Basal adjustment question

[Traci]

Ds has been a little lower than target at 10pm, so I have been giving him about 12 carbs to get him up. His bedtime target is 140, but he's usually between 90 and 100 and says he feels low. I do believe he would go low without the extra carbs. He has begun to creep up and has required a small correction at 3am for the past several nights. (At midnight he's been over target, but not high enough to correct.) By breakfast time, he's been under 80--usually under 70. Soooooo, my question is this: would you adjust the basal leading into bedtime first so that he was not that far under target and did not require the extra carbs? or would you adjust both that one and the one leading into 3am at the same time?

or would you do nothing since school starts in two days and everything is gonna change then????:rolleyes: Thanks for any advice!

[Abby-Dabby-Doo]

Is he getting insulin for those 12 carbs?

[Nancy in VA]

What do you think about leaving that high at 3am alone for a night or two to see what happens? We went through a period when we were correcting at 3am and waking up low. Turns out Emma was having a growth spurt and her body was excreting hormones while she was sleeping that made her go high - but its self-correcting and every time we corrected with humalog, she went low.

[Lizzy731]

Ds has been a little lower than target at 10pm, so I have been giving him about 12 carbs to get him up. His bedtime target is 140, but he's usually between 90 and 100 and says he feels low. I do believe he would go low without the extra carbs. He has begun to creep up and has required a small correction at 3am for the past several nights. (At midnight he's been over target, but not high enough to correct.) By breakfast time, he's been under 80--usually under 70. Soooooo, my question is this: would you adjust the basal leading into bedtime first so that he was not that far under target and did not require the extra carbs? or would you adjust both that one and the one leading into 3am at the same time?

or would you do nothing since school starts in two days and everything is gonna change then????:rolleyes: Thanks for any advice!

I would adjust the insulin leading into his bedtime first so he will not need the extra carbs, most likely the high is caused by this because I assume you did not give him insulin for the 12 carbs.

Then...I would test at 12A and 3A again that night to see where he is going. He may need another basal adjustment between these times as the lows in the morning may not necessarily be caused by the correction, it may be caused by a too high basal.

GL

[hold48398]

I just wanted to add a comment about middle of the night correction factors- Mia only requires 1/2 correction after midnight..for some reason she is super insulin-sensitive on a completely empty stomach. Might be something to consider also...

[Traci]

Thank you for the answers. I did adjust the bedtime basal, but we had dinner at Macaroni Grill and he ran high all night (not terribly high, but mid-200's--enough to need a correction). So, I plan to give him a normal dinner tonight and see what happens.

Abby Dabby Doo: No, I am not covering the 12 carbs with insulin because he is below his bedtime target and also feeling like he is going low. (Ds does have an amazing sensitivity to his lows--thank goodness!) That's why I was thinking he might be re-bounding between 12am and 3am from the extra carbs that he seemed to be needing at bedtime.

BTW, he had the chicken tenders and french fries at Mac Grill and that always seems to throw him high during the night.

I will gather more data and post again in a few days. Thanks again!!!

[Traci]

Quick update: I adjusted his basal leading into bedtime and his numbers leveled off beautifully. He was still high at 3am (normal at midnight), so after a few days, I went up by .05 on his midnight to 3am basal. He bottomed out. I changed it back to what it was and he still bottomed out!!! Argghhhhh!:confused: I guess things are just changing with school starting. Anyway, I plan to reduce that basal by another .05 tonight just to see what happens.

Thanks for listening...

[Lizzy731]

Quick update: I adjusted his basal leading into bedtime and his numbers leveled off beautifully. He was still high at 3am (normal at midnight), so after a few days, I went up by .05 on his midnight to 3am basal. He bottomed out. I changed it back to what it was and he still bottomed out!!! Argghhhhh!:confused: I guess things are just changing with school starting. Anyway, I plan to reduce that basal by another .05 tonight just to see what happens.

Thanks for listening...

I hear your frustration, it could have been a growth spurt which was causing the high and the end of it coincided with you changing it. This happens with Bethany too. I have to change her basal usually once a week. I may be reading it wrong, but did you increase the 12A, 1A, & 2A by .05? It is recommended to only change the basal 2 hours prior to the high and only that basal. I think that he may have went low because you increased too many basals (if I read it right?).

[Lizzy731]

I just wanted to add a comment about middle of the night correction factors- Mia only requires 1/2 correction after midnight..for some reason she is super insulin-sensitive on a completely empty stomach. Might be something to consider also...

Why not change the correction factor and/or the target for that time? This is what I do for Bethany. Her target for 12A to 5A is 160 and her sensitivity changes to 280 at midnight.

[Traci]

I may be reading it wrong, but did you increase the 12A, 1A, & 2A by .05? It is recommended to only change the basal 2 hours prior to the high and only that basal. I think that he may have went low because you increased too many basals (if I read it right?).

Yeah, I changed the three hours preceeding the low by .05 each. I debated doing just one or two hours then seeing how it went, but I figured that the correction he was getting at 3am had been around .35 to .5 each night and that the total additional bolus of .15 (3 hours X .05) would not crash him...guess I figured wrong.:rolleyes:

I'm gonna see what he does tonight then adjust it again if he is still not right. Thank you for your help!!! Another set of eyes really does make a lot of difference.

[Lizzy731]

Yeah, I changed the three hours preceeding the low by .05 each. I debated doing just one or two hours then seeing how it went, but I figured that the correction he was getting at 3am had been around .35 to .5 each night and that the total additional bolus of .15 (3 hours X .05) would not crash him...guess I figured wrong.:rolleyes:



Well unfortunately, it doesn't work that way (that would make it just too easy, wouldn't it? :)). If you are trying to prevent an upswing at 3A, you just adjust the 1A basal (and probably higher than .05 based on how high he went from 12A). If you increase the 2A basal as well, you also run the risk of him being lower 2 hours after that (@ 4A). Think of it this way, you test 2 hours after a meal because that's how long the insulin should take to work. It's the same concept as the basals...does that make sense?

Good luck!