My nine year old son recently started on an insulin pump, and his diabetes team wants him to skip meals in order to see if the daytime basal rates are correct. I realize that this seems to be standard protocol, but I question its value in a child. My son rarely has a day with little activity. Also, I believe that the minute we figure out the “right” basal, he’ll have a growth spurt or something and we’ll be right back to searching for the perfect numbers again. Wouldn’t it be more practical to aim for the best glucose values based on what he routinely eats and the activity he gets as opposed to setting up an artificial situation that is stressful for us all and only provides accurate information for a limited time?

There are different approaches to starting and adjusting insulin pump dosages. One involves skipping meals to adjust basal rates. Other ways to look at basals closely include having families delay meals by an hour or two, serve meals with only “free” or very low carb foods (such as salads), or keep carbohydrate content as consistent as possible meal-to-meal for a while after pump start.

If it would be very problematic to skip meals to adjust basals, I would discuss these other options with your diabetes team to see if they might be possibilities. Doing all the adjustment up front as carefully as possible does have rewards in the long run, because once basal rates and bolus/corrective doses are accurately determined, learning and trying day-to-day adjustments for activities and illness becomes much easier.

LAD