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Is there a ratio of how much Lantus to Novolog?

Discussion in 'Parents of Children with Type 1' started by Lisa - Aidan's mom, Dec 12, 2011.

  1. Lisa - Aidan's mom

    Lisa - Aidan's mom Approved members

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    I have a call and an e-mail into our endo...waiting, grrr.

    Is there a ratio of how much Novolog to Lantus, i.e, if a child receives approximately 16 - 19 units of Novolog during the day to cover meals, is there generally a certain amount of Lantus that should be given?

    We eat dinner at 6:00 and my son goes to bed around 9:15 with decent numbers and receives 7 1/2 units of Lantus. At his 4:30 am checks this last week, his numbers have been thru the roof - 345, 322, etc. I have to give him 2 units of Novolog while he is sleeping so by breakfast, he is somewhat in range (although still on the high side - this morning he was 183). I'm familiar with dawn phenomenon, but this seems extreme.

    I remember our old nurse saying there is some correlation between the numbers, but I can't recall the equation. Any input would be greatly appreciated.

    Many thanks,
    Lisa
     
  2. Fairlight

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    We were told that the Lantus should be 40-50% of his daily dosage. Right now, Ds gets 29u of Novolog and 28u of Lantus most days. He is on a sliding scale for the Novolog, so he gets more if his numbers are higher at meals, but the Lantus dosage always stays the same.

    Now, I'm sure there are instances where this is not the case. Our son was diagnosed when he was 10 years old, so we have no experience dealing with babies and younger children. HTH.
     
  3. manda81

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    My son is a few month younger than yours, and we've seen everything from a 50/50 split (rarely!) to 80/20. It just varies based on what his needs are at the time.

    When he has a growth spurt, we see what you're seeing now. We started pumping a year ago, and his basal needs go up almost double from 9pm to around 2am, specifically while he's in this growth spurt, then it tapers back off to "normal" after a few weeks.

    I would check more frequently for a couple nights, say 8-10-12-2 and see when that rise is happening, and maybe try to catch it in advance, or lower his dinner ratio (if the spike is happening earlier).
     
  4. JaxDad

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    We pump so I am afraid I can't help on the ratio - but if his numbers are in line the rest of the day, and Lantus is 1x per day, then are you sure you want to change his Lantus? Might it not send him low the rest of the day?

    It might be a good idea for you to check his BG a few times starting earlier in the night for a few days and see when the increase is happening and if its consistent. It might be a growth spurt or it could be dinner.

    My son is just a few months younger, we pump and see spikes like that mostly from different dinners. For us it's a bit hard to tell which it is because he's only 41 lbs and even small amounts of fat seem to set him off. About the only way we can isolate the difference is when we give him cereal for dinner. If he still goes high then it's a growth spurt. YDMV
     
  5. Lisa - Aidan's mom

    Lisa - Aidan's mom Approved members

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    Thank you very much for your responses, I really appreciate your advice.

    JaxDad ~ he's been high all day (and yesterday).

    I'm going to increase it by unit tonight (8 1/2)....I'll check him often throughout the night and let our wonderful school nurse to keep an eye out for him tomorrow.

    THANK YOU!
     
  6. Heather(CA)

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    IMO no, just do what works :)
     
  7. wilf

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    How often are you testing in the night? Are his numbers going up steadily from when he goes to bed?

    A typical night's numbers would be very helpful in better understanding your situation..
     
  8. Lisa - Aidan's mom

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    Thank you Wilf. Here are last night's numbers:

    9:00 pm: 135, gave him 8 1/2 units of Lantus and 10 gram snack
    10:07 pm: 161
    12:18 am: 193
    3:56 am: 127
    5:27 am: 113
    6:26 am: 140

    and, just in time for breakfast :rolleyes:
    7:50 am: 189
    (he was 193 yesterday morning with only 7 1/2 units of Lantus).

    Better numbers during the night than the past few days, but I can see that he jumped up a bit from 5:30 to 7:50 am.

    Do you think I should stay at 8 1/2 units for a few days and track his nightly patterns again? I'll see how his daily numbers are today when he gets back from school.

    Many thanks!!!
     
  9. Christopher

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    Those are not horrible numbers. It is possible the snack is responsible for the jump.

    As for the bolus/basal ratio, her endo tried to tell us it should be a 50/50 split and at the time she was heavy on the bolus. So I tried to make it more of an even split and ended up having a lot of problems. So my feeling is, your CWD needs what they need. Period. To try and artificially make an even split didn't make sense for her. And, I have never heard a good reason Why having a 50/50 split is so important (the reason I was given was "well, that is how someone's body without diabetes works, soooo..."
     
  10. Heather(CA)

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    What time was the last fastacting for dinner or snack?
     
  11. Lisa - Aidan's mom

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    Chris, I was happy with last nights' #s, it was the previous week when he was in the 300+ that I was concerned with. Like most people, I'm trying to get the right balance and then a growth spurt hits and it all gets knocked out of whack! So true ~ whatever works for your child!

    Heather, dinner was early and he had 6 units of Novolog at 5:30; it was chicken/veggies/rice - nothing like pizza or a hard to control food.

    I truly appreciate your help, I'm disappointed that I still haven't heard from our new endo/nurse and I'm grateful I can get your input!
     
  12. Christopher

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    Understood. Just as an aside, sometimes rice (depending on how much is consumed) can cause spikes for Danielle. Just a thought.

    Hope you hear from the Endo soon.
     
  13. Heather(CA)

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    In that case, those numbers are pretty darn good. It's most likely the snack that's raising him. If he will do with out it, I would lower the Lantus to 7 1/2 or 8 and not give a snack. Only because he went from 193 to 113. That's an 80 point drop. If you want to keep the snack it looks good where it is:)

    No problem, I love helping :D
     
  14. wilf

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    These numbers are obviously pretty good. Based on them I'd stay the course or even as Heather suggests forego the snack and lower the Lantus.

    Do you have numbers from a night last week that would help illustrate the concern?
     
  15. obtainedmist

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    This is exactly how we approached while on MDI. After first coming home from the PICU, we gradually lowered the Lantus dose as she became less insulin resistant. Then, as she gained back much of the weight, we upped it again. Then, trying to get rid of the morning highs, we upped it again! We usually did it by 1 unit increments (since she was 18 at the time). I just don't see how there can be an ideal ratio of basal to bolus...sometimes we eat more than other times, yadayada! ;)

    And yes, we too started skipping the uncovered snacks. They just weren't working.
     

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