advertisement

Page 1 of 2 12 LastLast
Results 1 to 10 of 17

Thread: Teenager High Food Bolus levels

  1. #1

    Default Teenager High Food Bolus levels

    My 14 year old son is using a Dexcom G5 and a t:slim pump. He is currently dosing a Bolus of Humalog of 1 unit for 4.0 carbs for breakfast, 1u/4.5 carbs for lunch, and 1u/4.2 carbs for dinner. He eats about 75 carbs breakfast, 60 carbs for lunch and about 90 carbs for dinner. We are going through so much insulin every day! And it seems like we may need to up the food bolus dosage to about 1u/3.75 soon. Could this be a pump site issue (i.e., poor absorption)? Insulin resistance? We were thinking of maybe changing to a steel cannula - would this help? Is this just a puberty thing? Is it normal to need so much insulin at this age, or should we be concerned?
    Dad of DS dx'ed 1/13 when he was 9 yrs. old - now 14
    Pumping with t:slim since 8/13
    Using Dexcom G5 since 09/16
    Uses Humalog for Bolus & Basal

  2. #2

    Default

    My Dd has a 1/3.5 or 1/4 ratio at breakfast. She drinks about 30 carbs for breakfast (coffee and protein milk drink). Her lunch is about 1/6 and so is dinner. She takes about 46 units of Levemir too. My DD is 16. I think these ratios are not unusual for teenage years - I suspect especially for boys that age that are eating like crazy. Her levemir is down from a few years ago. Her TDD is 75 to 80 units. She is on MDI - levemir and fiasp.

  3. #3

    Default

    If it is a site issue, and you are rotating sites properly, you should see a difference in the next few days when he does a site change. The way I have always looked at this issue is, the body needs what the body needs. In my opinion there is no "normal" amount of insulin the body needs. If his pancreas worked properly, it would provide however much insulin he needed at any given time and you would have no idea how much that was. My guess is that it is due to puberty and you just need to ride it out. Good luck!
    Last edited by Christopher; 09-11-2017 at 12:57 PM.
    Chris
    Dad to Danielle, 18 years old
    Diagnosed 17 Aug 2007
    MDI (Novolog and Levemir) Aug 2007 to Aug 2015
    Dexcom G5 System with Share 22 Jul 2015
    Omnipod 11 Aug 2015

  4. #4
    Join Date
    Aug 2007
    Location
    Hamilton, Canada
    Posts
    9,636

    Default

    Quote Originally Posted by ChrisDadT1 View Post
    My 14 year old son is using a Dexcom G5 and a t:slim pump. He is currently dosing a Bolus of Humalog of 1 unit for 4.0 carbs for breakfast, 1u/4.5 carbs for lunch, and 1u/4.2 carbs for dinner. He eats about 75 carbs breakfast, 60 carbs for lunch and about 90 carbs for dinner. We are going through so much insulin every day! And it seems like we may need to up the food bolus dosage to about 1u/3.75 soon. Could this be a pump site issue (i.e., poor absorption)? Insulin resistance? We were thinking of maybe changing to a steel cannula - would this help? Is this just a puberty thing? Is it normal to need so much insulin at this age, or should we be concerned?
    Puberty and the years around it are a time of high insulin needs in all children. For our Type 1 kids we have to give the insulin, which you're doing.

    What he needs is what he needs, and the Dexcom will let you know that.

    The only question I would have is in regards to bolus/basal ratio. How much of his total daily input of insulin is basal, and how much is boluses/corrections?
    ________________________________________
    Wilf

    Proud Dad of Amy (19), diagnosed Aug. 2006 and getting MDI of Apidra, Regular and Lantus..
    and Sylvie (15); very happy husband of Shirla!

  5. #5

    Default

    Thanks for the replies. I'm glad to hear that it is most likely a puberty thing. I hope his ratios go down as he gets older.

    Regarding his site rotation, yes we always do that, but we do notice that by day 3 the insulin doesn't seem to work as well. So by day 3, even using the above ratios, we often have to give multiple corrections throughout the day, or just change the cartridge & site. We hate wasting insulin though, since we barely get by with the approved amount of bottles.

