always up my basal for 6 – 8 hours when I eat Mexican food. Sometimes I’ll still need a small correction during the nigh, but often it works out perfectly.
I cannot even quantify how often I use temp basals. That is one of the reasons why I chose to stick with the Minimed pump … it allows you to set a temp basal at any increment (ie: 90%, 85%, 115%, etc as opposed to just increments of 10%). I love it for those times when I see my bg creeping up or starting to drop too … it just about always works. Also when your bg is high and you still have insulin “on board” which would result in a 0 correction, I increase my basal in those situations to bring it down. Glad you’re learning new things … especially if they are working!
Great information. Thank you for sharing about the work your doing with Gary and the progress.
s/b “you’re”
Super Hero numbers for Chinese.
I may need to order some in just to try that with the kids. Sure that’s it, for the kids yeah. Strictly for medicinal testing. I’ll suffer though it for just them
Brilliant! I have to try this one after pizza and chinese food for the boys.
Indian food meals are also an 8 hour deal for me. Temp basals won’t categorize the delivered insulin as meal insulin but at least it will
automatically shut off once it completes.
The best solution for long digesting meals is obvious and unavailable in
any pump on the market: meal presets that automatically deliver combo/extended boluses. *sigh*
Imagine what pump would be like if designed by us!
All pumps should be able to:
1)execute multiple overlapping combo/extended boluses all properly categorized as meal insulin.
2)deliver variable extended boluses/temp basals that deliver different amounts at different times which I have discovered would better cover mexican food. Such a feature would also be useful for post-exercise effects.
I can accomplish the same effect by customizing an alternate basal program but the # of button presses is discouraging and I have to remember to switch back to regular basal delivery. Kudos to Insulet for their “Copy” feature which at least makes setting up an alternate basal program much easier.
3)Super bolus
Improving the utility and end user satisfaction of pumps is a (relatively) simple matter of customizing features and software code that already exist. *sigh*
Indian food meals are also an 8 hour deal for me. Temp basal won’t categorize the delivered insulin as meal insulin but at least it will
automatically shut off once it completes.
The best solution for long digesting meals is obvious and unavailable in
any pump on the market: meal presets that automatically deliver combo/extended boluses. *sigh*
Imagine what pump would be like if designed by us!
All pumps should be able to:
1)execute multiple overlapping combo/extended boluses all properly categorized as meal insulin.
2)deliver variable extended boluses/temp basals that deliver different amounts at different times which I have discovered better cover certain extended digestion meals like mexican food. Such a feature would also be useful for post-exercise effects.
I can accomplish the same effect by customizing an alternate basal program but the # of button presses is discouraging and I have to remember to switch back to regular basal delivery. Kudos to Insulet for their “Copy” feature which at least makes setting up an alternate basal program much easier.
3)Super bolus
Improving the utility and end user satisfaction of pumps is a (relatively) simple matter of customizing features and software code that already exist. *sigh*
Gary always knows what he’s talking about. And he’s never one to criticize for how much or how little insulin one needs to take.
More good stuff this week from DMine! I love this idea – total new way of doing things! Thanks Amy (and Gary)!
Um, but I don’t think my Paradigm 522 allows for percentage temp basals. Phooey. So I’d have to create “Patterns” pre-set to percentage of normal basals. Oy – and there are only 2 Patterns you can program (and one of mine is already pre-set for when my normal daily schedule shifts). Help! (Time to upgrade to the new-fangled MM pump-o-rama???)
love stacey d’s comment about increasing basal rates to combat a stubborn high, even with enough IOB to not require an additional bolus. as a matter of fact, i just used this technique to combat a high on an airplane trip tonight. good luck amy
This is fantastic – this sort of day-to-day creative management is why I read this blog. Thanks so much for this.
T1 in Boston: yes, the 522 does let you do percentage temp basal rates (I have the 722). You have to change the settings though. Go to Basal -> Temp Basal Settings (at the bottom of the screen) -> then flip it from Insulin Rate to Percent of Basal. And you’re done!
Amy:
My daughter started working with Gary in 1996, at age 13, shortly after getting her pump. It only took one false alarm DKA E.R. visit ( with a $1100 bill for 3 hrs) to convince us that we needed a “guru” to teach us how to handle this. Enter Gary Guru , as he’s fondly known in the Philly area!! Of course I had to fight with the insurance company to convince them it was bad business to pay outrageous ER fees, but refuse to pay for essdential CDE instruction. I won!….14 yrs later, I know there are “tricks of the trade” my daughter still uses that came from her many years of being schooled by Gary!
Renee
omg Allison Blass, thank you so much!
I was going to say “pizza, ice cream, Indian food, here I come!” But the reality is: I already eat those things, I just suffer poorer control as a reult. So instead I’ll just say “hello new ideas for managing my diabetes!”
Now everyone here knows how hard a NORMAL Pancreas has to work everyday to keep blood sugars normal. It is a remarkable organ.
I’m a big fan of Gary. He is one smart guy, AND knows how to take those smarts and teach other PWD’s.