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What BG's go with an A1C of 5.3%

Discussion in 'Parents of Children with Type 1' started by Darryl, Sep 3, 2010.

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  1. MikailasMom

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    I think that, regarding an earlier poster, that as far as my childs privacy, she is ok with me posting her info, we have discussed it. She really appreciates the help we get here b/c it makes her feel better. What makes her feel really good is when someone can use something we have learned the hard way and make someone elses life easier. She is shy abt her peers knowing things b/c they dont understand, she knows people here do! Now if we were discussing bra sizes she would be mortified, but we aren't, we are discussing how to make life easier for our kids, to us thats what matters. :)
     
  2. chbarnes

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  3. Mimi

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    I can't pretend to have understood all that I've read in this thread but I do think it has been incredibly informative - even for me and we're not pumpers or using CGMS.

    Thanks for posting and taking the time to respond to questions and comments.
     
  4. annaluvspink

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    We are new to pumping and we are working hard to nail down those basal rates (specifically nighttime basals) w/o a CGMS. It is quite difficult to do, since DD seems to need almost double her daytime basal in the late evening/early mornng hours.:confused:

    I have read this entire thread and am quite impressed with the management you and Leah have learned to do. Thanks for taking the time to share and answer questions.
     
  5. NomadIvy

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    Ooo. Becky (haven't read through whole thread), K,s stll going low several times a week. Ugh.
     
  6. momtojess

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    Just cruious, as I may be missing something,

    but how many people actually start changing their child's basals hourly based on cgm trends? People are saying thanks for the great advice, etc, but I don't see anything saying how Darryl comes up with how much basal to use each hour, or any fomrula he uses to figure it out. Honestly, I know kids that if they went hours without insulin in the eveing because their bg was low, they would get ketones.

    I am glad Leah and Darryl have found a routine that works for them and he shares the proof that it works for them, but I just wonder how many other people actually start using the hourly changes after he posts these threads every couple of months?

    For us, after 8 yrs of diabetes, have found that a couple basal rates a day, varied i:c ratios based on time of day and 6-8 finger pokes a day to confirm what the cgmshe doesn't have an a1c in the 5s but I don't really want one that low either. is saying works for us (basically the more traditional widely use method). We don't see extended periods of unexplained stubborn lows , nor do see many unexplained stubbon highs.
     
  7. swellman

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    I agree with what you are saying - we have a lot of info but I, as of yet, have seen very little in the form of a "system". There's a lot more info yet to be addressed before I can even begin to use it to start considering how to apply it. Hopefully, the discussion will ultimately get there.
     
  8. Diana

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    We use a method adapted from Leah and Darryl.

    So, yes, I do adjust basals throughout the day based on CGM. Some days this happens many, many times a day. Other days we float through with just a few adjustments. It just depends on what is happening. This year, I am teaching my 9 year old son to make these adjustments by himself at school. We came up with our system based on threads like this - where Darryl explains what they do and gets peppered with questions for details (and gets criticized for his methods). He also helps lots of people (including me) through PMs. Our system is much simpler than Leah's because it is all my son can handle right now, but I can see that we will be able to refine it as it becomes more automatic for him. I would think that Leah's progression was similar.

    The "traditional" method decidedly does not work for us. My son's basal needs vary way too much from day to day to even come up with a basal profile that is worth programming into the pump. We get the prolonged lows (we have days of over 100g of uncovered carbs, reduced or no basal, and I can't get him over 80). We have days of prolonged highs where I can't get him below 200 with double basals, triple corrections ignoring IOB. Our endo didn't have a solution for us. Her head about popped off when I explained to her how we were using the CGM (and when I told her I got the idea from "a guy on the internet"). We have a low A1c that makes her nervous UNTIL she sees our data.

    For us, it is much less work and mental energy to manage this way - but it took a while to figure out how to make it work for us. But threads like this helped it happen.
     
  9. buggle

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    We change basals often too, based on CGM. We have our own "method." We pretty much go on intuition and make adjustments based on what we're seeing. I wouldn't suggest our way to anyone else, but it works for us. Brendan has constantly changing basal needs -- bolus changes a bit too. So, we've learned to just go with it and adjust often.
     
  10. hawkeyegirl

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    He's posted it before and people go absolutely bananas. If you search his old posts, you'll find it, or I'm sure he'd PM it to you. I actually fervently hope that this discussion does not ultimately get there because it's invariably a mess.

    We manage somewhat similarily to Diana with the big caveat that Jack doesn't self-manage at all. So if Diana's style is "Darryl lite", ours is "Diana lite." ;) So when I'm with Jack, adjustments take place on the fly, and when I'm not with him (like when he's at school or I'm at work), they take place at the end of the day when I review that day's CGM information.

    For us, like Diana, it is way less work and mental energy to manage this way. We get the same a1Cs as we did before, but I put in about 1/10th of the time, and my stress levels are much lower. I have no idea what we'll do when Jack is self-managing. It remains to be seen what style will work best for him. Since he shows absolutely no interest in doing any of his own care, I suspect we'll stick with this for the next few years at least.

    Very few people, and even fewer kids could do what Darryl and Leah do. I've taken what works for him, whittled it down to what works for us, thrown in my own twist on things, and come up with our system.
     
