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Having quite an unexpected wild fluctuation in basal rates

Discussion in 'Parents of Children with Type 1' started by ashtensmom, Apr 9, 2013.

  1. ashtensmom

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    In the past 2 weeks DD have had quite a BIG fluctuation in basal needs and I want to post here to hear about whether others have had similar experience.

    We are used to her basals going up for a week, then down for a week, and so on. Also, used to having to turn up basals 20-30% on weekends. However, when DD started Spring Break 2 weeks ago, we experienced a HUGE increase in her basal needs. We kept increasing the increments until they were about 50-75% more than usual and finally tamed the super highs. Just of note, the huge increase surprised us as even though we were on holidays, we did tons of walking and had lots of activity everyday, so we thought that her basals would stay the same as during school days. When it kept needing to be increased, we thought, oh well... must be hormones/growth. Anyway, we have been home from vacationing almost a week and as of today - downward spiral on the basals - lows after lows after lows. I just decreased everything almost back down 50% (this after two nights of 20% temp decreases and still lows). One thing that we noticed that stood out for explanation was that she's had playdates the last couple of days, whereas when on vacation, even though we were active, she did not have a friend to interact with.

    She is back to school tomorrow for the first day post Spring Break and out of fear of lows, I have turned down pretty much all basal setting back to what it was before Spring Break.

    Anyone here gone through drastic fluctuations of basal like these? Like I mentioned, we have always done 20% or so in either direction, but 50-75%??? Especially since we were somewhat active during these No-School days. Do interaction with friends contribute this much?

    Other variables that we thought of was different bottle of insulin (but that was ruled out). Altitude between home and vacation location (ruled out as we have been home almost a week and she needed the increase for 4 days after return).

    It's like insulin was just water while we were on vacation and for about 4 days after returning, and now just starting to work like insulin again.

    Thanks in advance. Thought we got the hang of this after almost 2 years but D is still throwing in surprises.
     
  2. SandiT

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    I've heard that this is common on vacation. We went on vacation a few weeks ago, and found it true for us, as well. I was very confused until I read here about someone else and a bunch of people chimed in saying that vacations tend to be that way.

    I was relieved to find out that it's relatively common. Do wish I had known prior, lol.
     
  3. Beach bum

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    We've had times where we've had to set up weekend programs, especially at the beginning of the school year when we are getting back into a more structured schedule. Depending on the type of vacation we will either have to raise or lower basal. If we go to the mountains, we increase, go to the beach, decrease. Almost always lower basal across the board when the weather warms up and then of course for the entire summer.

    Not strange at all!
     
  4. ashtensmom

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    Hi. Thanks for the replies. Yes, we were already aware of different weekend rates and summer rates. But we only needed about 20% or so increase. This vacation was a whopping 50-75% increase and still getting high numbers. So the surprise here was the amount we had to increase her basal. Can anyone chime in what % increases you need to do for weekends and if you need more than your usual %increase when you vacation? I know YDMV so that's why I am asking % wise. Thx.
     
  5. Beach bum

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    Vacations are always trickier because of many different variables. Heat, cold, altitude, foods being eaten. For example, we went to CA to visit my brother who lives pretty much in the dessert. It was pretty hot, they swam a lot, and we ate home cooked food (so it was fairly healthy)...lows the whole time. Massively decreased basal. 3 days later we went to Disneyland, cooler, lots of walking, but snacky, not exactly healthy foods. Back up goes the basal!

    As for summer we start slow, usually go a few days first to see what kind of patters are occurring. Then we try 10% and if it doesn't do the job in 2 days, 10% more and so on...
     
  6. MomofSweetOne

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    Is your daughter entering puberty? What you describe sounds like what our D-management has been for the past 1.75 years. Insane increases and decreases. I've tried to keep a tested basal profile and adjust it by temp basals. She ranges regularly from 100% to 200%, occasionally even going higher or lower than either of those. I've learned how to predict how much I need to change the basal by pretty accurately, but it is nothing like the cautious 10% we learned at diagnosis. Last night around 2 a.m., her basal needs started fast-dropping. She was at 175% yesterday; today she's at 100%. The changes usually start in the night hours, too.

    If you don't CGM, I would highly recommend getting one ASAP to be able to safely make crazy adjustments to keep your daughter in range as much as possible.
     
    Last edited: Apr 9, 2013
  7. Darryl

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    You can expect this to start at this age and vary even more through at least age 14. Since age 11 or so we've had basal rates ranging from 0.25/hr one day to 5u/hr the next day, and everything inbetween. I think that would be a 2000% range if I did the math... Mostly this is related to growth hormone, which comes and goes at random intervals during the growth years and causes high insulin resistance along with glucose secretion from the liver, which together cause resistant high BG's. This is a normal process and in nondiabetic children the insulin secretion would vary over this range as well. Even during these times it is important to keep BG as close to normal as possible, so constant monitoring and adjustment is needed. The changes you'll see in the coming years are with rare exception not related to bad insulin, pump sites, or vacations, they are related mainly to growth hormone and physical exercise.
     
