Thinking of making some changes.. could use some

[Kaylee's Mommy]

others opinions..

OK.. I've been staring at K's chart.. I'm thinking of doing the following...I would like to back off her basal for 3am and 4am (changing the 1am and 2am basal) to keep her from dipping at 3/4am, we are constantly having to give her juice, which then sends her higher at 6-8am... looking like she needs basal adjustment there, but I don't think she does, I think its just because matt is alway correcting her at the 3/4am time. Also, I can't seem to get rid of the breakfast and dinner spike, lunch doesn't seem to give such high spikes.. We are pre-bolusing when we can (when we KNOW she's going to eat a good portion of her food.. which lately it hasn't been that way.. yesterday I didn't give her ANY bolus for lunch and dinner.. she didn't eat anything..) and doing a square wave for 3 hours at all meals.. so in order to help with those spikes I was thinking of upping the basal for 12p-2p (changing the 10am- 12p basal ) and 8p-9p (changing the 6p and 7p basal) to see if I can get her to stop spiking the way she does..

what are othes opinions? anything else that I should be considering, looking at her chart below?
http://i2.photobucket.com/albums/y1/jaylinkaylee/sensor1211121707.jpg

[momtojess]

others opinions..

OK.. I've been staring at K's chart.. I'm thinking of doing the following...I would like to back off her basal for 3am and 4am (changing the 1am and 2am basal) to keep her from dipping at 3/4am, we are constantly having to give her juice, which then sends her higher at 6-8am... looking like she needs basal adjustment there, but I don't think she does, I think its just because matt is alway correcting her at the 3/4am time. Also, I can't seem to get rid of the breakfast and dinner spike, lunch doesn't seem to give such high spikes.. We are pre-bolusing when we can (when we KNOW she's going to eat a good portion of her food.. which lately it hasn't been that way.. yesterday I didn't give her ANY bolus for lunch and dinner.. she didn't eat anything..) and doing a square wave for 3 hours at all meals.. so in order to help with those spikes I was thinking of upping the basal for 12p-2p (changing the 10am- 12p basal ) and 8p-9p (changing the 6p and 7p basal) to see if I can get her to stop spiking the way she does..

what are othes opinions? anything else that I should be considering, looking at her chart below?
http://i2.photobucket.com/albums/y1/jaylinkaylee/sensor1211121707.jpg

I agree with lower the basal in the overnight to prevent the lows,which will also probably take care of the morning higher#s...

We were told not to use basal to prevent spikes ( i asked about it last week when we were at our appt becuase Jess always spikes with breakfast). We changed her ratios, and on food that we know makes her spike (like oatmeal) she told us to just say it has more carbs then it really does (example, her oatmeal is 24 crbs.. we actually cover it as 38 crbs and this seems to have helped alot).

Again, this is just what we were told, but YDMV

[vettechmomof2]

FOr spikes we were always told the opposite. Alter basals to help with spikes from food.
I agree with momtojess on the 3-4am change.
Good luck and I have been doing the same decision making this week as well.
Allene

[Kaylee's Mommy]

I've played with her insulin ratios, the problem is that she'll crash at the end of a 3 hour bolus.. I was actually thinking of upping her basal and the changing the insulin ratios to help with the tanking at the end.. I can't extend her boluses more than they already are because she's going into the next meal.. maybe I'll start trying the dual wave and giving more up front and less at the end.. I could never ever get the dual wave right before, but now I can *see* what she is doing so maybe that'll work better now..

I can see what you wouldn't want to up the basal to cover that spike, just incase she doesn't eat.. then you've got a low problem.. she always eats SOMETHING for breakfast.. breakfast and dinner and the two huge problesm.. you can see her spike and then crash down most every time on both..

[momtojess]

I can see what you wouldn't want to up the basal to cover that spike, just incase she doesn't eat.. then you've got a low problem.. she always eats SOMETHING for breakfast.. breakfast and dinner and the two huge problesm.. you can see her spike and then crash down most every time on both..[/QUOTE]


That was the reasoning behind why we were told not to us ethe basal for spikes.

Why do you always do a 3 hr bolus? (not that I am questioning you doing it, I just wonder if it is something that I may want to look at more. We rarely do this)

[Kaylee's Mommy]

I can see what you wouldn't want to up the basal to cover that spike, just incase she doesn't eat.. then you've got a low problem.. she always eats SOMETHING for breakfast.. breakfast and dinner and the two huge problesm.. you can see her spike and then crash down most every time on both..


