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Basal help

Discussion in 'Parents of Children with Type 1' started by Charlotte'sMom, Aug 9, 2012.

  1. Charlotte'sMom

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    I need to step it up and fine tune C's basals, especially while she's at school. I'm realizing they are probably way off but right now I need to focus on the morning. She's on Apidra and DIA is set at 3hrs right now.

    My biggest concern is this drop we're seeing from 11:00 to 12:00pm. She gets on the bus to come home at 11:10, and twice a week that's right after PE so I don't want her dropping like that on the bus. Her bg is checked before she gets on the bus and it's fine, but she comes through my door 30 minutes later a lot lower. She doesn't eat anything at school. (And FYI, yesterday was very similar to this. I have noticed this pre-lunch drop the last week or so when I started really paying attention to her numbers. :eek: )

    Basals - Total 7.61units
    1200am - .150
    330am - .125
    630am - .425
    700am - .450
    930am - .325
    200pm - .375

    Today's numbers
    704am - 98mg/dl
    718am - bolused for 24 carbs (no prebolus :eek: )
    757am - 246mg/dl
    758am - bolused for 6 carbs

    1000am - 197
    1100am - 150ish (I don't remember exactly)
    1130-1200 Dex showed her dropping and Dex said she was 55 at about 1210

    Now, I just glanced at her TDD and it looks like her basal/bolus is too heavy on basals. We did have a problem with morning spikes, hence the heavy morning basal. Her bfast I:C is 1:23 and lunch is 1:31 and dinner is 1:37. For some reason I resist changing ratios more than basals, especially when her bfast ratios are already so much lower than dinner.

    Now, I know I should do basal testing. I'll have to do that Saturday. Though I already know something's off because of the way she's dropping. Since she dropped yesterday too, I had already switched the that 930am basal from .350 to .325 and moved it back from 1000am.

    It's just all so messed up I'm don't even know where to start.
     
  2. Jordansmom

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    When basals are really messed up and I know its going to take a lot of basal testing to get it straightened out, very first thing I will do is just stop the lows. Then you have time to sort it out without worrying about her on the bus.

    So if it were me, I would lower the existing basal segment before/during the time she is obviously dropping right now and then do the basal testing in pieces as you have time.

    Basal testing on Saturdays can be a problem if your schedule and activity is vastly different from school days. That is definitely the case for us. Sometimes its all you can do, so I'd have her get up at the same time as she would for school, and try to keep a similar schedule.
     
  3. hawkeyegirl

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    I agree with Jordansmom. It is impossible for us to do basal testing for school days because it's impossible for us to replicate his school day at home. I'd just go ahead and lower the basal two hours before you are seeing the drop at school and see how that works. It's what we do - try something, and if it doesn't work, try something else. ;)
     
  4. maciasfamily

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    Agree completely! We are starting to set up a different basal for weekend and one for school/daycare.

    Our son too was really high at breakfast, and we had high basals. But now that he's having a little more activity in the mornings he is dropping low, or staying lower than I like. We've had to make several changes to basal and it looks like you do too.

    Start with the 2 hrs before she drop up until the low happens. I agree on waiting to change her ratios.
     
  5. Charlotte'sMom

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    I didn't think about how a different routine would affect the basal testing. Since I'm pretty sure her basals are too high (b/c the BG drop comes more than 3 hours after a meal bolus) I'm anticipating lows, and I hate to send her to school after eating a carb-free breakfast and have her go low. I think maybe we'll eat just eggs for breakfast till Monday to give me time to see what it does each day.
     
  6. Jordansmom

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    I totally understand where you're coming from. I admit I am pretty aggressive with my first guess at lowering basals to fix a low pattern at school. I would rather see a bit of a slow rise on the dex that I can fix by creeping the basal back up, than see any big drops at school. I'd be particularly aggressive because of the recent addition of recess and PE to her schedule.

    I always make a second basal pattern and leave the original alone for reference, until I'm done making changes and feel somewhat sure what I've changed is working.

    Eating lower carb over the weekend to get a general idea of where changes need to be made is still smart. If things are really out of whack like you think they are, it gives you a stronger starting point for school basals.

    Good luck. I hope after school bgs gets better soon.:cwds:
     
  7. Charlotte'sMom

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    Okay, so I changed the basal slightly before starting basal testing this morning. Clearly, her basals are still too high, especially since she's been sitting around watching TV this morning and not going to recess at 10am like the last 3 days. :eek:

    Updated Basals
    1200am - .150
    330am - .125
    630am - .400
    700am - .400
    830am - .325
    200pm - .375

    (According to her Dex she had been holding pretty steady for the 3 hours before I tested at 624am, but I also corrected a high at 1am, just fyi)
    624am - 181
    803am - 155
    933am - 133
    1019am - 88

    At this point I need to abandon our basal testing. (I just gave her 4oz of juice, but I'm sure that's not even enough to hold her until noon) But I know she'd still be dropping until noon, since that's what she's done the last 3 days at school.

