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Day 1 of a "Tuesday" basal - not so good

Discussion in 'Parents of Children with Type 1' started by Nancy in VA, Feb 25, 2015.

  1. Nancy in VA

    Nancy in VA Approved members

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    We worked with the Endo last week to come up with a basal / correction profile to deal with Emma's Tuesday's. She is homeschooled and the only child at home, so our regular days actually involve a lot of sitting. But Tuesday involves a homeschool co-op AND almost 3 hours of dance class. Needless to say she goes low - even with a reduced basal.

    So, we set up a new basal profile that was a reduction of 80% of her basal from normal from 3:30 until 8:15 - 1 hour before dance class until dance was over. We then changed the basal to be about a reduction of 60% of normal basal from 8:15pm to 3:00am to deal with post-exercise lows. We also DOUBLED her correction ISF from 55 to 100.

    She was still low for most of dance class and until about 1am, even with multiple low treatments. She did go up about 4am, so I'll see if maybe I can reset the basal sooner, but the correction (at the new 100 ISF rate) that we gave her for going over 200 dropped her to below 70.

    So, even with only 20% of her basal for dance and 40% for another 7 hours, we couldn't keep her from going low She did start at the low end of range and had gone low at our homeschool co-op, so one thing I think I'll do is start the reduced basal at lunchtime instead of 4:30 to help combat the early afternoon lows she seems to have at co-op. But gosh, we really didn't want to drop the basal down more than 20% because that's barely any basal, and honestly, I don't know the lowest setting I can go but 0.100 might be it! We have 7 weeks of co-op and about 14 weeks of dance left and I feel like that I won't get this figured out until June when dance is over!! Frustrating!
     
  2. jenm999

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    Wow! That is some dramatic response to exercise. My son has a huge response to recess at school - afternoon basal on school days is .2 vs .8 on weekends - but Tae Kwon Do does nothing to his BG and swimming is usually cancelled out by no basal when pump is disconnected.

    You are right, .1 is the lowest per hour rate on the t:slim.

    Two thoughts: Are uncovered carbs part of the equation? Is really low basal really such a bad thing?
     
  3. GChick

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    Agreed. I cut my basal by about 50% an hour prior to my Karate class and am disconnected for the hour and a half class and do not feel the need to have any basal during that hour and a half.... it just isn't required. Its a hard class to set things up for, never know exactly how much activity to account for, so I still often go low in the middle and overtreat in trying to bring it up quickly instead of efficiently and end up high, but for those that I dont have to treat for it will level off nicely or may have to increase basal ~slightly~ for a half hour after class.

    I'd maybe aim to have her basal so low (even at 0% for a time) that she will be a little HIGH after class instead of aiming for perfect and then correct THAT instead with a basal increase until you work it out more to prevent the low.
     
  4. Nancy in VA

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    Ketones would be the worry if having no basal for too long. In previous weeks before we had the profile, she would often end up low for hours after class and we would find ourselves setting a 0% basal for almost an hour to try and get her to spike up and then bring it down slowly. We'd much rather the highs than the lows - certainly not shooting for perfect, just not low. Since we can't go lower than 0.100, our only option is to program a 0 basal for a period of time and then alternate back and forth to try and get it lower - ugh!
     
  5. GChick

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    Oh sure, I get that, but I guess I didn't consider the length of a class (as long as sugars remained "stable") to be long enough to be concerned with, if sugars were consistently low during your average class. Cus to me that generally means that the insulin IS there, its just in small quantities from the time before class started and due to exercise is just working super-efficiently?

    I could be wrong though.
     
  6. jenm999

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    How about alternating 0 basal hours with low basal hours?
     
