#1004 Diabetes Pro Tip: Temp Basal
In this episode of Diabetes Pro Tip, host and diabetes educator Jenny Smith discusses the topic of manipulating basal insulin with her guest, Jennifer Smith. They cover the importance of understanding basal rates and how they can be adjusted to better manage diabetes.
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Key Takeaways
- Static Basal Rates Aren't Enough: It is unrealistic to expect a single, static basal rate to cover your body's constantly changing needs throughout the week or month.
- Temp Basals for Complex Meals: High-fat and complex-carb meals (like pizza or Chinese food) require "carpet bombing" insulin over an extended timeframe, making a Temp Basal increase crucial for avoiding late spikes.
- Hormones and Illness Require Adjustments: Life variables such as menstrual cycles, specific illnesses (e.g., sinus infections vs. stomach bugs), and even sedentary days often necessitate significant, prolonged changes to your basal rate.
- The Secret of Artificial Pancreas Systems: Automated insulin delivery algorithms (like Loop or OpenAPS) maintain stability primarily by making continuous micro-adjustments to basal rates, not by administering large boluses.
- Bumping and Nudging: Utilizing temporary basal increases or decreases allows you to gently guide blood sugars back into range before they swing drastically out of control.
Resources Mentioned
- Wrong Way Recording: wrongwayrecording.com
- Diabetes Pro Tip Series: diabetesprotip.com
- Juicebox Podcast: juiceboxpodcast.com
- Integrated Diabetes Services: integrateddiabetes.com
- Juicebox Podcast Type One Diabetes (Private Facebook Group): Join on Facebook
- DIY Loop Systems (OpenAPS, Loop, AndroidAPS)
Introduction and Podcast Overview
Scott BennerHello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CDE and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisitable. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Temporary Basal rates do a number of different amazing things,
Jennifer Smith, CDElots and lots compared to what your doctor told you.
The Reality of Static Basal Rates
Scott BennerYes. And so here's how I always think about it about Basal rates in general, it is bizarre for us to think that we can set up a static Basal rate that will always work at 2pm for the rest of this week, or this month or our lives, right. It's just an odd statement. I don't have diabetes, my blood sugar varies based on what's happening in my body or what I eat. And I bet you even though I have no medical training whatsoever that my body is more aggressive with the amount of background insulin that I get the amount of force it pushes on my blood sugar at different times,
Jennifer Smith, CDEbecause it's got natural compensation. Yes. And I think that that that piece about about basals is also really, really, really important for women. Right?
Using Temp Basals for Complex Meals and Hormones
Scott BennerOkay. Yes, because of their periods. Or, by the way now I've been told not to say, Lady time by people that I should say period, so that I went back to period to make that person happy. Then I got a beautiful note from somebody the other day, who said, I think Lady time is delightful. And I'm like, I can't win, but that's not the point. So the so so here's a couple of ideas. We get Chinese food coming into the house, right? Or pizza or something that's high carb that breaks down slowly in your system. Okay. My Pre-Bolus For Chinese food is this Temp Basal increase 95% for two hours, boom, I start right there. Then I get a healthy Pre-Bolus in you know, and I start the I went to a decline when when Arden starts eating her food. Chinese is a good example because it's not it's simple sugars and complex carbs at the same time, right. So the coating on the meat might have a lot of sugar in it like the sauces will hit you quickly. But that rice could sit in your system forever and take hours and hours and hours to break down and to go away. So I think of it as carpet bombing insulin. I went to I went to cover the entirety of the timeline that this food is going to have impact on Arden with an increased Basal insulin. It I would also use an increased Basal insulin. When Arden's hormones are affecting her. Yeah, we just got done doing that this week. There was a day and a half or Arden ran a Temp Basal increase of 80% for two days straight.
Jennifer Smith, CDEYep, get a straight. Yep.
Scott BennerIf your Basal is not right, your boluses aren't going to work. Right because you're just replacing basal with your Bolus. So even again, you count your carbs. 100%, right. But if your Basal insulin is set at, let's say a unit, but it should be at two units, then when you make a Bolus for a three unit snack, the first unit of it is only covering the basal you don't have. Plus, you haven't had enough basal leading up to that. So you're probably so insulin resistant and having a higher blood sugar to begin with. None of this works without basal. When people come to me and say, Oh, my God, look at my roller coaster. I'm 60. I'm 400. And the first thing I say is okay, let's get your basals right. If your basals aren't right, the rest of it doesn't work, right,
Jennifer Smith, CDEand temporary basals are not going to work either because they're working off of a setting. That's not That's not right to begin with. Yep.
Scott BennerInevitably, while I'm talking about basals with people, they say, Well, what about my insulin to carb ratio, and I went, That's not even worth thinking about until we have your basals right. So now you can think about Basal insulin as Basal insulin used, you know, in the normal course of your day to keep your body function low when you don't have any food. And if you really start to think about them around food, that's when they become incredibly powerful. Yeah. And so there's also a time where, like I alluded to before, you can bump in nudge with basal, right? So not only can you create a hard basal that helps you with carb, heavy meals, but you can look at a blood sugar that's at, you haven't had insulin for hours, and then suddenly, it drops to 75. And it sits there for a little bit. And instead of feeding that 75, you can Temp Basal back. So Temp Basal is unlike the, you know, when I think about the tug of war with with Pre-bolusing, basals, I think of this way. I imagine if you and I put our hands out, stood up and put our hands together our palm the palm, and we pushed equal amounts on each other. That's you don't fall back, I don't fall back. That's a perfect Basal rate. Right now there might be a situation where my my blood sugar is starting to fall. So I need the body function to push a little more. So I, I take a little power away from the Basal which allows me to push up. Same thing if I'm at a 90 that's going into a 95. And it's creeping up. But a Bolus is definitely even a tiny Bolus is going to make me a little lower later I might just do a Temp Basal increase to stop that kind of creeping.
