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Basal Needs Doubled - how do you know if Temp?

Discussion in 'Parents of Children with Type 1' started by mamattorney, Dec 16, 2013.

  1. mamattorney

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    How do you know if it a true increase in needs or if she's getting sick or otherwise having a temporary increase in needs?

    My Daughters basal needs have literally doubled (plus) in the past three days. And that includes lots of outdoor sledding and other snow play.

    I've been addressing it as best as I can with temporary basals running virtually around the clock, it's working sort of (I'm keeping her out of the 300's, but seeing lots of low 200's that won't budge)

    How do you know when to pull the plug on the basal profile and start over with higher rates and when to just assume its temporary?
     
  2. roo'smom

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    I have no sage words of wisdom for you, but just want to commiserate. My DD is the same age, 11, and we're having the same issue. This is the second time it's happened (happened back at the end of the summer). She went almost back to her "normal" basal pattern last time, but we'll see about this time. My best guess is that it's hormonal. Our endo said that when they first enter puberty there is no rhyme or reason as to when the body will spit out hormones, so it's difficult to be proactive instead of reactive. Once she starts her cycle there will be more of a pattern and it will, hopefully, be easier to deal with. It's enough to send me over the edge though!! Hang in there :eek:
     
  3. MomofSweetOne

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    Unfortunately, you often don't know with puberty until afterwards, if then. Use your CGM to see that your daughter is getting the insulin she needs to be healthy and feel well; that's the most important thing.

    How many profiles does the T-slim have? Medtronic has 3, so we have one that is profile, one that is 200% of profile in case of really insane need increases, and one that is 0.0 for when she doesn't wear the Medtronic. I use temp basals for all amounts in-between. The temp basal alert doesn't get noticed anymore than any other clock chime in our house. On the Pod, there are seven profiles, so I have them set to different percents of basal. As I found patterns of amounts she used more often, they became set. They range from 70% to 150% of profile. The pods temp basals only go for 12 hours, so using them didn't work well for us; we'd forget to reset them!

    Hang in there; it's a wild, wild ride for a long time, but I'm starting to see longer and longer stretches at the same basal rates again. I've been told more stability happens around 16-17, so I'm hoping that by the time my daughter is ready to be on her own, this craziness will be only a memory.
     
  4. Shopgirl2091

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    We had the same problem too - my son isn't entering puberty but I thought he was getting sick. After a week and a half of running temp basals of 180% plus I finally started to wonder if his pancreas was dying just a little bit more (we have been honeymooning) I dialed up the normal basal and down the temp basal one day at a time until he was no longer getting any temp basal. Now he is getting two more units of basal insulin a day than he was before.

    I think that after a certain period of time you would attribute it to growth or hormones, or something else other than getting sick. I kept expecting him to start getting sick - I would think it would only have been 3-4 days of highs before an illness, but for me after a week and a half that was the point I started to think that it was something else and he needed an across the board basal change, not just a temp.
     
  5. Wren

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    Same here with my 10 year old.

    We've done 2 things. Run temp basals for 12 hours at a time (the max you can go without resetting on omnipod) for a few days, then decide we're sick of restarting temp basals and change the profile.

    And, we have about 4 different profiles saved on the Omnipod that we can go to (or go back to).

    Just this month, we had a day with a TDD of 100 (huge hormone rush) and another with 5 (intestinal illness).
     
  6. hawkeyegirl

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    I consider all basal rates to be temporary. ;)

    But seriously, I never use long-term temp basals. I increase basals on the "regular" basal pattern (or decrease) as needed. You could always copy the regular pattern over to a new pattern and adjust on there, so it's easy to go back to the original pattern if need be. It's SO easy to do that on the t:slim.
     
  7. wearingtaci

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    This happens all the time to us,it seems cyclical. We increase,increase,increase....then bam...decrease. Every time we increase/decrease her new basal remains somewhat higher then when the cycle started
     
  8. MomofSweetOne

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    But you've never managed a girl in puberty, either. The basal rates can and do literally change on a daily basis. Until recently, I used basal on a 24-hour basis, resetting at bedtime each night unless it was obviously wrong during the day.
     
  9. KatieSue

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    We make a new pattern with the changes. Then you have the old if it goes back. Quite often it doesn't.
     
  10. mamattorney

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    This is a good idea. I think I will double everything and make it a new profile. the t:slim doesn't like 200% temp basals - it periodically beeps to warn you that are using a 200% temp basal, so I've been running 199% temp basals. . . and still watching her sit at 201 straight arrow with corrections not helping much. I just keep waiting to see the double arrow down as I knowingly stack corrections, but it just hasn't come.

