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Temporary Basal Rate

If you have not done so already, we recommend that you read the following WaltzingTheDragon.ca pages on insulin pumps as background for the information that follows:
A Basal-Bolus Approach
Getting More from Your Insulin Pump: 7 Basic Pump Features
Getting the Most from Your Insulin Pump: 5 Advanced Pump Features


Getting the Most from Your Insulin Pump: 5 Advanced Features

Advanced Pump Feature #1: Temporary Basal Rates

A Temporary Basal Rate (or "temp basal") is an insulin pump feature which allows you to override your current active basal rate in order to add or subtract a specified amount of insulin from each basal dose, for a specified period of time.

For example, you could choose to increase the current basal rate by50% for the next 3 hours; if your current basal rate is 3 U/hr, the resulting temporary basal rate would be 50% more, or 4.5 U/hr. Or you could choose to decrease the programmed basal rate by 30% for 24 hours; for an active basal rate of 3 U/hr, the resulting temporary basal rate would be 30% less, resulting in 2.1 U/hr.

How this temp basal is expressed depends on the pump manufacturer - for current information on your child's pump, check your user's manual and/or contact the company who makes the pump. At publication time, the specs on pumps available in Canada were:

Medtronic pumps allow the programmed basal rates to be increased or decreased by a percentage of the current rates, OR by units per hour, for a temp basal duration of 30 minutes to 24 hours. For percentage adjustments, 100% is the starting point, with a temp basal increase expressed as a number over 100 (150% would be an increase of 50%) and a temp basal decrease expressed as a number less than 100 (75% would be a decrease of 25%);

Omnipod pumps can also activate a temp basal as a percentage of the current basal program (from -100% to +95% in 5% steps) OR units per hour (from 0.0U - 30.0U in 0.05U steps) for a temp basal duration of 30 minutes to 12 hours (in 30-minute increments).

Animas pumps use zero as the starting point and then express a temp basal increase as "plus" a certain percentage (+50% would be an increase of 50%) and a temp basal decrease as "minus" a certain percentage (-25% would be a decrease of 25%), with a temp basal range of -90% up to +200% (in 10% increments). The possible temp basal durations on Animas pumps is 30 minutes to 24 hours, in 30-minute increments.

Accu-Chek pump temp basal programs are adjustable in 10 % increments (0 to 90 % for decreases, 110 to 250 % for increases) with a temp basal duration of 15 minutes up to 24 hours, in 15-minute increments.


Again, for detailed and current information on a particular pump model, please consult the manufacturer.


Why Bother With a Temp Basal?

There are conditions under which you can predict that your child will need proportionally more or less insulin (such as sick days, or when your child's activity level varies from the usual), but changing the programmed basal rates would be inconvenient, as would having to remember to change them back when that condition ends. At these times, using a temp basal allows you to adjust the basal rate temporarily, without actually changing the basal program.

Remember!
In Waltzing the Dragon's Level 1 article, An Introduction to Blood Glucose Management, we talked about factors that can raise or lower blood glucose, such as:        
  • Exercise
  • Illness
  • Hormones
  • Stress / Excitement

Some specific examples of times when a temp basal may be helpful:

  • During and After Spontaneous Exercise (when the body likely needs less insulin)
  • Before Planned Exercise (when the body will likely need less insulin)
  • Before, During and/or after experiencing a cold, flu, infection, stomach bug, etc
  • During a long car or plane trip (in which there is significantly less physical activity than usual)
  • As the driver on an extended road trip, to reduce the potential for hypoglycemia at the wheel
  • When on an extended fast (such as Ramadan, Lent, or Yom Kippur)
  • During menses, when additional basal insulin may be needed.
  • Before and/or during a test
  • During or after a scary movie/TV show
  • During or after a day at an amusement park

Note: For many of the above conditions, you could use an Alternate Basal program instead. The choice is up to you.


tips from the trenches of type 1 diabetes
When Paul was 12, he decided it would be a good idea to run barefoot on a treadmill. Needless to say, he slipped off and ended up severely cutting the top of his foot open (requiring 14 stitches). By the next day, we noticed Paul’s blood sugar was continually climbing. We felt like we were doing constant corrections for high BG’s (which is a good indication that his basal insulin wasn’t high enough). Knowing that his body had just experienced huge trauma, it made sense that the reason for the high BG’s was because of an outpouring of stress hormones (and the dramatic change in his activity level didn’t help the situation). We found it helpful to use a temp. basal increase of up to 60% rather than permanently changing basals because his insulin needs would change every day.