  11. Ali

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    I believe that the basal rate adjustments that being done are temp rate changes when you think that basals are the problem of highs or lows that appear to be for several hours and unrelated to food but due to exercise changes, activity changes, hormones, etc. all things that might be very temporary. This eliminates the need for multiple corrections. Also it allows you to sort out longer term basal rate changes ( more fundamental) before making a permanent change to basals or setting up a new pattern. I hope someone else jumps in to correct me if my assumptions are off. This has just been my reading of the posts. Ali PS My reply is not more clear.:p
     
  12. hawkeyegirl

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    Actually we do both. We do "permanent" rate changes if we see BG heading up or down where it's fairly clear that it's not being affected by meal insulin, food, or activity. And then sometimes we need to do temp basals to get BG back up or down where it belongs. The "permanent" changes are to (hopefully) prevent the same thing from happening tomorrow, and the temp changes are to get BG back where it belongs now.

    That may not make sense to anyone but me.

    ETA: I say "we", but I mean me. One of the (large) downsides to my system is that I'm the only one who understands it in the slightest. Although I daresay that would be true if we were still managing the "traditional" way too. Others can care for Jack, but I'm really the only one who can make adjustments effectively.
     
  13. momtojess

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    This is what we do. We have her basal pattern set, then if we see times where is going up/down (usually because of food, activity, excitement, etc) then we do a temp basal to adjust. We only permanent changes if we see the same issue for 2-3 days in a row. Obviously, if the high/low is caused when she eats then we adjust the bolus ratios instead.
     
  14. emm142

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    I do this as well, Karla. I wait 3 days for patterns before making changes to my basic basal settings, but I do temp basals everyday, usually several times. My basal needs fluctuate a lot, but I can't function solely on temp basals because there are times when I can't be thinking about my BG all the time and so just go by my average general basal needs (ie. whilst sleeping [most of the time, unless something is really off] or whilst really busy doing something else). I often do temp basals at times where it's really obvious I don't need a permanent basal change, like when I've underdosed a meal by a few carbs and ended up in the 200s-300s, which causes insulin resistance and means that my average general basal isn't right anymore. Sometimes, though, I do just need a massive increase or reduction in (temp) basal, for "no reason" (like up to 4u/h from my typical 0.8-0.9u/h). It doesn't repeat itself in a patterned way, so if I didn't use temp basals proactively I'd get stuck HI a lot more than I do.
     
  15. Midwestmomma

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    Congrats on the great control...and low A1c.

    This method would NEVER work for us. My son is too active one day, and not active at all the next. We never have 2 days the same in the way of BG's...a good BG waking morning will never happen here 2 days in a row...and neither does a good bedtime BG...my kid varies WAY to much, and so does his food intake. One day may be 100 carbs, the next may be 400 carbs. He is a growing, pre-puberty, active as all get out, hungry kid, and is not gonna put up with hourly changes of things. And I don't expect him to...CGM or not. No we don't have one, and never have. Even though we do want one..

    I am glad micro-managing has worked out for you and your daughter, but would never work for us and our lifestyle. We have had one "badish" A1c in almost 3 years...and with the way my sons body reacts to BG's of 60-40...we are not to run him very low. I will not expect my kid to have D micro-management on his mind all the time...he is a kid first...and a kid with D second. Just my opinion and 2 cents....:D
     
  16. albasmom

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    This is similar to what we do, and our endo is thrilled with the way we manage. I know that we are very much in the minority in managing this way, as Alba is one of a few kids in the country using CGMS full time, and as far as I know the only one pumping with apidra. We have the same low or lower A1C as before, bu with much fewer lows, and much less stress. Darryls posts on the subject is the reason we fought over a year to get CGMS covered and paid out of pocket for half that, even though the price in Denmark is probably double that in USA.
     
  17. Diana

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    We don't use temp basals.

    I have one rate in the basal program at any given time. We change it up or down and leave it there until the next time it needs to be changed up or down.

    ETA: Also - we do not change basals hourly or even get hourly alarms. We have days when we have very few alarms, and days when alarms go off like crazy - but it was the same when we were using "traditional" methods. The difference is that our results are much better now.
     
    Last edited: Sep 5, 2010
  18. momtojess

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    This is where my confusion is coming from......

    How did you know what basal to put in to start with, and how do you determine what to change it to? How does this work when your son is not with you (like at school?) since he is just learning to do those changes himself.

    I guess, technically, we do a modified version, since I do temp basals based on the patterns we see, but since Jess doesnt do basal changes herself and she isnt with me all the time, having different basal rates throughout the day works.
     
  19. swellman

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    I started with info from a study that published average insulin need for children per kilogram. They published a percentage of basal vs bolus. I calculated why my son's needs would be based on this info and set a total daily basal and broke it down. I started flat then adjusted it somewhat but ended up with only two programs. It seems to be spot on.

    I will look for that study later or perhaps someone will post it.
     
  20. danismom79

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    Do you only change basals, or do you work on ratios as well?

    I can't imagine myself doing anything close to this, unless I were doing a perpetual basal test, thus never giving carbs (except for lows). Plus, it's such a pain having to suspend the pump, go into the settings, and change one basal. Multiple times a day.
     
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