Jennifer Smith, CDEYep.
Bumping, Nudging, and the Artificial Pancreas
Scott BennerThis all occurred to me when I interviewed someone about artificial pancreas and they told me that most of the adjustments that an artificial pancreas makes is through Basal insulin.
Jennifer Smith, CDEYes, not through Bolus 100%. If you're doing anything within the looping community, the do it yourself insulin pumps, either open APS or looper, Android APS or whatever that is, that's the gist of the algorithm. It is most of most of the incremental adjustments based on the trend in glucose are being done by positive and negative what's called tamping you get a bit of a bump up, you get a bunch of a bump down, you had a bit of bump bump up, and it's all being based on your current Basal setting.
Scott BennerRight? Right.
Jennifer Smith, CDEBut the incremental ups and downs are what keep you stable
Scott BennerSo when I talked about bumping and nudging, which is going to come up in the future a little more, it's the idea that if you don't use too much insulin, it can't cause a wide swing. Correct, right. So bumping a 120 Diagonal up back to 90 takes a smaller amount of insulin than ignoring your blood sugar till it gets to 180. Now you're putting in a bunch of insulin, it becomes mistimed and you get low later. So using these little bumps, just make sense that you can accomplish that with Temp Basal. Again, remember, Temp Basal is going to start working right away. You can't save yourself a 65 one arrow down with a Temp Basal. No, that's, that's juice time.
Jennifer Smith, CDERight, right.
Scott BennerBut, but but a 70 that's drifting low and has no impact from insulin really could be saved with it, it could be saved it maybe it won't be but you try and figure it out for yourself, maybe that'll end up being a 90 that's drifting low that you'll eventually use Temp Basal for. But they are, they are such an important tool. And if you're not using them, you're missing out. I will say it here I'll say it again . an insulin pump is not just the way to get less injections. It's also a way to be able to give yourself micro Boluses to be able to manipulate your Basal insulin to be able to manipulate your Boluses to spread them out. These tools are are vital. So please tell me and I know you and I are short on time here. But tell me how you talk about Temp Basal with people like where do you where do you really focus in on on education about it.
Variables: Exercise, Illness, and High Fat Foods
Jennifer Smith, CDESo i we i and i usually really, really focus in on all of the scenarios that are likely to come up where temporary Basal is really an important piece of management, that that bumping and nudging that you talk about, you know, unfortunately, most people are only taught about exercise and the benefit of temporary basal. And they're usually told, well just, you know, just set it for 0% or turn your basal off during that time. Well, that's 100% incorrect to begin with. But exercise is one of many reasons that you may want to change your Basal for a, you know, a duration of time, illness, a woman's menstrual cycle, or that woman's time of the month or whatever you're going to call it. That time you're going to definitely need temporary basal, you're going to need it for sedentary days, I can go to a conference where I'm literally sitting for eight hours. And while I might be walking between conference rooms, the sitting and sedentary I need a 25% increase in my basal. In order to not run high that whole day. I've figured that out right? I figured out what I need to do to take a five mile run versus a 12 mile run temporary basal changes. I figured out what to do for different kinds of illnesses stomach bug may require a decrease. An illness like a sinus infection or a bronchial infection may require an increase. Even even temporary basal around food like you mentioned before with the Chinese high fat food
Scott BennerYes
Jennifer Smith, CDE100% requires knowledge of using temporary basal because I know we'll talk about extended boluses and things a little bit too but temporary basal for high fat man. Fat can affect you eight to 12 hours after you're done eating it and it keeps you high. And you may go to bed with an awesome looking blood sugar thinking that man, I nailed that I really got it. What do you get an alarm at two o'clock in the morning? Where are your 300? And you're like, what happen?
Scott BennerAnd those are the examples, by the way, when you can't say to yourself, oh, well, that's just diabetes. It's not just diabetes, if you didn't use the insulin, right, and so every time you think diabetes is just this, this, you know, magic fairy that runs around messing with you, it's something happened, like, you might not know what it is in that moment. But something happened, and you can figure out what those somethings are and stop them. And there's a great example high fat, you might need a Temp Basal increase that goes on for hours and hours later, and maybe
Jennifer Smith, CDEmaybe fat 50%, at least 50% increase for at least six to eight hours after the meal. Right?
Scott BennerRight. It's just it's, I know, it's a little mind numbing to think that, but that's a lot to think about. But I want to, I think now's a great place to say this. As much as we're breaking things down and really stretching them out. So you can see the tiniest little aspects of these ideas. For people who understand them, I will speak for myself. I do not think about diabetes that frequently during the day, this stuff just kind of happens. I know that sounds crazy. But I look at a plate and I go, Okay, here's what this needs. And if and if I miss I readjust. But But I don't spend a lot of time, of course aside of this podcast, but I don't we don't say the word diabetes in our house very frequently, I guess is what I'm saying. We're not always fighting and, and you know, scary lows, and oh my gosh, she's been high for three hours. Like that doesn't happen around here. And you can live that life too. By understanding how insulin works.
Episode Conclusion and Pro Tip Series Outline
Scott BennerIf you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast, private Facebook group Juicebox Podcast, type one diabetes, there are over 41,000 active members, and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you, or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community.
I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low BGs in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1018 pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025, we talk about transitioning from MDI to pumping. Before I go, I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult, and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now in my learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend . listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Jennifer Smith, CDEJenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link.
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