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HELP - Expert number crunchers needed!

Discussion in 'Parents of Children with Type 1' started by Lindy, Feb 4, 2010.

  1. Lindy

    Lindy Approved members

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    In need of advice on numbers... things have been up and down at school and we have been constantly mesing with settings to try and even out. We are changing some of the care at school over to Cooper - long story! Trying to simplify things for him for now, shut off pred. alarms, set low alarm up higher so a bit more room for error. School not so happy about changes, and right now, school and Cooper correcting for lows (both)... we are going to have to work on that communication problem, but would like to be able to address these problems with numbers. Monday makes sense to me (see below)- high in the afternoon so adjusted afternoon basals to help with higher numbers, Tuesday I see as an overtreatment of low - so we spiked high, correction factor has to be wrong to drop him like that? And, wondering why we are not seeing BG respond in 30 minutes which is what our low snooze is set at (still seeing dropping numbers)... Wed. is just a mess with school correcting and Cooper correcting - but what's up with a BG of 54 @ 10:25 after 30g of treatment??? I get the spike with all the free carbs, but why isn't BG responding faster??

    We are trying some new things out for care to try and minimize staff decision making - we have 3-4 different people giving care thru-out the week - we are also trying to minimize disruptions to Cooper's school life.... Right now, we don't feel it is age appropriate for Cooper to be making decisions on numbers, but can handle alarms (if we have things set properly)... just something we are trying!

    Any thoughts out there?? Does someone see the magic missing link - cause I just don't get what is happening!


    Monday
    6:17am BG 115
    6:44 bolus 3.85
    7:08 bolus .85
    10:56 -15 free carbs (self administered with CGM low alarm)
    11:35 - BG 156 - 45g (Bolus 1.7)
    2:13 BG 293 - 1.5 correction

    Tuesday
    6:38 BG 109
    6:55 Bolus 3.85
    8:40 15 free carbs (self administered with CGM low alarm)
    9:04 15 free carbs " "
    10:10 BG 335 1.8 correction (+11g snack)
    11:30 BG 145 (20g free, bolus for 10g = .55)
    12:16 15 free carbs (CGM low alarm)
    12:40 15 free carbs (still dropping)
    1:53 BG 298 1.55 correction
    3:16 BG 109

    Wednesday
    6:25 BG 118
    6:49 Bolus 3.6 (changed from Tuesday to a 1/15 from 1/14)
    10:00 BG 92 - school gave 15 free carbs
    10:09 15 free carbs (CGM low alarm)
    10:25 BG 54 - 15 free carbs
    10:40 BG 116 - 15 free carbs (CGM low alarm)
    11:30 BG 319
    11:45 Bolus 53g 3.25
    1:00 15 free carbs - moms decision with sensor reading 154 2 arrows down
    3:15 BG 172

    Basals
    6-7am .6
    7-9am .35
    9-11am .45
    11-7pm .6

    Correction Factor
    6-12pm 155
    12-12am 120

    ICR
    12-8:30am 1/15
    8:30-12pm 1/26
    12-12am 1/18

    Thanks Much!
     
  2. wilf

    wilf Approved members

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    The obvious issue is that while he's had good waking numbers, he's gone low enough every morning that he's had to be treated with carbs (often multiple times) and that often the low issues persist into the afternoon. All your other problems have flowed from this basic one.

    I note that his carb ratio at breakfast sees him getting more insulin than for other meals, and that his basals increase from his early morning setting at 9 am and then increase again at 11 am. He is just getting way too much insulin!

    Whether you change the carb ratio or the basals will be your call. If it was me, I'd be changing the basals (leaving them 0.35 through the school day for starters and tweaking from there as I saw what the numbers look like).

