Adjusting basal insulin in pump therapy is different than in MDI. Basal insulin adjustment in pump therapy requires:
- meals and/or snacks be missed or a set meal plan be followed
- more frequent blood glucose testing than MDI, especially overnight
- basal rate assessment to be done for different periods of the day: overnight, morning, afternoon, and evening
- rates be adjusted by fractions of units. E.g. an increase of 0.1 units/hr
It takes more time and effort to set basal rates for people on pump therapy compared to MDI. The glucose results from the testing are reviewed with your diabetes team. Necessary changes are made to basal rates and repeat basal rate assessments are done to see if the new rates are working. Usually, the goal is to have sugar readings that are stable, and not changing by more than 2 mmol/L over the tested period.
After setting basal rates, people may need to change their insulin-to-carbohydrate ratios and/or insulin sensitivity factors (formula for correction insulin). This means food records and more blood sugar testing is required.
All of this may take up to several months, which can be frustrating for the new pump user. Keep in mind that basal insulin requirements change over time; the above procedures need to be repeated for part, or all of the day, at various times in the future.
It is a lot of work. However, after basal rates are set, people usually have fewer low and high blood sugars and more flexibility with meal timing.