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Anyone willing to help me overhaul calculations?

Discussion in 'Parents of Children with Type 1' started by khannen, Feb 1, 2013.

  1. khannen

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    I think our settings are a bit out of whack and we've been struggling with highs lately. I googled the guidelines on where to start with calculating doses. This is what I found....

    Total daily dose- weight in lbs divided by 4 - which for my daughter would be 60/4 or 15 units a day
    If I go with 50% basal, that would be 7.5 units a day

    ISF correction- 1800/TDD would be 1800/15 or 120

    Carb ratios- 500/TDD would be 500/15 or 33 so 1 unit for 33 carbs

    Are those guidelines still used often? I know it's just a starting point, but some of them seem WAY off for her. She typically is over 20 units a day with 10 of that being basal. According to this, it would be much less at only 7.5 units.

    Also, she goes with 1:20 for breakfast and 1:24 at other times. I currently have her ISF set at 100 so that seems to be the only one above that 'fits'.

    What am I missing? She uses Apidra and we're still getting spikes postmeals. She didn't use to do that nearly as much. Highs seem more stubborn and corrections don't seem to bring her down like they used to. This is a pattern now, so it's not that we just may have a bad vial or something. Anyone willing to offer up some advice? What would you change out first and why? Are there better guidelines to use? Any help would be appreciated. My head is spinning lately. ;)
     
  2. Sarah Maddie's Mom

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    I'm confused as to why someone who has been at this 6 years (if I read your siggy correctly) would be using some arbitrary web guidelines for dosage? Why not start with what your daughter actually uses rather than some formula that in your own words seems "WAY" off for her?

    I have a 5 year theory. I think after 5 or so years it just gets harder to control those numbers. Or maybe it's hormonal (not sure how old your dd is). But whatever the cause, you know the answer, she needs more insulin. Without knowing when she's high it's impossible to suggest any changes... have you thought about logging for a week and sending those numbers off to the CDE or endo for suggestions? If you are uncertain about it, best to ask her Drs for a little help.;)
     
  3. khannen

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    I haven't been using them. I looked them up as I was curious and simply looking for a starting point. Since there are so many different settings, I just wanted to make sure I wasn't heading off track and way overcompensating for one while not properly handling the others. I know everyone is different and the whole YDMV thing. I posted what she is currently using in hopes someone would perhaps see something out of balance and have a suggestion.

    The highs are post-meals...spike within an hour and often just end up correcting at two hr mark. She is nine yrs old. I've done basal testing and they seem to be right on for most days. When I've adjusted carb ratios or correction factor even slightly, the change seems to be drastic so I'm feeling lost.

    Endo and I agreed that we should change her pod every two days instead of three since we were clearly seeing more issues on day three. That hasn't touched the issues on day 1 and 2 though. Only other suggestion has been to possibly switch back to Novolog. Since I have a stash of Apidra and have to pay a lot for Novolog, I was hoping to make this work as she used to do so well on it.
     
  4. Sarah Maddie's Mom

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    Ok, so she's not getting enough bolus or she's not getting it early enough. I know that it's hard to watch their insulin needs increase, but I think you just need to nudge her insulin to carb ratio a bit and see what happens. Is she using her CGM now? If you, you'll know if you've made it too low.

    Fwiw, that formula you posted was what I would expect to see in a kid just out of honeymoon - your dd is 6 years in and probably in the early stages of pre-puberty. It seems totally normal to me that she needs a bit more to cover meals;)
     
  5. mmgirls

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    How far ahead are you prebolusing?
     
  6. mmgirls

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    how long have you been on Apidra?

    When you say "When I've adjusted carb ratios or correction factor even slightly, the change seems to be drastic so I'm feeling lost" are you doing them at the same time? also do you mean that she IS going low from the changes?

    I know when we switched to Apridra either the sight of how fast she could drop or the lack of a spike scared me at first because I thought that for sure she would go low. I thought this because I was used to the duration and tail of Novolog witch for my dd is very different than on Apidra.

    Our dd's are very similar in size and age. she is very active and needs lower basal and higher bolus to not spike so high with no prebolusing at school. She has always needed almost double insulin for breakfast and without her number being close to 100 and a prebolus of at least 15minutesshe will easily spike after breakfast.

    we just did an overhaul and are close to the 40%basal and 60%bolus for 20units.

    8yrs old 60lbs 7years of D
    Basal 7.5 Lantus
    1:13 breakfast ISF 100 target 100
    1:22 rest of day ISF 120 target 120
     
  7. virgo39

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    As for the guidelines you are citing, I think that people do continue to use those calculations as a reference point, although I've also seen "1700" rather than "1800" used in calculating ISF. We do that periodically. Another factor that I look at is what percentage of insulin is being used for corrections (I think Gary Scheiner suggests that this should be below 8%).

    I'm not certain what I would change first. I'd probably keep a detailed log for several days to see if something obvious appeared (e.g., looking for pre-meal BG that involved small to no correction as a way of determining whether I thought the meal bolus worked or looking for a correction that took place when she wasn't eating, to see how that worked). Failing that, I'd just choose one thing to work on and try tweaking that to see how that works.
     
  8. khannen

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    Yes, she wears her "Mr. Beepy" (as she named him ;)) 24/7 more or less. Makes our lives a lot easier and she says it makes her feel better...both safer and physically better as BGs don't swing as much. It definitely makes adjustments easier to deal with as I can see how she is trending at any given moment.
     
  9. khannen

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    She started using Apidra about a year and a half ago. We prebolus by 15-20 minutes for breakfast. Other times, it's closer to 10 minutes. No, I'd only change one setting at a time. Yes, then she would often drop low and it would seem like she was overly sensitive suddenly. Just want that happy middle! ;)

    Thanks for sharing her settings. They are very similar.
     
  10. khannen

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    She is definitely over 8% for corrections. Will have to keep an eye on that.

    I'm curious to see how lunch plays out. She was 136 and prebolused (5-10 minutes early) for 30 carbs. Now, thirty minutes after eating she is sitting steady around 110. We use 115 as her target. Usually, I see the spike kick in around 45-60 minutes later.
     
  11. mmgirls

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    what changes did you make? do you home school?
     
  12. wilf

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    If you're going to use "The Rules" to get ballpark estimates of ISF and carb ratios, then the starting point should be an average of the last 3 days' actual TDD (all boluses + corrections + basal added together).

    Let's assume she's getting 22 units/day TDD (I'm guessing based on your posts):

    ISF correction- 1800/TDD would be 1800/22 or 82, so 1 unit drops BG by 82 points.

    Carb ratios- 500/TDD would be 500/22 or 23, so 1 unit for 23 carbs.

    How does that sound? :cwds:
     
  13. khannen

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    We did for a few years, but we no longer homeschool. I had recently adjusted carb ratio by two. I could try 1, but that didn't seem like it would make any difference. When that didn't seem to help, I went back and tried isf instead. I'd have to look at my notes, but I think I went from 100 to 90. She then seemed to drop like a rock. I'll try a difference of five instead.

    After lunch today, she ended up at 250 two hours postmeal. Three hours was 182 I think, so I ended up correcting.
     
  14. khannen

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    See now...that makes more sense. LOL I got that TDD in my head when I was trying to figure out what ballpark basal should be. Thanks
     
  15. mmgirls

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    with just this and knowing that you are on Apridra I would guess that your basal is too high and bolus too low. IF you did not correct at 2hrs.

    The signifigant drift downward was excess basal and the post BG that was high was not enough bolus.

    This is something I had to get used to with Apridra that is easily seen with basal testing alone.

    I have come to the conclusion that basal testing is only good for those hat plan on not eating!
     

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