    Your school is mighty patient if they're accommodating all this - you need to make this much easier for them.. :cwds:
     
  3. Lindy

    Lindy Approved members

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    Thanks Wilf - was hoping you would reply! The problem is more of not being able to get consistent days to compare. All of them are all over the place - but yes, the goal is to avoid any actual lows. We don't mind him getting a low alarm and treating it, but we want that to be enough (obviously) and not have continuous drops. Monday was more the goal - Wednesday NOT! How can we have several days of Monday - then get several of Wednesday's... This has been happening for quite some time now - and I cannot find the patten with outside activities, food etc. He might have several lows at school, then high all weekend, or all high numbers at school, literally in the 200's all day.. We are chasing some evil number monster and we are going crazy! His bkfst ICR used to be 1/10 - so we have come up, and lunch 1/21 - so we have been playing the numbers....

    The school staff is all new - and I think they think we are doing this to them on purpose, which is so far from the truth. We want to lessen their interaction with Cooper and have him spending less time on all this - believe it or not, we are trying to simplify for everyone - it's just not working!!!!
     
  4. ecs1516

    ecs1516 Approved members

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    I may be totally off on this but your .6 in the morning may still be bringing him down before you cut it back to .35 at 7am. What is his basal before 6am? I think when you check him at around 6am , he is still coming down from the basal of .6 it can affect the BG about 2 hours after. So, the BG of 118 would continue to drop even without a breakfast bolus. So, I just wonder what the basal before 6am is. My thought is lower the basal of .6 or start the .35 earlier.
     
  5. Lindy

    Lindy Approved members

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    Thanks Carol - His pump settings are off to school with him, and I'm not sure what the other settings are. My husband is typically our numbers guy - but we are just stuggling too much with this! In another thread about "doing better" - I saw one endo simplified by just setting 2 basal settings - and I may want to go back to that for now...

    He is doingTae Kwon Do, has swimming lessons - heading to a waterpark for the weekend, running the school halls for his brother's wrestling practice, snowmobiling, etc. Tae Kwon Do and swimming mess with his numbers for MANY hours after... I just need the kid to veg in front of the tv, eat on a schedule and stop growing! ;)

    His numbers aren't consistent because his life is not consistent! I just need to get ahead of this problem!
     
  6. ecs1516

    ecs1516 Approved members

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    Our endo had told us in the past when it seems a mess to start over with one basal or two and move from there to get it right. Good Luck

    My son can be doing the same things each week and he needs change. He was having highs after breakfast changed his ratio to 1:12. Then after a few days too low after. Changed back to 1:13 still have some low issues. It never ends!!
     
  7. kiwikid

    kiwikid Approved members

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    We recently went back to just 2 basals after Racel being on Prednisone.
    She is now .45 from 10pm until 6pm and the .85 for the 4 other hrs.
    It has worked amazingly well.

    You seem to be giving a lot of free carbs so insulin must need to be reduced somewhere.
     
  8. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Have you done morning basal testing? We had a bunch of highs lately and I thought it was a bolus issue but after a basal test it was very clearly basal needs.

    Can you stay home saturday morning and give him some sf jello and video games for a while?
     
  9. BrendaK

    BrendaK Neonatal Diabetes Registry

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    I just read your post about being so crazy busy. I'm in that club too!

    We've found that for exercise he needs about 15 carbs for every 1/2 hour of exercise. Then after a workout or basketball practice, we reduce the bedtime snack carb bolus by 1/2.

    I don't mess with the basal settings with exercise, I mostly give extra carbs and reduce boluses.
     
  10. Lindy

    Lindy Approved members

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    This weekend we are heading to a waterpark - which I am sure will be great for numbers! :cwds:

    I agree - he's dropping, just not consistently!

    The issue with how many free carbs he is eating - is in part a problem with coordination and communication with school staff and Cooper - as they are BOTH treating the same numbers.... that we have to stop!
     
  11. wilf

    wilf Approved members

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    For the 3 days that you posted, which is all we have to go by, he is CONSISTENTLY dropping to a low every morning. In my opinion this is the root of all your other issues, as overtreatment of those morning lows and/or rebounds throw the rest of the day right off..
     

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