I just knew that working with expert CDE Gary Scheiner was going to be eye-opening. After all, I've barely touched the settings on my pump since I started using it three years ago. What a sense of empowerment to start altering so many Pump Settings — which have frankly intimidated the heck out of me until now.
Based on those yucky basal testing exercises, we have completely revamped my basal settings, with no less than seven different segments throughout the day — wow! I'm apparently one of the very few PWDs who needs a tighter insulin-carb ratio mid-day; most people get "tighter" towards dinner. Who knew?
And now for the latest Revelation I learned from working with Gary: you can use temp basal changes to cover food! In our latest session, we reviewed advanced pump features, which mostly had to do with setting temp basals to cover sick days, "predictable stress," and "prolonged inactivity" (like when you know you'll be sitting on an airplane for many long hours). This was all pretty familiar ground for me.
What I did not know — and I'm sure never would have thought of on my own — is that it's useful to employ a temp basal in combination with your bolus dose to cover high-fat foods (or even foods that aren't obviously high-fat, like many Chinese dishes). Gary suggested I try +60% basal for eight hours after eating a meal like that, or a rich dessert, for example.
I'd been using "extended bolus" for chocolate and other items I consider high-fat, with mixed results. "Just bolus for the amount of carb you think is in there, and then raise your basal in the background," Gary said.
But for 8 whole hours?! That sounded like overkill. Until I tried it last night, on a Chinese dinner that included egg rolls and chicken and beef dishes with that yummy, sticky-sweet Asian sauce we all love. And guess what? I was 140 at bedtime, took a small correction, and clocked in at 118 at my 2am check. Nice!
Gary also suggested adjusting basals to cover alcohol: a temp basal of -40% for two hours following each drink. Yipes! I drink a fair amount of white wine most evenings, but always along with ingesting my dinner. I'll have to do a bit of trial and error with that one.
Weird to think that you can mix and match basal changes with bolus doses. But as Gary says, learning to master these advanced pump features "can make the difference between good BG control and great BG control" — our collective aspiration, no? And as Hannah said so eloquently yesterday, "intensely accurate dosing is vital to everyone's diabetes management," and it is always a work in progress.