~Danielle


  • Exercise typically lowers blood glucose. If your child has pretty much the same amount of physical activity every day, then the regular programmed basal rates will likely be set to account for this. But what if your child has soccer practice on Wednesday and games on Saturday, but not much activity the other days of the week? You could set a temp basal decrease on soccer days to account for the increased physical activity. What if your child is active at school recess during the week, but is a weekend couch potato? You could set a temp basal increase to account for the decreased physical activity.
Sometimes exercise leads to a rise in blood glucose. Under these conditions, a temp basal increase (rather than the typical decrease) may be helpful.

For more information on exercise and type 1 diabetes, see Waltzing the Dragon's Exercise sections under Readiness Levels 1 and 2.

  • Illness can either raise or lower blood glucose. If your child is vomiting, setting a temp basal decrease takes off the pressure from having to "feed the insulin". If your child has a cold, fever, or similar, her body may be insulin resistant, in which case a temp basal increase is a handy way to avoid the predictable high blood glucose over the next few days.

tips from the trenches of type 1 diabetes
This has been one of the MAJOR benefits of a pump for our family... we value not having to keep pushing a steady stream of carbs when our son can't keep anything in his stomach long enough to maintain an in-target BG against the effects of basal insulin! We just set a temp basal decrease (of something around 30 - 50% less) and then within an hour or two, we don't have to worry about pushing sugar. Conversely, when he starts to get the sniffles, accompanied by highs that are likely a result of his cold, we bump up the basal insulin by 30 - 60% to allow for the increased basal needs while his body is fighting off the "bug". It is not uncommon for a body to need twice the usual amount of insulin, or even more, when dealing with illness. It's wise to start with relatively small adjustments, increasing the adjustment in reasonable steps until you see an effect on blood sugar. It took several tries for us to figure out a good amount to increase or decrease the insulin, and it's not exactly the same with every sickness, but we're so much closer than we would be without a temp basal feature.

~Michelle
For more information on managing diabetes during illness, 10 Safety Rules for Managing Diabetes when your Child is Ill is a good place to start.

  • Hormones can either raise or lower blood glucose. When hormones surge, due to physiological processes such as menstruation, due to physiological stress such as surgery, or due to emotional stress/excitement from an exam, a scary movie or a day riding roller coasters, these hormones affect the way your child's body uses insulin; a temp basal setting (increase or decrease, depending on whether, in the past, you have observed your child's blood glucose rise or drop under these conditions) may be helpful a few hours in advance of the stressful event, or for a few days during her menstrual period.
A Note on Stress: In some individuals, stress hormones may cause insulin resistance, in which case you need more insulin to keep blood glucose in target during stress. However, the OPPOSITE is also true for some individuals. We have heard from some students who say their blood glucose tends to go low around test time. We suggest that you base your strategy on blood glucose data from previous occasions of these conditions. As in all things related to the dragon, consider both alternatives when addressing your individual situation. In short, YDMV! (Your Diabetes May Vary)

A Few Notes On Temporary Basal Rates...

  • If you find that too often you have to set the same temporary basal rate (increase or decrease), across a variety of different conditions, it may be helpful to change the regular programmed basal rates instead.
  • A temporary basal rate changes the background (i.e. basal) insulin only - it does not affect the amounts given as bolus to cover food or correct high blood glucose. Under some conditions, you may also choose to increase or decrease the amount of bolus insulin in addition to setting a temp basal. For example, if your child has a gastro-intestinal (stomach) illness, he may not be absorbing as much from his food as usual, and you may find that a weaker insulin-to-carb ratio is needed in addition to a temp basal decrease.

tips from the trenches of type 1 diabetesWe both find that even after symptoms of a tummy bug have completely disappeared and our son is eating normally again, if we do not provide less insulin for food (via a weaker I:C ratio) for a few days, he will have repeated lows. It seems that even after he's back to normal on the outside, he is still recovering on the inside; perhaps his GI system isn't absorbing as much nutrition from his food as it normally does, so less insulin is needed to cover the food that is absorbed.
~Danielle and Michelle



Looking for more information on Advanced Pump Features?
Go back to Getting the Most from Your Insulin Pump: 5 Advanced Pump Features,
or go directly to:
Advanced Pump Feature #2: Alternate Basal Programs
Advanced Pump Feature #3: Split Bolus (a.k.a. Combo Bolus, Dual-Wave Bolus, Extended Bolus)
Advanced Pump Feature #4: Suspend / Resume
Advanced Pump Feature #5:
Delivery Speed


Any questions? Comments? Feel free to Contact Us.



The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.


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