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Adding meal bolus to Basal Program - anybody doing this?

Discussion in 'Parents of Children with Type 1' started by Guru_rb, Mar 1, 2014.

  1. Guru_rb

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    Hi All,

    My daughter's school does not have a nurse on staff. Her school timing is 8:30am to 2:30pm with 2 food breaks at 10am and 12:15pm. She takes her breakfast at home before leaving to school and we bolus for that. And I have added the insulin to cover those 2 meals at school to the respective hours in the basal program itself since she is too young to be given the responsibility of bolusing herself (according to me). Of course this took some trial and error & we have eventually arrived at a dose which is consistently keeping her BG within acceptable range. We thought of trying something like this as the meal timings are fixed and her activity levels are fairly consistent.

    What is strange though is the amount of insulin I have had to add, which is much lesser than what would be required if we were to bolus her for the same amount of carbs. This was our own experimentation and when we asked our endo about this, she said it could be because this way of insulin delivery might be more closely mimicking the natural insulin secretion resulting in much better efficiency.

    Has anybody here tried anything like this and has any experience that you could share?
     
  2. Sarah Maddie's Mom

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    Our CDE often uses a ramped up basal rate to help combat highs with kids who graze and snack after school - so a similar principle. I suspect that since your dd was only dx'd 6 months ago and you are obviously very aggressive (in a good way) at regulating her bg that her natural insulin is playing a big part.

    I commend you for coming up with such a creative solution so soon after pump start :)
     
  3. mmgirls

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    No, not really but sort of.

    I pack a low carb snack for my dd to have 2pm, I keep it less than 10 carbs but bump up her basal a smidge so than she will not rise the last hour of school. It too is less than what the bolus amount would be.

    We do run a higher basal than is needed and lower bolus insulin for the waking hours because at school she does not pre-bolus like we can do at home.

    I have thought of doing what you describe but we rely on the IOB calculations and I would have to try to figure out a new way of looking at it. I just wish I could program a meal bolus amount t be automatically given at a set time.
     
  4. StacyMM

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    I do this with my son's lunch because he wasn't very good about bolusing at school. We've experimented with it to get the right balance. He gets the same carb count at lunch every day and it works best at 90-95. Anything less and we had grazing issues after school, anything more and I couldn't get the afternoon numbers right. He does correct for highs and lows when his CGM alarms so this just accounts for the food.

    I've discovered two oddities. First is his post-lunch correction number. Because the pump doesn't see basal as insulin on board, I tried running with much higher numbers. In the end, though, his post-lunch correction is 30 while other times of day are 20. So not much of a change, which seems odd to me. Second is weekends. Because weekends are with us and he does bolus at home, I was using a different, non-lunch included basal on weekends. His pump doesn't allow settings by day though so the change in correction was a manual change twice a week. I decided to use the school pattern on weekends, too, and trial and error showed me that he needs to bolus for his lunch on weekends. No matter how many carbs. Which means there is basal for 95 carbs AND bolus for whatever he eats...but it works. And I have no idea why. He does have to eat by 12:30 to prevent lows but that's it.

    I also use basals to pre-bolus for breakfast for both kids. I adjusted the patterns so it isn't more insulin, just a redistribution of it. They still bolus for breakfast but it eliminated spikes.
     
  5. Guru_rb

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    Thanks for the kind words. Is there any test to figure out whether her pancreas is still producing any insulin?

    Yes, the IOB algorithm will not take this additional insulin into account and if you are giving another meal within say, 2-2.5 hrs you will not have IOB available to you.
    And yeah, how I wish I could program a bolus to be delivered at a specific time. I sincerely hope the day is not far when we can do a complete remote monitoring/management of our kid's D. The technology is all there, just the integration is what is required.
     
    Last edited: Mar 2, 2014
  6. Sarah Maddie's Mom

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    They can look at C-peptide levels to assess natural insulin production - though I think I've read that it can be a finicky test to time. Generally speaking it would be very, very unusual for someone dx'd with Type one to be completely reliant on injectable insulin within the first few years. They have even found c-peptide in Type 1s decades after dx, suggesting that the body keeps trying to generate beta cells despite the auto-immune assault.
     
  7. KHS22

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    This is very interesting! I was thinking about this for my daughters snack time at school... she has a nurse come at lunch, but every AM they have aboyt a 15-20g snack. Only issue I guess is, if they don't eat that day? I guess the teachers need to make sure they eat, and if they don't/aren't hungry etc, they need to make sure they take some juice or something???
     
  8. mmgirls

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    So is you dd then on a pump already? Or are you thinking of the future?
     
  9. Mish

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    The only thing I would want to share is that what you're doing is pretty much what we used to have to do using an older type insulin like NPH. Because of the insulin peak, it covered lunch at school. While most of us completely hated NPH, it really did have good points, and the fact that it allowed lunch/snacks with no shot while at school, was one of those good points. The bad stuff is that you really have to be sure that the food is being eaten at the right times and in the right quantities.

    So I would just make sure that 1) meals are always eaten fully and that 2) someone is monitoring that they're always being given at the same time. I probably would, at the very minimum, write out specific step by step, button pushing, instructions for your daughter as to how to turn off her basal if something were to happen with the meal. Or at least keep some sort of food on her, in the event of an emergency.

    And I think that as far as amounts, your endo is pretty much right on. We absolutely see the same things.
     
  10. KHS22

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    March 31st is our go-live date!!! :)

     
  11. MomofSweetOne

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    Our endo said that when testing c-peptide, the BG should be at least 150 so that the pancreas would (hopefully) be working to bring BGs into range.
     
  12. mmgirls

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    I believe that they like to do a mixed meal glucose tolerance test, have a glucose load and let BG climb and test blood for the presents of c-peptide over the course of 2hrs. something also about being high carb for a few days before to get the "best reading"
     
  13. Guru_rb

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    One cannot attempt this if not sure about either the timing or quantity of food. At my DD's school her teacher makes sure that all the kids finish their meals. And my wife packs what DD can easily finish. And we have taught her to stop and restart the pump, should it come to that.
     
  14. Mish

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    Then, I think you're spot on with what you're doing. :) That really is one of the beautiful things about pumping, the flexibility.
     
  15. shannong

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    I think that is a really cool idea. I am curious then: if your child eats lunch at say 12, what time do you increase the basal at, and for how long?
     
  16. Guru_rb

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    My daughter's day time basal is 0.25 U/hr. For her 12:15pm lunch, I have increased the 11am -12 noon basal to 0.50 U/hr and 12 - 1pm basal to 1.45 U/hr. Her lunch has 37 g carbs. 1 -2 pm, its back to 0.25 U/hr.

    Interestingly her carb ratio is 1:15 and if we were to bolus for the same food, it would be 2.5 U, where as here the net addition is only 1.45 units of insulin!!
     
    Last edited: Mar 3, 2014
  17. shannong

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    Thanks. I may try that for one of my son's snacks in the morning. He calls me when he is going to eat and we discuss the bolus, but he doesn't like taking the time out to call me 3 times a day. He doesn't feel comfortable bolusing for food without talking to me though (he just turned 8).
     

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