  8. Lizzy731

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    This happened with Bethany at the beginning of last summer. Crazy highs and dramatic basal increases. Then it just stopped and went back to normal. Have no idea what or why it happened. It's one of those crazy D things.
     
  9. Lizzy731

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    Didn't read all the comments and I just noticed her age...did she get her period yet?
     
  10. ashtensmom

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    Hi. No period yet. Gosh, she's only 9 I hope not to deal with periods for a couple years :cwds:
     
  11. ashtensmom

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    We live in Canada. I may be wrong but I think CGMs are not as prevalent in Canada. Our team has not even discussed this with us yet.

    I wonder how kids and parents manage puberty without a CGM (is it even possible). I can't imagine going from .25 u/hr to 5 u/hr within the night. Definitely would not attempt such a drastic increase unless using a CGM. However, I don't know much, or for that matter, I don't know anything at all about CGMs, but if you were rising that fast wouldn't the CGM not read it accurately?? And, from what I understand, you can't calibrate when dropping or raising, so how helpful is the CGM when one is experiencing such a drastic change in basal requirements? I am really trying to learn so please let me know.
     
    Last edited: Apr 9, 2013
  12. Lizzy731

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    I assumed she's almost 10 due to your sig. 10 is a little on the early side but could happen! The body starts preparing a long time in advance so it may be just the background beginning as well.
     
  13. shannong

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    We had the same thing happen to us recently. We are also from Canada, went away to Florida in March, and he was having these crazy highs. I thought he would need lower basal from all the swimming, etc, but the exact opposite happened. He needed a huge increase in basal (I can't remember exactly how much but it was something like up to 50%). When we got back, he started having lows and we gradually scaled it back again. Apparently this has happened to others when they go on vacation. I'm definitely go to look out for this the next time we vacation!
     
  14. MomofSweetOne

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    The basal craziness starts a long while in advance.
     
  15. MomofSweetOne

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    The CGM is still helpful. You have to be much more careful with Medtronic calibrations than with Dexcom, but you can calibrate under less than ideal and still have it read. I know the recommended with Medtronic is to calibrate with in-range stable BGs, but sometimes that isn't reality. I would calibrate in the 200s rather than not have it reading, and it still did ok. When we got stable and in-range, I would give it four calibrations to stabilize it again. It often didn't read as high as my daughter might be, but it was still letting us know she was high.

    Obviously, parents in the past didn't have CGMs and most T1s survived. I would imagine they ran high on the days when they needed more insulin, and that they had many undetected nighttime lows when less what known about what happens during the nighttime hours. However, we do have the ability to go for tightened BG control with the newer technology and it benefits our kids both now and in the future. I can tell the difference in my daughter's footsteps and how well she focuses on her schoolwork whether I was able to get her in range or close during the night. Without CGM, there's no way I'd feel comfortable dropping or increasing her a unit per hour at a time, but I do it regularly now to her benefit.
     
  16. JackyH

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    Hi S! How are you?? We were on spring break last week too. Our basals were BONKERS! I had several days where I never got him below 15 from the time he ate breakfast - we hit our first 100U DAY - yes, 100 units in one day with not a whole lot of carbs!!! He has grown 4 inches since his last appointment! We have been dealing with crazy basals since Oscar was about 10 1/2. We have cyclical periods where his basals increase overnight about 50-75% and then, just as drastically, drop back down. It nearly drove me insane until I realised it was what it was, most likely growth spurts, puberty, etc... and there was nothing I could do about it but go with it and adapt.

    When we started pumping, on his 10th birthday:( we were on 7 units TDD, about 2 units of that was basal - FOR THE WHOLE DAY!!!.... Now he is 12 he regularly gets 3 or more units of BASAL an HOUR!!! His highest basal rates are in the middle of the night when there is no food to contend with. His breakfast ratio is 1 unit for 3 (Yes - 3 -it's not a typo!!!) carbs with a one hour pre-bolus and he will still spike to 20 (360) before dropping back down!!! He isn't even a teenager yet! Back at the beginning it was 1 unit for 60 carbs (those were the days!). Honestly, they just need what they need and it will change constantly - the CGM definitely makes it easier for me to make drastic changes quickly but we are in a minority at ACH - I only know of a couple of kids who CGM out of over 1000 - they won't mention it to you unless you ask, but if you do, they are very knowledgeable but not necessarily pro-CGM (Shannon is the most pro/knowledgeable and she did our training). But, really, the number one reason we CGM is that Oscar is COMPLETELY AND UTTERLY hypo unaware. I regularly look after another D kid who can sense his lows before he even hits 3.9 - we do sleepovers and he will wake up when he is low!!!! There is a world of difference in the anxiety level as a parent!!!


    Hope you are well -has everything returned to normal now? We've dropped back to 2 units an hour at school :rolleyes: - still 1-3 at breakfast though!

    Hope we have a c-pak get together soon.
     

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