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Okay when to adjust basal vs bolus on MDI

Discussion in 'Parents of Children with Type 1' started by Debdebdebby13, May 30, 2012.

  1. Debdebdebby13

    Debdebdebby13 Approved members

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    Dec 15, 2011
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    I think right now we are having a basal issue, mixed with a coming out of honeymoon issue. Molly has been running generally high. High-ish before meals, like 200 and then 2 hours post meal she's usually in the 250-275 range. Then by the next meal she is back to 175-200, usually.

    At night has been bad though. She was 140 before bedtime, but had at least 1 unit of insulin still "on board". So we gave her about 15 carbs, because 1u usually drops her about 200 pts.

    We checked about 1.5 hrs later and she was 290, and it had been 4+ hours since her last insulin dose. So...whoops. We gave her 1/2u to correct, because typically at night she drops like a rock. DH checked 2 hours later and she was 410. For some reason he decided to do nothing. I checked another 2 hours later she was 315. I gave her 1u. When we got up 4 hours later she was 188, super high for her first thing in the morning.

    We had increased her before bed Levemir about a week ago, but I ended up fighting lows we could not get rid of, that was going from 1 to 1.5u, so we went back down to 1u.

    So, I'm pretty sure we need to increase our morning Levemir from .5u to 1u, but what do we do at night?

    6 months in and this is the first significant bump we've encountered, mostly it's been relatively smooth sailing.
     
  2. AJMom

    AJMom Approved members

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    Hi Debby, I have no suggestions as we are just into this about 6 months also. I PDF'd all DD BG logs and emailed to the endo as we were seeing the same thing over that last 7 - 10 days. Endo changed our ratio for dinner and Lantus (night). While the emails with the endo have gone over 2 days - of course DD had a 'normal' night (not 300+ rather 180 all night) and normal day (95 at lunch today) :confused: We started fall soccer this last night, so I think that might have helped keeping her numbers down a bit.

    I can offer you just a hug and some hope it well get a bit better! I know how bad we have been feeling with these crazy highs lately.
     
  3. Yellow Tulip

    Yellow Tulip Approved members

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    Hi Debby,

    What you are describing at night is what I struggled with for my son before he was pumping. His basal needs are very variable, and 95% of the time he was high during the first part of the night, no matter how many corrections we gave him. An increase in Lantus would bring those highs down, but he'd be low the second half of the night. We would be comfortable putting him to bed at 70, because we knew he was heading nowhere but up.

    My guess is that during the day she needs more basal. It seems like the numbers pre and post meal are relatively similar, so my guess is that the bolus amount is ok. Do you have the flexibility to change only the daytime basal?

    Not sure what to suggest for the night though. We struggled with it for months, and it only ended with getting on the pump, where we could set variable basals. Do the nighttime numbers follow the same pattern every night? Or have you noticed that they correlate with the kinds of food she may have had for dinner?
     
  4. danielsmom

    danielsmom Approved members

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    My son has been going through some drastice number changes too..high at lunch...high after dinner..and moving up at the am...he's broken 200 three times in the am...recently...so since my CDE is out of town...I've been making my own adjustments..... .5 more at breakfast, .5 more at dinner....5 more of levimir...but since he is now in the mid 100's in the am I am moving up another .5 of levimir.. He was at 7 units of levimir a number of months ago, but he had several wake up numbers of 69/71..so we adjusted all the way down to 6..but now it seems to move up again.. Daniel is 11 and I"m sure this is a growth spurt..but since we are 11 months into this I'm just thinking its honeymooning ending? Lunch and after dinner are much better now....so we will see how we do with the 1/2 unit more of levimir.....
     
  5. Becky Stevens mom

    Becky Stevens mom Approved members

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    Hey Deb, We are almost 8 years on the d train and all those miles with MDI:) And yes, there are days and even weeks that Im pulling my hair out trying to figure out what to adjust and when to adjust it and how much to adjust it. Then I make a bunch of changes, sometimes things get better....or worse. And then he's fine again:rolleyes:

    So first some questions. Are you using pens or syringes for Levemir? Im not familiar with Levemir as we use Lantus. Im thinking with a syringe you can try to just give a small amount more then the one unit. Its best to try and get one thing right, then the other. I usually start with basal issues. I do lots of testing and make sure he gets his dose at the same time each night and then wait a few days to increase or decrease. Are you consistently seeing high #s at night? If so, it would mean that your dd does need more Levemir then but 1 1/2 units might be too much. Also, different foods eaten at night will affect night time blood sugars. Things that are high fat such as pizza or full fat ice cream. If she still has IOB at bedtime, maybe just give a little low fat milk. That should be digested and used up in a short amount of time and not make her run higher.

    After night time and morning #s are looking better, you can start making some adjustments in I:C ratios if needed. I would keep logging blood sugars now and get in touch with the endo or CDE to see if you can fax them the #s and go over some ideas with you
     

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