    So Tina, what's "agressive basal changes?" Give me some numbers. I don't want to pull them out of thin air. ;)

    Also, I'm assuming I will also need to change her breakfast I:C ratio which is currently 1:23. (I still think back to the days when her rations were 1:45 and 1:60 and gasp at the thought of how high (low?) they are now!) For the first 3 days of school she had whole grain toast with eggs, and a couple slices of cantaloupe, which totaled about 30 carbs. I didn't get much of a prebolus in, but we still saw spikes into the 250s. Friday she spiked up to 325.
     
  8. Charlotte'sMom

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    Also, just wondering out loud here after looking at her total basals for the day. If I know her AM basals are too high, is it safe assume to some of these other times of days are also too high? A long time ago C's endo pointed out most people change basals before they change ratios, and I know that's true for me. I know I *should* do basal testing for every time of day, but you can imagine how cooperative a 5 year old is going to be when I suggest that one. :rolleyes:

    Basals - 7.02 U
    1200am - .150
    330am - .125
    630am - .400
    700am - .400
    830am - .325
    200pm - .375
    630pm - .400
    730pm - .475
    930pm - .250
    1100pm - .175

    Lunch 1:31
    Dinner 1:37
     
  9. Jordansmom

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    I wish I had an answer for you.:eek: Charlotte's basals are so drastically lower than Jordan's have ever been, I'd be stupid to guess. Hawkeyegirl is right, sometimes you do just take a best guess and pull a number out of thin air, and if it doesn't work, adjust from there.

    You can see its got to be a big change though. She dropped 100 points in one hour. I know she gets ornery when she's high. But I'd rather guess and see her a bit high on the bus than low.

    I make bigger changes when I'm fixing lows and then small conservative changes over days if her bgs run higher when she's in school. Right or wrong, its just what makes us both feel okay about making changes during school hours.
     
  10. hawkeyegirl

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    I think for her size, I'd consider a 0.05 increment a "big" change and a 0.025 increment a " regular" change.

    I also wouldn't assume that other basals are too high. They may be, but not necessarily. :)

    We do not do much actual basal testing. If I see an increase or decrease in BG where I don't think I should, I just change a basal and see if it helps. ;)
     
  11. Charlotte'sMom

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    I just don't want to do the guessing either. ;)

    So what about this?

    1200am - .150
    330am - .125
    630am - .350
    830am - .275

    And then change her ratio from 1:23 to 1:20?

    I don't think she'd let me do basal testing again tomorrow morning. :rolleyes: But if I keep it lowish carb it should give me an idea if we're headed in the right direction.
     
  12. Charlotte'sMom

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    Okay, so I made the above basal changes, and then I went ahead and changed basal rates all day. Basal total is now just about 6 units, so it was a pretty drastic change. But I changed her lunch ratio to 1:27 and dinner to 1:33. I am LOVING the results. Hardly any spikes, and no lows 3-5 hours after a meal. I think we're on the right track! Unfortunately, a friend brought over donuts for breakfast yesterday, and since I was SWAGging the carb counts, I'm not sure if the great numbers afterwards were b/c of her pump settings or sheer luck. ;)

    Today we had the same for breakfast as we did last week. She spiked a little bit higher than I thought she would. According to her Dex, she spiked to about 260 and then came down steadily. Here's how the rest of the morning went.

    703am - 116 and 1.2U for breakfast
    CGM spike to 260
    1000am - 178 (and then 15 minutes of recess in the heat)
    1100am - 130-something

    Apparently the teacher gave Charlotte 12g carbs about 10:30am. I haven't talked to her yet, but that's what the nurse said. But C's CGM shows her at just above 100 then. She may have had one arrow down since the teacher felt it necessary to treat her. By the time she got home, the 12g carbs had brought her back up to 235. So, I'm guessing that she was going to hold pretty steady at 100ish, otherwise the 12 carbs wouldn't have brought her up so high.

    However, the drop from 178 to 100 in 30 minutes is still a bit concerning. Recess is going to affect her more than I'd hoped. (And PE tomorrow is going to be worse) Any suggestions on what to do from here?

    Also, I was pretty sure the Ping could hold 2 different basal rates for different days. I can't figure out how to do that.
     
  13. mmgirls

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    in sett up go to "advanced"
    hit ok on next to go to go to screen 2
    arrow up twice to select program "1"
    hit OK
    arow up once and it will change to "4" basal patterns
    ok twice to accept and then get out

    Now you will have 4 basal patterns to do
    1 weekday
    2 other
    3 weekend
    4 exercise.
     

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