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Help!!! I cannot figure this out!!!

Discussion in 'Parents of Children with Type 1' started by Lori_Gaines, Aug 3, 2014.

  1. Lori_Gaines

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    We have had issues with DD going low very frequently, and I cannot figure things out. At our last visit, we tightened all of her IC ratios a smidge, and it worked pretty well. Now, she goes low all day long. I correct with a pack of fruit snacks, which is 19 g carbs, and that does not send her too high. If I am having to suplement every meal by approximately that amount (and I can do the math), is that it? Or is this more complicated??? I am so frustrated at how often her body changes and that figuring it out seems so impossible.
     
  2. Sarah Maddie's Mom

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    Have you lowered her basal?
     
  3. Lori_Gaines

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    Yep. Her basal makes up around 40% of her TDD right now. Shouldn't it be closer to 50% or so? I just downloaded Think Like a Pancreas, which I have heard so much about. Hoping that that and the advice of you wonderful people can help. What is so beyond frustrating is that any settings that do work, stop working very quickly, and I am left banging my head against a wall once again! Booooo!!!!!! :confused:
     
  4. MomofSweetOne

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    Can you look at her CGM graph and see how steeply she's trending when there is no IOB? That's how I've survived puberty thus far; I would look at the increase or decrease during a fasting (usually night) time and increase accordingly by temp basal for 24 hours and reevaluate each evening. I found the carb ratio didn't change near as much as the basal needs but that the basal profile itself didn't change that often.
     
  5. Lori_Gaines

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    I know her nighttime basal is fine by the steadiness, but there is no way to get my 4 year old to agree to do any sort of fasting during the day. That girl loves her snack times! I know people always say it is harder in the younger ones, which is why their range is broader, but still.
     
  6. MomofSweetOne

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    Any form of basal testing is on the top of my daughter's Worst Things About Diabetes list. But, she knows that at times we have got to figure out what is happening. Different age, though, and I always do the fast with her and complain more than she does about it. She tells me I'd make a lame diabetic, and I whole-heartedly agree.
     
  7. Lori_Gaines

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    I am really wondering if extra insulin is getting in when we do a site change. We did one today at 4:30. Her BG was 282, so I gave her a correction of .75 units. One hour later, she was 55!!!! This is happening all the time!!!!!!!
     
  8. Nancy in VA

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    Our endo has yet to want my daughter close to 50% basal. If we are over 36%, she starts to look at basal as too high. If she is low all the time, its a basal issue.
     
  9. Sarah Maddie's Mom

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    If the rule of thumb doesn't seem to be working then ditch it. Drop her basal rates across the board and see what happens. Gotta make the management fit the kid not the other way around.
     
  10. Lori_Gaines

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    I will give it a try!!!!!
     
  11. nebby3

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    Don't worry about what the statistics say her basal rate should be. Give her what she needs. My dd's needs seemed to change about every 3 days too when she was littler. Things got a wee bit better around age 7 until pre-puberty began to kick in. If she's running low, lower basal. There are so many things that could be going on-- she could be getting sick, she could be more active, she could be coming out if a time of growth. To say everyone's basal should be 50% always seems crazy to me. How many carbs you eat will affect it so much not to mention how old they are etc.
     
  12. Chaser

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    My son was never close to the 50% basal until he was around 7. Everyone is different. Now at almost 9 is is close to 50/50.
     
  13. MomofSweetOne

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    This makes it sound as if her ISF may be off. If her basal is correct at night, but you see these kinds of drops after correcting her, it might be worth playing around with the ISF to see if it makes a difference.
     
  14. Sarah Maddie's Mom

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    I still think horse, not zebra
     
  15. Lori_Gaines

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    I did the rule of 1700, and that had her ISF at 155 (we had it at 150). I just lowered all her basal settings a notch, so we shall see. Then I will play with her ISF. I agree that may be an issue because she tanks during the day with corrections, but not at night. Do I worry about Celiac? She has been tested, and her last test was negative, but I cannot help but wonder if her body has stopped processing carbs. On the other hand, if I do give her carbs for a low, she reacts. It just seems to be a bit delayed. I don't know, now I'm just rambling lol.
     
  16. MomofSweetOne

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    I'm thinking it could be a combination.

    I just used the rule of 1700 to calculate an ISF for my daughter. It came out 1:35. Her real-life ISF that I've observed over and over is 1:70. If we used 1:35, we'd be seeing daily lows.

    To the OP, what does your daughter's basal profile look like?
     
  17. Lori_Gaines

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    Before the changes I made this evening:
    5am .225
    9am .175 or .200 depending on the day
    12pm .250 (although earlier this week I brought it down to .225)
    4pm .200 (to try and fight the horrific evening lows we were having)
    9pm .150

    Our lows the past week have been frightening. She was 25 two nights and 32 on another. All around the 5:30 time frame. I also had to have them adjust the dose protocol on her morning snack at school because we were having lows at lunch, just not as low as the evenings.
     
  18. nebby3

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    It's not uncommon to have different correction factors for different times of day. That may be what you need here. It is also not uncommon as kids come out of honeymoon or get older to find that carbs just affect them differently than they did before. I have also heard it said that the very act of eating makes one more insulin resistant.
     
  19. Snowflake

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    Go with the technical tweaks first, but stay on top of the celiac possibility if this persists for several weeks.

    My daughter tested negative for celiac when dx-ed at age 2. We had her retested for celiac early based on persistent lows. The lows mostly presented as "rolling lows" -- they wouldn't come up with the standard 15-carb treatment, and required second and third treatments, as well as big TBRs, to get her into range. DD didn't have classic symptoms besides the lows (not to get too graphic, but the only other subtle symptom we saw was the occasional funny-colored poop).

    All that said, generally, I agree with the "horse not zebra" approach.
     
  20. missmakaliasmomma

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    I was curious and looked at my daughter's basal profile. It seems very similar to your daughter's. My daughter is 43" and almost 40 lbs and is 5 1/2. Her daily basal is about 4.6 units right now. I had to lower it over the course of about a month from almost 6 units to the 4.6 units. I have no idea why but that's what I had to do. I STILL have to do some adjusting because she's still dropping at some points. Basically what I have PERFECT is 3am-9am lol. To me it's the easiest bc it's basically the only time theres no iob. I agree with the others. If you're daughter doesn't fit the "rule", thats ok. Just do what she needs

    ETA: I think her ISF varies from 125 to 185 throughout the day and night.
     
    Last edited: Aug 5, 2014

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