- advertisement -

60/40 Basal/Bolus works!!

Discussion in 'Parents of Teens' started by mariaweber, Nov 13, 2010.

  1. mariaweber

    mariaweber Approved members

    Joined:
    Feb 19, 2006
    Messages:
    95
    We are just finishing week one of have Sofie's basal insulin at around 40u per day and her boluses filling in the rest for about 65 to 70 units per day. Things are going much more smoothly, thank you very much. Morning spikes have been tamed and she's just completing her first 24 hours completely in range since, well... I can't remember when:)

    Our issues are around going low, particularly during and after workouts. While the increase basal insulin is fantastic, we are still having to play around a lot with temp. basals and partial boluses before workouts. Even without a workout, Sofie's basals are around 2 - 2.2 u/h in the morning and then taper off to about 1.5 u/h in the afternoon (is this normal?). Her heavy workouts tend to be with the track team after school, so often the basals will have to be cut down even further, still she has gone low every day after school and almost every evening. The lows have been easily dealt with, but fairly persistent. Also, what we're finding is that she needs almost no insulin at night now. Most nights she's on a basal rate of .8 and sometimes as low as .5 for at least 5 hours (midnight to 5 am) and still wakes up in the magical 5 to 5.5 range (100 or so).

    Any suggestions for the lows? She's taking them a lot better then she was -- not so afraid of them, but they still make her feel pretty bad and last week she didn't get much sleep because she was pretty low most of the night. Needless to say, I'm not getting much sleep these days either.

    Does anyone else have this situation of needing so much less insulin at night? Is this normal?

    Five years into this, I still feel like such a rookie.
     
  2. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Very glad to hear you're making progress! :)

    REgarding the lows, what I see happening is this. Her workouts are affecting BG levels 3 ways - they burn carbs directly (during and right after the workout), AND they increase the effectiveness of the insulin she's getting and also require considerable carbs from her bloodstream to rebuild the energy stores of her leg muscles.

    What this means for you is that highest insulin needs will be starting with breakfast in the morning and lasting until her workouts start. Then much lower the rest of the day, evening, and overnight. Don't be afraid to keep reducing basals for the 12 hours after a workout until she evens out.

    Good luck! :cwds:
     
  3. Heather(CA)

    Heather(CA) Approved members

    Joined:
    Jun 18, 2007
    Messages:
    10,153
    Yep, what your experiencing with the exercise is totally normal. I totally agree with Wilf, but I would start lowering the basals 2 hours be for exercise:cwds:
     
    Last edited: Nov 13, 2010
  4. kiwiliz

    kiwiliz Approved members

    Joined:
    Sep 25, 2008
    Messages:
    893
    I am glad things are going well. We usually do a 12% temp basal reduction on training nights. It is just a matter of trial and error. It might be a good idea to write things down as you go along - I find I am so tired some nights that I actually forget what I did and when! Temp basals don't show on the history.- or maybe they do and someone can tell me where.:)
     
  5. KRenee

    KRenee Approved members

    Joined:
    Jul 23, 2008
    Messages:
    322
    We experience the exact same situation with swimming as you do with track. We still do MDI so I'm not able to help with pump settings, but we can identify with you on the lack of sleep. Once nightime basal is as low as it can go, you just have to carb up before bed to cover the impending lows.

    It takes time to figure out what works best.
     
  6. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Yes, very good point.. :cwds:
     
  7. chbarnes

    chbarnes Approved members

    Joined:
    Jul 5, 2008
    Messages:
    1,215
    I don't think there is anything magical about 50/50 basal/bolus. It just helps you see overall if you might be compensating for too little of one by giving too much of the other. Think of it as a dynamic process that you are watching over time rather than something that must always be equal. We use the CGM to look at the day and set basal segments. If our son has show choir after school he tends to go low - during the activity and overnight. If the average day on CGM is low at 3 pm, we decrease basal an hour or two in advance. If he trends low at 2am we cut basal starting at midnight. The pattern widens, flattens, and changes over time, so every few days I look at the average pattern and make adjustments. While there are some who make immediate adjustments based on CGM, the biggest value for us has been the ability to see these patterns and make long-term adjustments.
     
  8. ecs1516

    ecs1516 Approved members

    Joined:
    Dec 11, 2007
    Messages:
    7,028
    Is a 60% basal , 40% bolus recommended? Maybe that is our problem with my younger one. He is the opposite. He is about 65%bolus, 35%basal. I didn't realize that until I ran Animas Ezmanager report.
     
  9. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Our trick (without a CGM) is to plot all of DD's BG levels on a 24-hour chart. It gives the same picture overview that the CGM does, albeit with fewer data points.

    But having a bit more than 50% basal in the mix is a trick used by many to smooth out BG fluctuations.. :cwds:
     
  10. Scotty's Mum

    Scotty's Mum Approved members

    Joined:
    May 23, 2008
    Messages:
    305
    Scott is currently on about 55-60% basal. With exercise he will start his temporary basal 2 hours prior to starting exercise and will run it for at least five hours after finishing. He uses a 60% reduction in basal. It took us a bit of trial and error to get to this point, but for now this is what works for us.
     
  11. ecs1516

    ecs1516 Approved members

    Joined:
    Dec 11, 2007
    Messages:
    7,028

    My older son has the 60Bolus/40basal mix and he goes low often with exercise. Would a higher basal make this even worse?
     
  12. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623

    Kaylee's always been 60/40 basal bolus.. I know if she starts getting to 50/50, and I make adjustments, poof, issues gone.. I adjust her basal far more than I touch her bolus/ratios.
     
  13. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Depends. Is the exercise after a meal, or hours later?
     
  14. ecs1516

    ecs1516 Approved members

    Joined:
    Dec 11, 2007
    Messages:
    7,028
    He seems to go low with activity anytime. I will have to take more notice. I cannot give a definite answer. I almost think it is hours after he eats. Usually if he eats dinner and goes to practice he is okay.
    I am talking about my older son who's numbers are pretty good right now.
     
  15. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    If it is 3 or more hours after a meal, then you may need to reduce basals a couple of hours prior to the activity.

    If it is within 3 hours, then it's more likely the boluses for the meal(s) before the activity that need to be reduced.
     
  16. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623

    He could always eat a small snack before practice, especially if he has active insulin.
     
  17. obtainedmist

    obtainedmist Approved members

    Joined:
    Aug 3, 2010
    Messages:
    1,537
    I don't think there is anything magical about the percentages that the basal/bolus are "supposed" to be. So much of this is trial and error...and don't forget the amount of carbs that your kids crave!!! Our 18 y/o daughter is a vegetarian and so she is very carb heavy in her diet...her TDD is all over the place depending on what she's eating that day. She is generally at 40/60,give or take unless she is pre-menstrual (then heavier on the basal). Also, depending on if your teen is still honeymooning...the ratio can be different.

    The greatest gift our endo gave to us was to allow us to make our own adjustments in basals starting with .05-.1 and then confirming with testing often. This empowered us to adapt the situation to our specific needs and it was really liberating!! We were just cautioned to make one change at a time and that has served us well. It frustrates me to hear about all the restrictions that endos place on the battleworn parents dealing with this dx for the first time. We had to email our numbers in for two months after starting the pump, and once it looked like we were responding to issues appropriately, the office cut the cord (until the next visit, that is). Oh, we've had our ups and downs...but this is D we are talking about and it comes with the territory!!:)

    So, bottom line...I am a firm believer in making your own decisions but then testing like crazy! ;)
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice