Anyone's child get way less of their insulin through correction/coverage than basal?

I have read that about 50 percent of a person's daily insulin should come from the basal. However, Matt gets about 30 total units of insulin a day, and only 10 of them are from basal. Our doctor has tried to nudge it up over time, but when I do my own basal testing with him, the amount of basal that keeps him steady is actually less than what the pump has been set at.

When I asked his doctor why this was the case, he said that this is more common among thin and/or muscular kids.

Anyone else in a similar situation?

 

My feeling is, a person's body needs what their body needs. When Danielle was getting more bolus than basal her Endo wanted to try and make it a 50/50 split. I didn't think it would work but tried it anyway. It didn't work. I have heard several reasons for wanting a 50/50 split, but none of them made much sense. So I just go by what works in actual daily practice.

 

My insulin needs haven't been more than 30% basal in a long time.

 

Unless you are on some kind of strict meal plan, which we are not, I think the percentage is really relative. Basal is relatively stable, but bolus insulin varies for my daughter enough to mess with the percentages depending upon how carby the day was.

For example, we generally go out to eat on Saturdays. When I isolated January 11th, which was a Saturday, she was at a 50/50 percentage

If I do an average of Sunday the 12th through Friday the 17th, the percentage shifts to 58/42 in favor of basal; so, no we don't fit in your pattern, but depending upon the day we could fit into your doctor's ideal, or we could be way off in the other direction.

So the same person, with the same basal, might be at a different percentage if they eat more carbs, fat, etc than the other person.

I just go with what works in the moment.

 

I checked the stats in Rachel pump last week just before clinic and was surprised to find the following for the last month: Meal 29.5%, Correction 2.83% and Basal 67.67 percent... it seems completely out of whack but we're having good numbers and the only thing I can think of is that she seems to have been eating much less lately than she had been.. no diet, just natural curb of appetite..

 

I actually asked the endo about this because I was ignoring it and her opinion was that I could ignore it, too. My kids are opposites - my daughter gets 50-60 units basal a day (puberty...multiple basals...) and only 25-35 bolus. My son gets 33-35 basal and wildly different bolus amounts - probably ranges 40-60 a day. He's in that "eat us out of house and home" stage.

 

Even my daughter's basal has just been hovering at about 30% so far.

 

This makes me feel better. Jack will be 10 in March, and his basal is around 24 units a day at this point. He was probably requiring 10 units of basal a day when he was 4 or 5 years old.

I've never paid any attention to the ratio of his basal/bolus. He needs what he needs.

 

In a perfect world, if my son doesn't eat or eats very low carb, his basal needs are very, very low, somewhere around 30% of the TDD. However, whenever we drop the basals to that point based on basal testing, we simply cannot effectively cover meals with the correct amount of bolus without seeing ridiculous spikes followed by ridiculous drops. No one has ever been able to explain why this is. So we just keep the basal jacked up for normal days, and know that we need to turn it way down if the circumstances require it.

My son is neither thin nor muscular.

 

My son definitely isn't at 50/50, either.
He gets 5u of lantus a day. And his ratio for Novalog is now 1:20 or 1:15 depending on the meal. He is a high carb eater, so he gets anywhere from 10-20 units of bolus per day.

 

My response is a carbon copy of this one, including the 30%, and the lack of thinness and musculature. :glee:

We're only 2 weeks into pump start, so have been experimenting a bit to bring numbers into good control. The days where I had basals set higher than actual testing shows is necessary, he had MUCH better days, lower meal spikes and generally in-range numbers. Then we lowered the basals (as per the CDE), and since then... horrible spikes. Sure no lows, but who cares IMO when the highs after every meal hit 15 mmol?? I'd rather be a bit more vigilant (especially as he's 4 1/2 so home with me most of the time, only 2 1/2 hours a day at school) and keep the basals jazzed.

 

During the day, we definitely keep basal a bit too high. We also would have obnoxious spikes otherwise.

 

We've been at about 35% forever and that's where the Endo wants it.

 

My daughter uses 68-70% basal, and that's when we see the most steady levels. Less basal, more swings.

 

I wonder if there is a difference between those that use Apidra and those that use Novolog or Humolog

 

Interesting that you say this. I am not sure if I am only noticing this since I am testing more, but I am finding that he is spiking after meals lately. He is back down to range within 4 hours, but if I test him at 2 hours, he will be around 275. I am wondering if that is normal. I think, and I stress "think", that he didn't spike as much when his basal was higher.

BUT, with that said, he was also going LOW too frequently for my liking when his basal was higher. And if the goal of the basal is to simply counteract the rise in blood sugar that would occur naturally, then I feel like I should give him only what will keep his blood sugar steady while fasting. Everything I have read suggests that is the case. I guess I am just a bit confused at this point.

 

Just curious to know... how long before the meals do you bolus? Also, if the meal timings are fixed, you could jack up the basal of the previous hour a bit too.


For my daughter, I actually cover 2 food intakes in the school with jacked up basal as the timing is fixed and we are fairly sure about the activity levels. I add about 40% of the additional insulin to the previous hour and the remaining to the break hour. Has been working well so far.

 

well, if you find the answer, let me know. All I know is that my child (maybe yours as well?) doesn't live in a textbook. Sometimes..you just do what works. I'd love to just know that our basals were set to keep him steady. But I also know that if I do that, as soon as food touches his lips all bets are off. Since my child (maybe yours too?? ) doesn't spend a whole lot of time fasting I figure it's just easier this way...

We don't see many lows with the raised basal because we're much more cognizant about subtracting out IOB when it's necessary, and we've lengthened our DIA quite significantly. All together - higher basal, longer dia, more hands on pump involvement, have made a tremendous difference.

I long ago gave up caring if he fit the textbook picture.

 

Most valuable point in the entire thread.

 

I find the same thing when I do basal testing: I usually have his basal settings too high. But, I too get way better numbers for my son when basal is set higher. I often wonder how useful fasting basal testing is, because the reality is my son is constantly eating throughout the day. I guess it would be much more useful if there were times when he actually went for long stretches without food. I don't see that happening anytime soon.:smile: