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Does basal help?

Discussion in 'Parents of Children with Type 1' started by ashtensmom, Nov 29, 2011.

  1. ashtensmom

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    Wondering if an increased basal will help tame a post meal spike?

    DD's BG after Bfast went up to 15.9 (286 mg) checked at 1 hour 15 mins post meal, not 2 hours because she thought it was a low feeling. Without a correction, she dropped low before lunch to 3.3 (59 mg)(about 3 1/2 - 4 hours after Bfast). We have increased her I:C ratio but know that this doesn't help with the 286 mg spike. So, is it advisable to "increase" the basal. Would this help with lowering the after meal spike and prevent the low at 4 hours?

    So a "high" after meal, but "low" 4 hours post, change I:C from 1:13 to 1:15 and also would increasing basal help here?
     
  2. wilf

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    She needs a little less insulin for her breakfast bolus, and she needs it sooner.

    Ideally you want to make your decisions on basal based on proper basal testing - no carbs or insulin working in the time period to see what blood sugars are doing.
     
  3. lil'Man'sMom

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    Another important factor besides a prebolus is having a in range starting Bg too.
     
  4. Ali

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    True,true,true. If you can be in a general range i.e. 80 to 110 when you are trying to figure stuff out it makes a difference. Insulin needs, at least for me, vary on the level I start out at. Ali
     
  5. Ali

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    Sorry, second post. As stated earlier by others, yes a correct basal is critical. So it may be that it is not that an increased basal helps a spike but that you have a rise due to not enough basal no matter what the meal. If you can force you and your child to do it, try basal testing every couple of days for a week during different times. Your basals may be spot on and you need different bolus ratios for different meals, or you may need to use combo boluses etc for different types of meals, or you may need a change in your basal. I find it almost impossible to adjust my bolus if my basal is not pretty good. Remember also that if basals change probably bolus and corrections will change also. it is all relative.:pali.
     
  6. Melissata

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    You could also try a Super Bolus, which takes basal insulin and adds it to the bolus to prevent the spike. John Walsh wrote about it and there was even talk about a pump that would do this, but it hasn't happened yet. If you started out with an bg in range and waited to eat, then the Super Bolus would be a good thing to try. It is easy to do. Just add the basal amount to the bolus for an hour or two, then suspend the insulin in the pump for that length of time. You can google it also and I think that there are even a couple of Utube videos on how to do it with different pumps.
     
  7. JackyH

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    We used to add basal and while it dulled the spike it also caused lows later. We prebolus by 35-40 mins (you should start at 15 mins and work up slowly until you find what works for Ashley. It does not eliminate the spike but it usually tops out at around 11 before dropping into range within 3 hours.

    The super bolus sounds interesting too but I wonder if that would cause highs later... I must try it.
     
  8. ashtensmom

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    Hmmm, I have noticed that if she is high at a beginning of a meal, that at the 2-hour mark, she is still high. I used to think that giving insulin for the carbs, PLUS insulin for the correction would mean that even though she is high at start of meal, that at 2-hours she should be in range because of the EXTRA insulin. So does the above statement mean if she is high before meal "a correct I:C ratio and extra insulin will not bring her within range at 2-hours"?... and I should stop changing her I:C ratios based on this :p
     
  9. kiwiliz

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    We have a basal heavy regime. It keeps on top of spikes - as long as she doesn't forget to have her meal bolus!!!! If she ever wants to sleep in we can do a temp basal or a different pattern. I always find that if she doesn't have that "pool" of basal that she tends to go high later in the day. A temp basal increase at the same time as the meal bolus helps - but doesn't eliminate the spike.
     
  10. wilf

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    If your carb ratio is correct and your ISF is correct, then if she is high before a meal and you bolus with a correction added - then by 3-4 hours post-meal she should be back in range. At 2 hours post-meal she still has a lot of insulin on board, and is still coming down.
     
  11. Melissata

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    Not sure how often she is testing, but the best thing is to try not to have her eat when she is high, if at all possible. If she tests a half hour or so before the meal, she can bolus for the meal and the correction dose together to start bringing the bg down before the meal. Otherwise she will just go up with the food, and that makes it even harder to see a decent 2 hour number. If she tested at 1 hour, you would probably be shocked at how high she is. We have been using CGM's for a couple of years now and that has been eye opening for sure and has enabled us to really stop spiking for the most part. Melissa's CGM is set to go off at 160 for a high, and that almost never happens after a meal unless we have let her start the meal above range.
     
  12. StillMamamia

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    True. And for us, at least, the more towards the low end of his range, the closer to the meal we try to prebolus. The higher, the more advance we need. If that made sense.:eek:
     
  13. MommaKat

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    Thanks for adding that Wilf!

    I noticed that the OP mentioned Ash checked post meal before the two hour mark (because she felt low). I've found with Niko that if we test anything before two hours we're not getting an accurate picture of what the IOB is doing / will continue to do, and she'll likely be mid 200s. If at 2 1.5 hours dd is close to 180 I don't worry. By three to 3 1/2 hours post meal I know she'll be right between 100 and 140.

    This is one area I really had to get it through my head the idea that your diabetes may vary (YDMV) was / is such an important concept. (I don't remember the first time I read that here, but thanks to all for bringing it up frequently!) Our endo insisted on a post BG two hours after the beginning of a meal. I noticed that if we went with that dd seemed high, but if we tested 2 1/2 hours after dinner she was perfectly in range, often at or under 100. Insulin action seems to have a steeper curve of action in dd (and the science part of my brain wonders if that's why we see a peak with lantus, but that's a different post)

    I was rereading the Pink Panther Book and Dr. Chase stresses that the post meal check is between 2 and 3 hours and the goal is to be 180 or less b/c the fast acting is still working. Looking back over my notes from one of his talks, I found that he really stresses the onset, peak, and duration of action for insulin really varies from patient to patient. Keeping detailed notes has helped us learn that Niko needs to prebolus most meals by 10 minutes, 15 minutes may cause her to go low before her food hits, and her peak action is a little delayed so we test 3 hours post, not 2. Other foods like pizza and pasta, we can't pre bolus at all, and have to split the dose giving 1/2 to 2/3 right before she eats, and the remainder an hour later. (She had pizza yesterday and never when above 143, wahoo!)

    Last thing, I keep reminding myself that everthing that seems to work right now could change before the end of the day or tomorrow. We have some good ideas on what's working, how, ect. but the moodiness tells me she's about to hit the next phase of puberty and everything will change - again.
     

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