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Calling Math wizzes. I need some basal help.

Discussion in 'Parents of Children with Type 1' started by joy orz, Oct 23, 2009.

  1. joy orz

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    Some background info. When Ava first went on the pump, she was a hungry toddler who wanted to eat about every two hours. Hence, we set her basal in the daytime absurdly high to counteract the grazing and breakfast spike.

    Now she's three and half, she has discovered the fine art of being a picky eater. :eek: So this little trick is now resulting in way too many gummy bears. Alas, it is time to drastically alter the basals and turn them into something that actually behave like a basal instead of a steady stream of bolus.

    Here's where I need help with the math. If I cut down the basal, I'm going to need to up the bolus. Help please.

    Currently Ava's daytime basals are as follows (and without carbs, she will drop)

    Overnight 0.150
    7:30 am 0.325
    1:30 pm 0.275
    7:30 pm 0.150

    Her ICR for breakfast and lunch is 1:14
    Dinner is 1:18

    Any suggestions would be appreciated, particularly from you mathletes (you know who you are :D) or toddlers who grew out of the graze a palooza stage.

    Thanks!!!
     
  2. Seans Mom

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    Disclaimer: I am not a math whiz nor do I pretend to be, just trying to help. ;)

    When is she needing the gummies? What's her DIA?
    If her duration of action is 3 hrs. and she's going low during this time, it's her I:C that needs adjusting. If it's after that time, say she eats BF @ 7:30 and her DIA is 3 hrs., if she is low before that 3 hrs. is up, change the ratio for BF to 1:16 but if at the 3 hr. mark she is in range but dropping after i.e. 11:00 then change the 7:30 basal down to .30 and go from there.
    Basal tests are best to determine what they need. Not fasting at her age, just carb free like cheeses, meats, veggie sticks etc... to see what the b.s. is doing without carbs and where they need tweaking.
     
  3. joy orz

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    Barb, her DIA is set to 4 hours and that's exactly where the drop is happening. I know it's the basal. Days she wants a non carb snack, or isn't hungry, she just plummets. We knew this going in, but until recently, she was always wanting to graze on something carby. Now I want to lower her basal to keep her steady, but to do that, I will also need to increase her bolus.
     
  4. Flutterby

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    is she falling all day long?? I'd do a blanket drop, if thats what happening..I'd leave the ratios alone for the time being until you get the basals set better..

    I know, I'm not much help.. but thats where I'd start (no math or science to it though.. just a guess ;) )
     
  5. saxmaniac

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    I'd take a different approach... adjust your basal down 10% and bolus up 10%:

    0.325 - 10% = 0.292 round to 0.3
    0.275 - 10% = 0.247 round to 0.25
    0.150 - 10% = 0.135 round to 0.125​

    10% is roughly one basal increment on Animas at these rates.

    At the same time, reduce the I:C's by 10% - 14 becomes 13, 18 becomes 16.

    Think of it like an hourglass, you are pouring out of one side, but it goes into the other side. You could do this really fancy with 50% TDD and total basal and total bolus blah blah blah, but I like simpler methods.

    Repeat as needed.
     
  6. Momof4gr8kids

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    I would adjust her basal rates, then work on her I:C. Since part of her basal rate has been to cover grazing - if it were me, I would probably bump them all down to .150 (her overnight basal rate) and make adjustments from there. Once you have her basals set, you can adjust her I:C to be more accurate, but it's really hard to get an accurate I:C if the basal rate isn't accurate.
     
  7. joy orz

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    Thanks Scott, that is closer to what I was looking for. I think I'm going to have to really scale the basal back, at least in the afternoons. Gosh this was working so nicely until she discovered cheese. :p

    On a side note, Ava just saw your siggy pic... She is currently wearing her Dexcom on her arm and got so excited to see another arm site. :D:D
     
  8. joy orz

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    Jamie, that was one of my thoughts too. Just set a flat basal and tweak from there, but I know she'll skyrocket if I don't do a corresponding bolus boost. Currently, much of her basal is working as a bolus for the grazing issue. So if she's NOT grazing, I need a bigger bolus.

    Scott, I'm a math deadbeat, if we go back to 0.150 or even 1.175, what should the carb ratio be? This stuff makes my brain hurt. :(

    Also, FYI, dinner seems to be working, so I'll leave that alone, but even on MDI she had a much bigger bolus for breakfast than dinner.
     
    Last edited: Oct 23, 2009
  9. Momof4gr8kids

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    well, that kind of depends, were you bolusing for the grazing carbs or just the meals? If the basal was just covering the grazing, it may not be as bad as you think.

    To elbarate further, you were basically doing a preset extended bolus for carbs with her basal rate. If those carbs are not there anymore, she doesn't need that extended bolus for those carbs, which you've already said. Now you just need to figure out what she does need for her basal rate.
    Since the reason for the extra insulin is gone, you shouldn't need it, but since your basal rate was partly a bolus, you maybe have to change the I:C a tad, and you may want to start the morning basal a little higher if she is more insulin resistant at that time, but if you do an even exchange, I fear you'll still see the lows because the reason you were giving so much insulin was carbs that are not there anymore.
     
    Last edited: Oct 23, 2009
  10. maha

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    Is her on CGM ?

    To do that the best is to see with your endo and do it in hospital but
    if you can not, you can manage by yourself.

    You should really note everithing she is doing, eat ... and doing more dextro,
    one 2 h after she ate, one 4h after.

