Advanced Pump Feature #2: Alternate Basal Profile

In WaltzingTheDragon.ca’s Basic Pump Features article we talked about setting a Standard Basal profile which would automatically deliver background insulin every hour of every day. But what if your basal insulin needs change across different days, or across different activities within a day?

For example, some kids have a moderate activity level through the school week, but are very active with athletic practices and tournaments every Saturday. In this case, their basal needs are lower on Soccer Saturdays than the rest of the week. To account for this, you could profile in an Alternate Basal profile, which is a set of different basal rates for the whole day (different from the Standard Basal profile, that is). For example, in our current example, if soccer practice starts every Saturday at 10 am and the last game ends at 3pm, you could create an Alternate Basal Profile that has lower basal rates than the standard profile from before 10am into the afternoon or evening hours (to account for the decreased basal needs following prolonged exercise). Then on Saturday mornings, you simply switch from the standard basal profile to the Soccer Saturday basal profile.

Conversely, if your child is very active outside at recess and lunch on school days, but then spends his weekend playing video games, you could program an Alternate Basal profile with higher basal rates for weekends.

Some other examples of when an Alternate Basal Profile may be useful:

  • Your teen goes to the gym to work out some evenings of the week. She could use the Standard Basal profile on non-work out days, then switch to an Alternate Basal profile on the days she plans to work out.
  • Your family’s participation in an extended fast (such as Ramadan, Lent, or Yom Kippur) may affect your child’s basal insulin needs across several days or weeks.
  • For a few to several days of her menstrual cycle, your daughter’s body may require additional basal insulin.
  • If your normally busy school-aged child is injured and therefore couch-bound for several days of recovery, his basal insulin needs will likely increase.
  • During vacations, the stress of travel (changes in routine, lack of the usual naps, being away from the familiarity of home, trying new activities) may increase your preschool child’s basal needs.
  • A young adult takes public transit to an office job throughout the week, and then sometimes spends her Sunday afternoons mountain-biking. She could use the Standard Basal profile on work days and low-activity weekend days, then turn on the Alternate Basal profile for mountain-biking days.

Note 1: Alternate Basal profiles do not kick in automatically just because it’s Sunday – you have to manually switch the basal profile from Standard to whichever alternate profile is applicable. Similarly, you need to manually switch it back when you want to return to the Standard Basal profile.

Note 2: As your child’s insulin needs change, it’s important to keep all basal profiles updated: if you make a permanent change to one basal profile, make a corresponding change to the other basal profile(s) at the same time.

Note 3: In Tandem’s t:slim insulin pump, these different basal profiles are contained within the larger “Personal Profiles,” which also allow you to program different Insulin-to-Carb Ratios, Correction Factors and blood glucose targets for different days or activities.

For many of the above conditions, you could use a Temporary Basal setting instead. The choice is up to you…

Temp Basal Rate or Alternate Basal Profile?

You may have noticed that we have used these same sort of examples here when talking about Alternate Basal Profiles as we did when talking about Temporary Basal Rates . That’s because in many situations in which basal needs are either significantly higher or lower than the “usual”, either feature can be used .

So when should you use one or the other? There’s no “right” answer – both ultimately have the same outcome of altering the usual basal rates. However, under certain conditions, using one feature may be more convenient than using the other…

You may prefer to use an Alternate Basal profile when:

  • basal needs (and therefore basal rates) will vary significantly from the usual rates for more than 24 hours. Temp Basals can only be set to a maximum of 24 hours. If you would need to keep resetting the temp basal every 24 hours, it may be easier to use an Alternate Basal Pattern, which will continue to function until you manually switch to another basal program.

Tips from the Trenches

When we go on family vacations, the stress/excitement of air travel and changes in routine typically lead to several days of highs for our son at the beginning of our trip. An alternate basal program allows us to preserve the pre-trip basal profile for when we return home, and we don’t have to re-set them every 24 hours like we would have to do if we used a temp basal. ~Michelle

You may prefer to use a Temporary Basal Rate when:

  • you have a pretty good idea of when you will switch back to the usual rates, and don’t want to have to think about it then (or are not sure that you’ll remember to switch back!). With Alternate Basal profiles, you need to manually switch back to the Standard Basal profile when desired – it never expires, and so will not revert back the usual rates until you tell it to. A Temp Basal, however, will expire after a set time period, automatically reverting back to the standard basal rates. So if the conditions will end in a predictable time (for example, there’s no mountain-biking at the office on Monday), and you want things to go back to normal at that time without having to think about it, a temp basal may be more appropriate.

Tips from the Trenches

The biggest culprit we find for affecting BG’s much later (due to insulin resistance) is pizza. We have found that Paul will predictably require 40% more insulin from hour 4-9 following a pizza supper so we set a temp. basal increase to cover this. The increase is only temporary and will automatically go back to the regular basal profile, which saves us from having to remember to reset (especially because this typically lands in the middle of the night). ~Danielle

On Alternate Basal profiles in general:

Tips from the Trenches

We tried using an Alternate Basal profile for our son for weekends vs. school days, but didn’t feel like it was a fit for our family. Maybe our son’s activity level didn’t differ enough, or maybe we didn’t persist in adjusting it until it worked… in any case, in the end we went back to using the same basal pattern for school and weekend days. Though his insulin needs clearly varied between school and non-school days (with the same insulin, he was consistently above-range on school days), we found that varying the I:C ratios between school and non-school days was more effective for keeping his blood sugar in-range. ~Michelle

More 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 #1: Temporary Basal Rates
Advanced Pump Feature #3: Split Bolus (a.k.a. Combo Bolus, Dual-Wave Bolus, Extended Bolus)
Advanced Pump Features #4 and #5: Suspend/Resume and Delivery Speed

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

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