That was the reasoning behind why we were told not to us ethe basal for spikes.

Why do you always do a 3 hr bolus? (not that I am questioning you doing it, I just wonder if it is something that I may want to look at more. We rarely do this)[/QUOTE]

Kaylee's endo suggested doing the 3 hour bolus on ALL meals (we were doing it on high fat meals already..) she said that data and research is showing that an extended bolus on ALL meals helps with the meal spikes, helps keep them more even.. but I'm not seeing that with Kaylee.. I could never figure out the dual wave and HAD decent luck with the square wave, she was ALWAYS within range at the end.. the problem was that we weren't seeing what I'm seeing in the graph now.. those huge spikes.. the square wave seems to help a lot with lunch.. we don't see the spikes like we do for dinner and lunch..

[D-Dad]

I agree with the 1/2 am basal to help prevent the 3/4 am drop.

To reduce the spike - I'd try a super bolus - where you temp lower the basal and give more insulin via a bolus (or through a fixed prime).

[blbrocky]

I'm a bit confused..... I thought the basal is a fasting BG and not used for spikes with meals.

My son just started pumping in November of this year and has four basals set (all very similar). The nurse from Childrens Hosp. has been adjusting these weekly if needed along with the I:C ratios. We have just started using the dual wave and decided to do a 70/30 split over 4 hours for pizza. The nurse said we should only do a 2 to 3 hour duration on the dual wave. She thought that it works best with a 2 to 3 hour duration. The 70/30 was too much insulin up front for my son as he dropped low so we will try the 60/40 split or what the pump recommends next time.

Changing numbers really scares me right now as I'm not so sure I fully understand the adjustments that are made and why.:confused:

[Kaylee's Mommy]

I'm a bit confused..... I thought the basal is a fasting BG and not used for spikes with meals.

My son just started pumping in November of this year and has four basals set (all very similar). The nurse from Childrens Hosp. has been adjusting these weekly if needed along with the I:C ratios. We have just started using the dual wave and decided to do a 70/30 split over 4 hours for pizza. The nurse said we should only do a 2 to 3 hour duration on the dual wave. She thought that it works best with a 2 to 3 hour duration. The 70/30 was too much insulin up front for my son as he dropped low so we will try the 60/40 split or what the pump recommends next time.

Changing numbers really scares me right now as I'm not so sure I fully understand the adjustments that are made and why.:confused:

technically,no, you aren't suppose to use a basal to help with a spike.. but by Kaylee's chart we can see a very clear pattern of her spiking at a certain time.. it never fails, she will spike (unless she doesn't eat breakfast) I've tried different combinations so in a last ditch kind of effect to help with this spikes I am going to try to up her basal at this time.. Kaylee currently has 8 different basals set.. and we are going to add 3 more.. With the sensor we can see exactly what is happening, unlike tradition finger pokes.. if she weren't on the sensor I probably wouldn't touch the breakfast spike with 10 foot pole because you can't see exactly what she is doing.. you are only seeing pieces..

[D-Dad]

I like the super bolus for spikes...... basically if your basal is .5/hour.... then over the next two hours you will get 1 unit of insulin via the basal. So lets say at dinner you give the regular bolus for carbs but you also add one unit and then turn off the basal for 2 hours. The total amount of insulin after two hours is the same but rather than getting the basal over a two hour period - you gave it all upfront. this will help reduce the spike. the chart seems to be screaming for a super bolus at dinner - because your numbers are good before dinner and 3 hours later - so your total insulin is good - you just need more insulin upfront. I like this better than playing with the actual basal rates as it allows for more flexibility as to when you actually eat.

[D-Dad]

I'm bumping this because I'm hoping the super bolus may help others.

I like the super bolus for spikes...... basically if your basal is .5/hour.... then over the next two hours you will get 1 unit of insulin via the basal. So lets say at dinner you give the regular bolus for carbs but you also add one unit and then turn off the basal for 2 hours. The total amount of insulin after two hours is the same but rather than getting the basal over a two hour period - you gave it all upfront. this will help reduce the spike. the chart seems to be screaming for a super bolus at dinner - because your numbers are good before dinner and 3 hours later - so your total insulin is good - you just need more insulin upfront. I like this better than playing with the actual basal rates as it allows for more flexibility as to when you actually eat.