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December 2, 2008

Daily Care, Insulin Pumps

Question from Omaha, Nebraska, USA:

I would like to evaluate my son’s basal program for the overnight hours. How do I go about doing this? I have never done an evaluation before. My son has been on an OmniPod insulin delivery device since February 2008.


From: DTeam Staff

Speak to your diabetes team about how to do this for your child. There are more instructions on basal testing in many books, such as Pumping Insulin by John Walsh.

In general, the idea behind checking basal rates is to see if the glucose stays stable when your child does not eat. There are other factors besides food that affect the basal needs, such as illness, exercise, schedule changes, stress, etc. It is a little bit trickier to check a child’s basal rates as adults can just skip meals and see how they are doing. Kids need to eat and skipping meals is harder.

Depending on the information you want, make a plan with your diabetes team on what to do. Adults often truly want to see what happens when they don’t eat. For kids, it might be to learn what happens on a typical day, with typical snacks eaten. You can modify your glucose monitoring to get the exact information that would be most helpful for you.

To check basals, pick a very stable and typical day (no illness, not a different level of activity, and not have eaten high fat foods or unusually large meals). Keep a close eye on what happens to glucose either with frequent finger blood glucose checks or with continuous glucose monitoring. Be prepared to stop the basal testing for low or high glucose levels that occur. If you are checking in the evening and overnight, you would start after the effect of dinner wears off, perhaps three or four hours after dinner. Skip the bedtime snack and check the glucose levels overnight every hour or as frequently as your diabetes team recommends.

Another modified approach for kids is to give the bedtime snack and check pre snack and then hourly. Give it some time to see the effect of the snack wear off and then follow the glucose levels hourly. The basal requirements would be after the effect of food wears off. Is the glucose rising or falling by more than 30 mg/dl [1.7 mmol/L] to 50 mg/dl [2.8 mmol/L] (or whatever you and your diabetes team call “stable”)?

Stop the testing to treat a low or a high glucose that occurs and use that information to learn how to prevent it if it is a recurring pattern. Typically, if you want to prevent a low or high when you see a pattern, you change the basal rate an hour or two before the high or low appeared (depending on your diabetes team’s individual recommendation for you).

Remember that basal requirements change as children grow, and with different sports and activity seasons, etc. Also, because a high or low happens on one night, typically the basal rate would not be changed unless you see that happen a few nights and you should not change the rate if you know the reason and it would not be happening typically.