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question for pumpers- about basal/bolus

Discussion in 'Parents of Children with Type 1' started by LauraC, Sep 26, 2014.

  1. LauraC

    LauraC Approved members

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    My daughter is not pumping yet (she will be soon). I have been reading a lot of the posts about pump settings, combo bolusing, etc. This may be a stupid question, but when you set your basal rates on the pump, do you want them set so that your I:C ratios for meals are pretty close for the day? So right now my daughter is 1:12 at breakfast and 1:25 at lunch and 1:30 at dinner. So when she starts pumping, would I adjust her basal (make it higher) in the morning so that her I:C ratio is closer to 1:25? From what I understand, we want the basal to be set so that if she didn't eat all day, she would stay pretty level. I'm trying to learn as much as I can before she starts pumping. Thanks for any feedback.
     
  2. Nancy in VA

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    Your last statement is right - you want basal to basically reflect that you could go all day without eating and stay flat. With Lantus, being one shot a day, a lot of patients have some screwy I:C ratios to help "mimick" variable basals throughout the day by using the I:C to give extra insulin at mealtime that really you would need regardless of food, i.e. through basal. So, when you start, your nurse will likely set a flat basal rate and have you do basal testing at certain times to day to REALLY see when you need different basal rates, and as a result, you will expect to find your I:C ratios will probably change.

    We KNEW that we needed variable basals before we went on the pump. Emma would go low overnight and high mid-afternoon on a flat Lantus and changing one way or the other just didn't work. We also did find that our I:Cs were covering some basal needs around mealtime that we tweaked.

    Also know that things will change FOREVER. You may have basals that are set and look good, and I:Cs that look good, and then they grow, or they get sick, or the wind changes direction, or someone breathed wrong and cursed it, and the rates change again - FOREVER!!
     
  3. mamattorney

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    You are right, in a perfect world, the basal should operate like you say - keep her level if she doesn't eat . Sometimes the tighter I:C ratios are really functioning to cover missed basal. With variable basal, you may see more similar I:C ratios throughout the day.
     
  4. Sarah Maddie's Mom

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    forgive me if I'm misreading your post, but are you perhaps confusing basal rates with meal bolus?
     
  5. LauraC

    LauraC Approved members

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    Thank you. We have been changing her lantus dose a lot the past couple weeks to fix lows over night and then as a result we have highs during the day. I know we won't be able to correct the issue without a variable basal.

    Nancy- We have experienced the constant changing doses due to growing, vacation, the heat, or as you said -the wind changes direction. Fun stuff. :)
     
  6. LauraC

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    No, I don't believe that I am. I was wondering if by changing basal rates throughout the day (which we can't do on lantus) it would affect my daughter's I:C ratios at mealtimes. From the first two responses, it sounds like it will.
     
  7. Lori_Gaines

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    OMG truth!!!! "Hey look, the sky is blue, I think I'll change up now!"
     
  8. cdninct

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    Maybe yes, maybe no. As mamattorney said, you may be able to fine-tune basal rates to make them more closely match her actual basal needs, which might change the I:C ratio a bit. On the other hand, it is quite common to need higher I:C ratios at breakfast--my son definitely does. I don't think there is any need to make, or benefit of making, the I:C ratio more consistent over the course of the day. As the others have said, the goal is to make sure that your daughter can keep a fairly steady BG even without eating.
     
  9. Sarah Maddie's Mom

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    Thanks for clarifying my ? to the OP. I didn't do a very good job of asking.

    To the OP, you should probably separate out the job of the basal and the job of the carb ratio more distinctly and not look to using basal to "regulate" differing bolus needs. There's really no benefit (and considerable downside) to infusing high amounts of insulin over hours just to make uniform the ratios for meal time.

    I'm sure it will all make more sense when you have the pump up and running and can see for yourself all the ways you can adjust things, especially since you have the G4.
     
  10. Charliesmom

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    I suggest getting the book Pumping Insulin. I got it when we were still trying to decide if we wanted to start the pump. It answered a lot of questions and I still use it.
     

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