  7. Ali

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    Did the endo discuss having her consume some uncovered carbs during exercise?
    Ali
     
  8. Nancy in VA

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    Ali - she actually eats dinner in the middle of this and she only doses for about half of the carbs when she does. And of course, she's still treating the lows she's experiencing even with the way reduced basal, so lots of carbs going in. She just really seems to burn the BG when she exercises. We have a similar problem when she's swimming. One of her seizures a few years back was a morning after a long day of swimming in the lake! She's played sports before and had dance before but this year, I guess her metabolism is just kicking it up a notch and she's really burning it up when she exercises!
     
  9. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Carson and I both take our pumps off for exercise for up to 2 hours at a time and consume a lot of uncovered, easily digested carbs. Anywhere from 20-50grams depending on the exercise. The endo also explained that exercise itself makes the insulin on board work faster than it would normally so we have to be careful about any bolus that's active. If she's eating in the middle of dance the food digestion could be delayed and the insulin could be working at super speed.
     
  10. Nancy in VA

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    Brenda- good to know how exercise affects insulin absorption / effectiveness. I'll try to figure that in when we try again next week.
     
  11. Ali

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    Brenda great points. I do some of this so automatically that I forgot about watching out for IOB.
    Ali
     
  12. BarbDwyer

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    We don't pump but Luke needs lots of uncovered carbs during exercise like swimming and for things like basketball he gets an adrenalin induced high (what I call it - don't know what official reason is) and we hold off on correcting those. They come down on their own and a correction causes a low. We do correct eventually if he stays high but we wait a few hours. He also does uncovered 15 carb (usually peanut butter) before bed on high exercise afternoons. If we plan ahead we reduce pre-swimmimg meal bolus too. Perhaps we do more uncovered carbs because we can't control basal like with a pump?? Not sure how that works I guess. Good luck in getting it worked out quickly.
     
  13. BarbDwyer

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    Please forgive all typos and grammar mistakes. Apparently I only proof read after I hit send and this mobile app won't allow me to edit.
     
  14. mcphelster

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    I don't understand this new language at all as I'm just 1 week from my son's diagnosis, but I'm sorry you and your daughter are struggling with this and hope it's settled for you soon. Hang in there!
     
  15. Sarah Maddie's Mom

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    This.^ We try to stick with low carb meals when they fall between two active, activities so that IoB can be avoided or kept to a minimum for this very reason.
     
  16. wilf

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    Why not skip the dosing for dinner?
     
  17. Nancy in VA

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    So, week 2 of our Tuesday basal profile. I started her reduced basal at 11:30am because she seems to go low at co-op and that happened again. It was a 50% reduction but we treated the moderate low and moved on. By the time we were home from co-op, even with a 50% reduction in her basal, she was in the upper 50s. So I had her treat the low and turned off her basal for 45 minutes - it was due to turn back on about the time she started exercising. Her "during exercise basal" is an 80% reduction of normal basal.

    She also threw a wrench in the mix by taking something for dinner that we don't dose well - leftovers from the night before when she had been low all night. So, I told her to dose half of what we had dosed the night before (with a higher I:C) since we were just unsure of the carbs. She came home from dance at about 180, saying she had gotten as high as 200 on the Dexcom. She stayed there most of the night - we gave her two small corrections (double the ISF of normal) and by morning, she woke up at 80.

    So, I consider that a pretty successful day of co-op and exercise. Still don't understand why she's going low at our co-op - she sits a good deal there too, but it could just be the excitement of being around her friends that's triggering her low. So, I may lower her basal during the day a bit more next Tuesday and see if that prevents the early afternoon low.

    Crazy huh.
     
  18. jenm999

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    I was told to expect him to need more insulin at school but it's the opposite for my son. He needs less.

    Congrats on moving forward!
     
  19. Ronin1966

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    Hello GChick

    <<hour and a half.... it just isn't required. Its a hard class to set things up for

    90 minutes is a fairly long class? What is the art/practice(s), I might have an idea or two...

    Hwrang-Do is a different creature than Bagua, and different from Isshinryu karate entirely. Similar arts but different technical foundations, different fundamental ideas. What are you practicing...
     

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