    I think I'll just have to make sure my daughter and the school nurse are thinking of this new profile in case she does crash. They started the X-country skiing unit for gym and have been skiing every day and will be skiing all week this week, too. I made sure she had the potential for lows on her radar due to the skiing (and sledding this weekend), but we haven't seen a number below 130 in three days.
     
  11. Lee

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    I just want to suggest another point of view - though rare...are you testing outside of normal times? When I see suspicious higher rates, especially with intense exercise like sledding, I always try to test outside of the standard times. Sometimes I catch a low that causes a rebound and it just starts trend where she is running high due to rebounds and not too little insulin.

    I have only heard of one or two other parents who have experienced this, but it does happen.

    With that part said, when Coco started puberty, we would have two high weeks followed by two low weeks. We managed this with two patterns and as soon as I saw a few high days or low days in a row, we would switch over.
     
  12. hawkeyegirl

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    I don't think I was disagreeing with you. :confused: I adjust basals quite frequently. We definitely have times where we are adjusting daily. I would prefer to adjust the rates themselves or use patterns, as opposed to using temps, but it doesn't matter that much.
     
  13. mamattorney

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    She has a dexcom - so I'm seeing it all, which is good because I can rule that out at least.
     
  14. MomofSweetOne

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    10 minutes of x-country skiing with IOB yesterday sent my daughter from 191 to 60s. If the skiing is immediately after a bolus, try reducing the bolus in 1/2, after an hour, try reducing by 1/4. Make sure she's at 150 or higher before starting. If it's for a longer period of time, a temp basal of 50% of whatever she's currently on works well as well.
     
  15. MomofSweetOne

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    I went with the temp basals because during one of the T1Us we took, Gary said that with puberty, the profile doesn't typically change, that the kids still need the same basic profile, just more or less. It's been almost impossible until recently to get 3 days at the same basal level to even try to tweak anything, but increasing the entire profile worked well. I couldn't have kept up with all the reprogramming that the last 2 years would have required; even keeping up with a temp basal has been extremely demanding.

    But, reading this thread makes me aware how different every child is. My daughter hasn't had 2 weeks of one profile, 2 weeks of another. She would stair-step insulin needs for a while and then have a dramatic, fast drop and then it would repeat, but never at consistent intervals. Sometimes once a week, sometimes 3 weeks. Nothing was predictable except that at some point, a fast scarey drop would come. Then for a while, things went really nutty where one day she'd be completely in range at 200% basal followed by 50% the next day. Now we're starting to see several days without changes and even the same pattern on the CGM, and I'm beginning to see the light at the end of the puberty-roller-coaster-challenge.

    Be glad your T1 is a boy; an endo told me that boys are extremely easy in comparison.
     
  16. Lee

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    THAT IS soooo helpful!
     
  17. missmakaliasmomma

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    My daughter needed a lot of extra basal and fast acting this past week, dont ask me why lol. Today, that broke and her nurse was treating 80s all day. She had no outward signs of sickness tho, no fever etc. My guess is its temporary, unless puberty is rearing its ugly head.
     
  18. Phyllis

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    Basal Rate Increase

    I suggest trying a new vial of insulin. Even if the expiration date is ok.
    If the vial has been open for over a month, it could lose its potency.
    This has been our experience. Let us know how this works out.
    (This is in response to the parent who had to double basal rates.)
     
    Last edited: Dec 21, 2013
  19. DavidN

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    I've had this thread starring me in the face for a week and it's STILL taken me as long to increase basal sufficiently. He's been running high for 5 days and raising and correcting, raising and correcting. Avg hourly basal is now at 1.1u vs .4u a week ago. I always thought increasing basal by .1u / hr and watching for 2 days was the way to go but that has been wayyyyy too slow. Poor kid. I suck.

    Quick question, when basal needs go up this drastically, do bolus needs typically do the same in your experience? Should I be cutting IC ratios in half? Or will the radical basal adjustments typically do the trick for the most part? Thanks.
     
  20. StacyMM

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    Thank you for sharing this. I love it. You have made my life simpler :) I decided to redo my daughter's basal patterns. I kept the one that has been working okay, then duplicated it 5 times and adjusted them so that I now have 20% increase, 10% increase, 5% percent increase, normal, 5% decrease and 10% decrease. When she's running higher, I just change the basal. When we are chasing lows, I change the basal. My use of temp basals has decreased considerably because now I can just run a different basal until we see a new need - sometimes two days later, sometimes just to cover basketball practice and the hours afterward. I love it :D
     

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