    I agree with, Momof4gr8kids, if her night basal is ok,
    for a BG after dinner ok she does not get low

    You'll need some day to adjust it

    Put all basal at 0.15
    ICR is insulin for carb ratio ?

    ICR 1:14 means so 1 for 14g ?

    I'ld test for the morning 1:10 because the basal dose was high so that's why I'ld, but to be more secure.

    Stay with the dose you have,
    If 4h00 after she is high - Correct the BG
    And with the quantity of carb eated + Dose of bolus done and the correction,
    you have the new value of ICR.

    Lunch stay with 1:14
    Don't Change dinner

    If the second day, with the new ICR,
    her BG is ok after breakfast but start to go high, it's the basal
    so you'll need to increase it.

    And trust yourself, you know your girl, I'm sure you know the dose she needs.
    I did maths, my mum not and she is more right than me about the bolus dose I need (even better than MD with ICR count because that count do not took in effect when the food are fat...).

    If during one or 2 days you do do BG 2h00 after she eats and 4h after and note allthing, with that you'll be able to deal it.
     
  11. saxmaniac

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    I suggest this...

    PS: if your overnights are good, don't change the overnight basal segment, assuming she doesn't eat when sleeping...
     
  12. joy orz

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    Nope, we're leaving dinner and over night alone. BUT if I scale back from 0.325 to 0.150, to try and start from scratch, (rather than decrease gradually,) how much should the bolus be?
     
  13. saxmaniac

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    I would still only do 10% anyway. I don't like big changes all at once.

    Actually, I find it easier to reduce the basal bit by bit, rather than raise it. All you have to do is eat uncovered food and if the BG goes down, notch it down. Solves the "fasting basal" problem.
     
  14. joy orz

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    I like it! Thanks for your help.
     
  15. ShanaB

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    I don't have any advice in terms of reductions/increases for you but our endo counselled me about this exact issue last time we were there. He said Emma is right around the age that she is going to really slow down with her eating and suggested we back off the basals. She will most likely go high from the back-off and he said at that point we would decrease her I:C to compensate. I haven't tried it yet because she got sick and her basal needs went way up but now that we have settled into the new basals I am going to try. Currently if she waits longer then 4ish hours to eat or has a no carb snack/meal she will bottom out which of course means her basals are too high.

    Good luck!
     
  16. wilf

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    I agree with this approach - this is how we would do it at this end too. What you reduce the basals by gets added to the meals. Doing it in smaller steps makes it an easier transition and reduces the risk of big lows or highs as you work your way toward the new regimen.
     
  17. Jacob'sDad

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    OK Joy, let me think out loud while I'm writing.

    Anytime you use basal to cover part of the bolus you have a situation where you are giving too much basal and not enough bolus. That's not necessarily a bad thing. The extra basal can help reduce spiking and within a certain range of carbs consumed, BG can end up where you want it at the end of the DIA.

    The problem is when the carbs consumed at the meal are OUTSIDE of the normal range. If they are MORE, then the bolus shortage becomes more obvious and BG ends up high at the end of the DIA. If the carbs consumed are LESS than the normal range, then the basal excess becomes more obvious and BG ends up low at the end of the DIA.

    So if I understand you right, you are now experiencing the latter with Ava more often than you would like. She is eating less carbs at certain times because she has become a picky eater and the excess basal is causing her to trend low too often.

    If it was Jacob, I could put up with that sometimes and just deal with the need to give a snack if he eats less for breakfast, which is when he gets the extra basal. It doesn't have to be gummy bears. The need for fast acting carbs only arises when they have already gone low. If you can catch the downward trend a little earlier, you could give a healthy snack.

    Now if she is being picky ALL THE TIME and refusing snacks, maybe you do want to make a change in the basal and/or ICR. I just think you need to be sure to not fix something that is not really broken. You currently are using excess basal to reduce spikes and that has worked for you. If you make too much of a change you might see spikes again.

    But enough of that; you want to see some math. OK, here it is.

    I could use a few more details but rather than wait for them I am going to make a few guesses instead. Let's sat Ava eats at 8am and eats 50g carbs for breakfast. Her ICR is 1:14 and her basal is .325. Her DIA will end at 12 noon.

    So the total insulin she gets is:

    50/14 = 3.6u
    .325 X 4 = 1.3u
    3.6 + 1.3 = 4.9u TOTAL to 12pm

    OK, let's say you wanted to drop the basal to .175. Then the total basal from 8am to 12pm would be .7u. To get the same total insulin in the DIA as you had before you would need 4.2u from bolus. (4.2u + .7u = 4.9u).

    So if you now gave 4.2u for 50g, that translates into an ICR of 1:12.

    So a new ICR might be 1:12 at breakfast and the basal might be .175u per hour.

    Well, that all looks pretty and nice, but in the real word things don't often work out so neat and clean. Honestly, if you're seeing her BG drop and you are sure it's from basal, then I would simply start by dropping the basal slightly. Keep dropping it until the downward trend stops.

    It's the same deal with the ICR's. Your best bet is to just make small changes and see how it works out.

    Basically I'm just agreeing with everything Scott said; I just took a very long route to get there.;):D
     
  18. joy orz

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    You guys so totally rock!!! :D:D:D

    There should be an 80's hair band singing ballads to your greatness. Thanks all for coming through.
     
  19. frizzyrazzy

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    I heart you mathy people. I never thought to look at it the way Dave just said it.....
     

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