Running high at night...basal or bolus?

[dqmomof3]

Question...when the numbers are good all day long, but after dinner (from about 7pm to bedtime) the numbers are up in the 250-300 range, would you assume the dinner ratio is off or that the basal is off from about 5pm forward? I think I'm seeing a trend in Jayden's numbers - she's great all day when the site is working, but after dinner she's spiking high. I can't decide where to start...should I basal test the evening numbers first, or should I change the dinner I:C ratio and see if that solves the problem?

[Blue8Coco]

I would tend to change the I:C Ratio first. Although - if you could delay supper one day to about the time she is high, that would give you an even better idea of basal or bolus.

What is her two hour reading? Also - if her correction brings her into range and she stays in range, then once again - that points to bolus!

So...you want me to flip a coin?

SORRY - THIS IS LEE - my dd left herself logged in!

[Sarah Maddie's Mom]

Oh I know this drill!:D
I would start with increasing her dinner bolus ratio. See how you do with that for 3 nights. Then if she's looking good 4 hours after dinner, but still going high in the night then I'd tweek the overnight basals. My feeling is that if there's serious food involved, start with the bolus because in our experience basals can't do their job if the bolus are too low. Hope that made sense:o

[StillMamamia]

I agree with the PP. Tackle the dinner bolus, and check for a couple of days. If not ok, tackle the basal.
If you can, maybe give a similar dinner for a couple of days (3 would be best, IMO). It might be not enough insulin to cover those particular foods. Are you pre-bolusing? Perhaps fractioning the bolus during the meal would help too. Just keep track of how much and when, to avoid overlap.

[dqmomof3]

That's what I've done, after another sleepless night of highs! I just increased the dinner bolus from 1:17 to 1:15, and I also adjusted the ISFs to fit the ratios, since I'm going with the BCR theory :-). We'll see what happens now. I think her DIA, set at six hours, is also too long, so if this doesn't work, I may shorten that to 5 and see if that makes a difference.

Thanks!

[Lee]

That's what I've done, after another sleepless night of highs! I just increased the dinner bolus from 1:17 to 1:15, and I also adjusted the ISFs to fit the ratios, since I'm going with the BCR theory :-). We'll see what happens now. I think her DIA, set at six hours, is also too long, so if this doesn't work, I may shorten that to 5 and see if that makes a difference.

Thanks!

I also think that an ISF for 6 hours in a daughter your age is incredibly long! I might call the endo and ask what they suggest for her age based on her ratios! That is probably the MAJOR problem right there for calculating any correction and any IOB!

[twodoor2]

I also think that an ISF for 6 hours in a daughter your age is incredibly long! I might call the endo and ask what they suggest for her age based on her ratios! That is probably the MAJOR problem right there for calculating any correction and any IOB!

I'm inclined to agree with Becky on this, I think the DIA should go to at most 4 to 5 hours as well (use 4 hours if you really want to be more aggressive). You're going to be contantly subtracting IOB from corrections because of this, and your ISF's aren't going to be working properly. I used to think a long DIA was a good thing, but in light weight children that take smaller boluses, I'm more apt to be less conservative on this. I think 3 hours is too short, and I like 4 or 5 hours. With Elizabeth, her average DIA is 4.5 hours, but I use 4 hours since I'm more aggressive with the corrections. You cannot program 4.5 hours into the Medtronic, only full hour DIA's.

[khoward1017]

Here is a quick tip to help adjust pump numbers that works for us...

- Adjust bolus only if blood sugar numbers are out of range 2 hours after shot.
So if my son's sugar was below 80 at 2 hours after bolus I would raise his i:c ratio and if he was over 180 at 2 hours after bolus I would lower his i:c ratio.
If 2 hours afterwards he is if fine...then I start fine tuning his basal rate. Don't be afraid to set different basal rates for different hours. We have at lest 4 different basal rates running everyday!

This really works for us. At first I had a hard time figuring out which numbers to change...but this usually works.

Hope that helps!!

Karen