Any advise, please?

[Momof4gr8kids]

Julia was on a 1:20 i:c ratio before pump start. We were bring down the lantus at the time, and so I figured that she would end up going back to the 1:15 as soon as we got the insulin balanced. Now her fasting b/g's are really good. However we were seeing a spike in the low to mid 200's 2 hrs post meal. So we changed i:c ratio to 1:15 with the CDE in ageeance. Now we are seeing lows 1-11/2 hrs post meal, not bad, but low 70's, high 60's. Julia's target is 130 with 50 pts either direction, so 80-180. So then after correcting the small low with 5-10g of carbs an hour later she is high. I am just chasing numbers in a never ending cycle.

Our CDE was supposed to call yesterday to go over numbers, but she didn't so I called last night, and left a message, I called again at 10am today, and left another message. It isn't an emergency, but I would like some help with this if anyone has any advise to offer.
Thanks, Jamie

[Kirsten]

Jamie,

If you're on a pump, can't you just split the difference and use a ratio of 1:17? I've never used Lantus, so I don't know anything about that.

Kirsten

[EmmasMom]

I agree, I would bump the carb ratio to 1:17, or even back to 1:20 and see if it fixes your problem. If she's low 1.5 hours after a bolus it's probably the carb factor.
You may not hear back from your trainer until after the holidays, so you may have to "wing it". :cwds:

Good Luck!!!

[Momof4gr8kids]

Is 1:17 ok to do? I know that 1:20 vs 1:15 is a huge differences in dose once you get the carbs up there.

Thanks for the advise. I will change the i:c for dinner, and see how we do. Would a extended bolus help with the small highs we are seeing post meal?

Thanks again, Jamie

[5miraclez]

Another thing you may want to look at which will take a few days is if the basals are set at the right amount. Also, you may need to use different carb ratios at different times of day. I am on 1:10 in the afternoons and 1:12 in the morning. My basals are set all over the place. I know it's different with a child so I don't know how they would check that the basals are set correctly. For me, I just had to skip that meal to see what happened.

[Kirsten]

I often adjust carb ratios in this range by one or two points. You'll be giving less insulin than you're giving right now, so you're not really risking anything. I think that if you get the ratios right your post-meal numbers will be OK. In the morning we have a slightly increased basal before breakfast because Griffin would run high at 10 am no matter how low our ratio was at breakfast and then at 11:30 he would just crash. Our increased basal pre-breakfast did the trick for us.

I use the extended bolus only for large meals and high fat foods. Most carbs take effect before the insulin peaks.

GL!

Kirsten

[Momof4gr8kids]

We had to do a few meal skips to chart the basals around breakfast, they were good the whole time and stayed put within 20 pts. I was impressed! We also did one day of hourly testing from 12-midnight to 6am, but the trainer told me to catch up on my sleep before doing it again.
We will do dinner next week, and will wait for Christmas break to do lunch. I am going slowly so I don't scare Julia off of the pump, or wear her out to quickly.
Thanks for the advise. I think even though kids are different, and need smaller doses of insulin most of the time the princapals are still the same.
Jamie

[selketine]

Why think you need to have the bolus set at multiples of 5? ;)

With pumping you can get out of the mind set. William's bolus ratio is 1:12 for breakfast and 1:24 for lunch and dinner. I will change it slightly (1:13, 1:14) if I notice he starts running too low, etc.

With testing just in case of lows or highs, I think it is good to learn to make those small adjustments on your own at times. You're new to pumping though so it will be more natural as you go on. Make the small changes and keep an eye on the numbers and go over what you do with the CDE when you can get ahold of them.

Sounds like you are doing great!