    As far as his bolus versus basal ratios, his basal is surprisingly low (says our endo.) So after the last visit, we ran a series of basal tests and made adjustments until we got steady numbers with boluses. It took a few weeks to tweak it right, but we believe the basal seems to be correct at this time. Here is a breakdown of his insulin usage daily averages broken down by food boluses, correction boluses, and basals over the past month from his Tandem report:

    Insulin Ratios2.JPG

    I really appreciate your response Sprocket. It's comforting to know that other teenagers are using similar amounts of insulin. In your TDD above, is that including both the levemir & fiasp? Also - just wondering - why MDI? We're so used to the pump, I'm just wondering if going back to MDI might be a better way for us to to go for our teenager.
    Dad of DS dx'ed 1/13 when he was 9 yrs. old - now 14
    Pumping with t:slim since 8/13
    Using Dexcom G5 since 09/16
    Uses Humalog for Bolus & Basal

  6. #6

    Default

    Quote Originally Posted by ChrisDadT1 View Post
    Thanks for the replies. I'm glad to hear that it is most likely a puberty thing. I hope his ratios go down as he gets older.

    Regarding his site rotation, yes we always do that, but we do notice that by day 3 the insulin doesn't seem to work as well. So by day 3, even using the above ratios, we often have to give multiple corrections throughout the day, or just change the cartridge & site. We hate wasting insulin though, since we barely get by with the approved amount of bottles.

    As far as his bolus versus basal ratios, his basal is surprisingly low (says our endo.) So after the last visit, we ran a series of basal tests and made adjustments until we got steady numbers with boluses. It took a few weeks to tweak it right, but we believe the basal seems to be correct at this time. Here is a breakdown of his insulin usage daily averages broken down by food boluses, correction boluses, and basals over the past month from his Tandem report:

    Insulin Ratios2.JPG

    I really appreciate your response Sprocket. It's comforting to know that other teenagers are using similar amounts of insulin. In your TDD above, is that including both the levemir & fiasp? Also - just wondering - why MDI? We're so used to the pump, I'm just wondering if going back to MDI might be a better way for us to to go for our teenager.
    Yes, the TDD includes both Fiasp and Levemir. My daughter has never wanted a pump - was diagnosed when she was 11. Despite her doctors and nurses pushing her towards a pump, she held her ground and has never agreed and I respected and understand that. She feels like she has more freedom with mdi. She doesn't mind injections whatsoever and feels more in control when she administers it herself. She also doesn't have any interest in being tethered to anything ( I know there is omnipod). She knows all the math and corrections and duration of action and has an excellent understanding of what's going on and why. I am really glad she has this foundation because if ever in the future she decides to pump, she will always have that knowledge in the event she decides to take a pump break or in case of malfunction. I have to admit, I also like having her basal insulin being delivered twice daily in the form of a long acting. If she ever misses a dose of fiasp, we always know she still has lots of basal insulin working in the background and the transition into dka, I would think, would be less likely. She does have a Dexcom G5 which we both LOVE and she wouldn't be without it.

    Her basal makes up about 60% of her TDD. We set her evening basal to have a nice straight line and her daytime basal to have a very slow decrease over the day. We've had our issues with Levemir (running out before the 12 hours and causing highs) and getting the exact dose was very challenging. However, as soon as Tresiba hits the pharmacy in Canada (I know it's been available in the U.S. for a few years and has great reviews), we will be the first in line to give it a whirl.

  7. #7
    Join Date
    Aug 2007
    Location
    Hamilton, Canada
    Posts
    9,636

    Default

    Quote Originally Posted by ChrisDadT1 View Post
    ..
    As far as his bolus versus basal ratios, his basal is surprisingly low (says our endo.) So after the last visit, we ran a series of basal tests and made adjustments until we got steady numbers with boluses. It took a few weeks to tweak it right, but we believe the basal seems to be correct at this time. Here is a breakdown of his insulin usage daily averages broken down by food boluses, correction boluses, and basals over the past month from his Tandem report:

    Insulin Ratios2.JPG

    I really appreciate your response Sprocket. It's comforting to know that other teenagers are using similar amounts of insulin. In your TDD above, is that including both the levemir & fiasp? Also - just wondering - why MDI? We're so used to the pump, I'm just wondering if going back to MDI might be a better way for us to to go for our teenager.
    I am wondering about the meaning of the phrase "we ran a series of basal tests and made adjustments until we got steady numbers with boluses".

    At our end the goal is to set basal so that numbers are steady or dropping very slowly in the absence of food and/or boluses. We don't use a pump either, so we just set her basal (Lantus in our case) to whatever amount gives a very slow drop in blood sugars over night.

    We had been on Levemir previously and were getting up to using the amounts your son is needing, and then made the switch to Lantus. Levemir had worked will in smaller doses pre-puberty, but didn't seem to work so well when we approached 50 units.

    Good luck with this.
    ________________________________________
    Wilf

    Proud Dad of Amy (19), diagnosed Aug. 2006 and getting MDI of Apidra, Regular and Lantus..
    and Sylvie (15); very happy husband of Shirla!

