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Help with dosing

Discussion in 'Parents of Children with Type 1' started by Junosmom, Feb 8, 2014.

  1. Junosmom

    Junosmom Approved members

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    I am asking for advice to handle basal/bolus at bedtime. We've had a recent change that I should be able to correct but want to do it in the best way.

    DX was 9/2013. Son is 11 yo. We are on Omnipod and Dexcom G4. Always try to bolus at least 20 mins before eating. 0.4 basal, 1:10 carb ration, 30 BG correction, uses maybe 40 U a day

    Before:
    Dinner at about 7 p.m. BG showing slight downward at 10:30 when he has bedtime snack, sending BG back up a bit. He would then go to bed with BG rising, but by 3 a.m. when I'd check, he'd be at 120 or nearby and stay flat at that all night. If I checked earlier, I could see still IOB and decreasing BG.

    Now:
    Same pattern dinner, snack, rising while going to bed, except I am seeing BG decrease as it should at midnight, but then turning around and going back up again! It goes up to about 180 one night, 160 another. Last night he was higher, like 240. BG stays there all night unless corrected. Good news is that he will stay at the same BG all night once it settles to a number. So if I can correct to say, 100 at 3 a.m., right now (I realize this can change), he will be 100 when he wakes up.

    I can correct with bolus at midnight, but I have to be careful. PDM has been advising more insulin than I feel comfortable giving at night. I usually give half of what it recommends and the number has gone to what I wanted it to - and had I followed the PDM calculation, he'd have gone low.

    I am thinking that I should probably be running a basal program for this in the evening, but being new, not sure. I see by reading here that a 50/50 basal/bolus is a goal? but we are at 25/75, so that is something I want to work toward anyway.

    Advice? I was thinking that maybe I should run a higher basal during dinner and up to midnight. His highest numbers are always dinner through midnight now and until I bring him to the number for the rest of the night.

    This is complicated with occasional pre-dinner workout (class), and on Mondays, he goes low at bedtime due to a 2-hour class before dinner. We are working on that and I think I have that going in the right direction.

    Update: slight dawn effect this morning starting at 6 a.m. but only about 10 BG.

    Thank you for your help.
     
    Last edited: Feb 8, 2014
  2. virgo39

    virgo39 Approved members

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    The PDM is recommending a bolus based on what you have programmed. If a half correction works, I'd start by changing the correction factor for the overnight hours, then tweaking the basal.
     
  3. nebby3

    nebby3 Approved members

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    Jun 5, 2007
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    I agree with using a different correction factor overnight. If you up basals, don't forget to do it a couple of hrs before you see the bg rise.
     

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