While I am still reading Gary’s book (savoring shall I say – or rather reading carefully so I do not miss something important) I jumped at the opportunity to see him talk about “Use of advanced features of insulin pumps”, here in Brisbane.
Like in his book, his words during the presentation came out so easily and made complete sense. He spoke about “Almost 101 uses of Temporary Basal” and examples of the use of combo or dual wave boluses.
I had “discovered” temporary basal about a year into Mr T’s pumping and have been exploring the various uses of this feature ever since. I was glad to find out I was familiar with most possible uses, some of which I did not fully understand, how and why they worked as well as they did. That is where Gary came in.
The magic of Temp Basal
- when you are sick(+), because your body naturally becomes more resistant to insulin
- when you are less active then usual (+), because your basal will not be as effective
- when you are more active then usual for prolonged time (-), because the activity will make the insulin more
- when you eat fatty food (+) and this I’ll explain separately
- when you want to prevent slipping in to the low zone if you have ended up below your target after the meal
bolus has finished its action (-) and do not want to eat more
- when you know that watching a scary movie raises your BG (+)
- when you know how you react to a stressful situation and what those situations are (exams, presentations
at work etc), you could preempt them and adjust the basal upfront (+). The stress hormone renders insulin
less effective and we all need more insulin in those situations to maintain the targeted BG.
- when you know how your menstrual cycle affects your body. Usually, he says women need more insulin (+)
a few days before, because of other hormone secretions which renders insulin less effective
- through growth spurts in children (+), again growth hormones make insulin less effective and you need more of it
- after the use of other hormone based therapies like cortisone against allergies (+)
- after consumption of alcohol (+ and -)
- after a severe low if you can sense the rebound response coming un (+),
and, for course, if you are testing basal settings and suspect a certain part fo the day needs a bit more (+%)
or a bit less (-%), use temporary basal to check it and then, if you are happy with the results, make permanent
changes to the basal settings.
YES it can look after small children to an extent, as Gary explained.
At least it can make sure they do not go hypo after activity. He says, some of his patients use highly reduced temp basal, even halving it after a particularly active day. Because temp basal can only be set to be active for up to 24 hours, for prolonged days of increased activity, like camps, they resort to switching to separately set basal program that is up to 50% less (very personal) then the originally set one.
Combo or Extended boluses
Because of this, Gary likes to use BOTH combo/extended bolus AND increased temp basal to deal with fatty meals such as pizza, pastas with cheesy or cream based sauces and even buttered popcorn in movie theaters! WOW, now we are talking complex programming. Sure it is easier to avoid such foods, but if you are up for it – there is a challenge for you!
No, do not worry I have not found the formula yet, not even one that works for us. I did use (+) temp basal with it, not really understanding why and how it would work. It was out of desperation, thinking and hoping that every little bit helps.
At least now I know some of the “science behind it”.
I have started experimenting with combo/extended boluses for Mr T’s meals when they too close to his bed time. It is hit and miss at the moment. We’ll see.
Gary also stressed that the key element of insulin therapy is a well set basal for the “typical” day in ones life.
Once that is done, tested and confirmed, THEN you start playing and using the Temp Basal effectively. But do not forget to retest your original basal settings from time to time. You might find that you actually need a permanent change at certain times of day, which might have been masked by the use of Temp Basal.
If you do use Temp Basal often and then look back at your basal history you might notice that not many days were the same.
Gary says, this is fine: how many days are really alike in your life anyway?
The first doctor that I discussed pump therapy with explained that we could use the pump in many different ways.
You can use it to deliver fixed basal and boluses and adjust the food to suit, you can combine it with long acting insulin shots and have the advantage of taking it off for part of the day and reconnecting it for boluses only; or you can try to make it work “almost like a pancreas” using its advanced features. Of course, it helps if you learn how to “think like a pancreas first”.
It is up to you, Gary says. As with other aspects of diabetes self management, one tries to understand the ones' bodies needs and workings and synchronizes these with the insulin using the tools at ones disposal. This, of course, means a LOT of self experimentation, testing, noting the results and consultations with your health care team.