  8. #8

    Smile

    Quote Originally Posted by Sprocket View Post
    My daughter has never wanted a pump ...she feels like she has more freedom with mdi.... I have to admit, I also like having her basal insulin being delivered twice daily in the form of a long acting.
    That's what I was thinking. We're looking at possibly going back to MDI because of the reasons you listed (and also because he wants to play HS Football next year - tough to do with a pump.) We are also looking at the inPen by Companion Medical, although we need to wait until it comes out to see if it will be right for him.

    Quote Originally Posted by Sprocket View Post
    She does have a Dexcom G5 which we both LOVE and she wouldn't be without it.
    Same here. We love the G5, don't know how we lived without it before. I just wish the Apple app didn't have so many "Signal Loss" and "Bluetooth" errors.

    Quote Originally Posted by Sprocket View Post
    Her basal makes up about 60% of her TDD. We set her evening basal to have a nice straight line and her daytime basal to have a very slow decrease over the day. We've had our issues with Levemir (running out before the 12 hours and causing highs) and getting the exact dose was very challenging. However, as soon as Tresiba hits the pharmacy in Canada (I know it's been available in the U.S. for a few years and has great reviews), we will be the first in line to give it a whirl.
    Wow, that's a lot of Basal! Guess that's why our endo says my son's appears low (currently about 20% of his TDD.) I don't know much about the different long-lasting basals, since we only used Lantus at the beginning, but it looks like you've done the research to make sure you get the one that works best for your daughter.

    Thanks again for your response.
    Dad of DS dx'ed 1/13 when he was 9 yrs. old - now 14
    Pumping with t:slim since 8/13
    Using Dexcom G5 since 09/16
    Uses Humalog for Bolus & Basal

  9. #9

    Default

    Quote Originally Posted by wilf View Post
    I am wondering about the meaning of the phrase "we ran a series of basal tests and made adjustments until we got steady numbers with boluses".
    Sorry - not "WITH" - should have been "WITHOUT."

    However, we did bolus a couple of hours before we ran the tests to try to get him to level out at a decent number (100-140) with no IOB remaining, and then we ran the tests with no food, no corrections, just basal only. We did many tests with different periods - first we did overnight (easy since no food during sleep anyways), and made adjustments each night until we got level numbers. Then we did mornings which was more difficult, since he wanted to eat but we made him wait until lunch. After tweaking and getting level numbers, we went to afternoons and did the same thing, and then we did evening basal tests, and then night tests before bedtime. Overall we did end up making quite a few adjustments, and tweaking the time periods was a bit difficult, but we feel like it was worth it. We still run tests often to make sure his basals are keeping him level and making adjustments as needed.

    I'm surprised how much basal you and Sprocket are using - I wonder if long acting basal requires a higher dosage than fast acting humalog given evenly throughout each hour via the pump. In other words, if we changed to MDI, I wonder if his Basal would be 50 units of Lantus also, not the 17 of Humalog he is getting now. I'd be interested to see the TDD of Basal of other teenagers using Humalog in a pump to know if our 17 is really abnormal or just a little below average.

    Thanks for all your replies.
    Dad of DS dx'ed 1/13 when he was 9 yrs. old - now 14
    Pumping with t:slim since 8/13
    Using Dexcom G5 since 09/16
    Uses Humalog for Bolus & Basal

  10. #10

    Default

    Quote Originally Posted by Sprocket View Post
    Her basal makes up about 60% of her TDD. We set her evening basal to have a nice straight line and her daytime basal to have a very slow decrease over the day. We've had our issues with Levemir (running out before the 12 hours and causing highs) and getting the exact dose was very challenging. However, as soon as Tresiba hits the pharmacy in Canada (I know it's been available in the U.S. for a few years and has great reviews), we will be the first in line to give it a whirl.
    This is about how much basal my daughter needed at the height of puberty, and according to Pumping Insulin, that is typical. Now, at 18, my daughter is using about 50-50% and down to 45 units from 90+.

    I, too, wonder whether the basal and bolus doses are upside down. We lowered bolus ratios at the beginning of puberty, but from then on, it was basal that needed upped and upped. Is he steady at night without corrections? My daughter also needed DOUBLE the morning basal insulin compared to afternoons during that period. She still needs more in the mornings, but not near that drastic of difference.
    8/2010 - 9/2011 MDI, Lantus & Humalog
    9/2011- Medtronic Revel 723 & CGM
    11/2012 - Dexcom G4
    2013 - Cut-The-Cord for water times after multiple Aquapac failures
    10/2015 - T-slim

    "Life is not waiting for the storms to pass, but learning to DANCE in the rain."

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
advertisement