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Help with numbers please

Discussion in 'Parents of Children with Type 1' started by Williamsville mommy, May 13, 2012.

  1. Williamsville mommy

    Williamsville mommy Approved members

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    My dd started pumping may 3rd. She was 1:12 b and l and 1:20 dinner.
    3 units lantus at night when we were mdi.

    They changed her carb ratio 1:15 b and l and 1:20 for dinner. We have slightly tweaked her lantus I believe she is up to 3.2 units over 24hours..
    Her numbers are good at bedtime. 110 -120. I have been doing 3am checks anywhere from an occasion 104 but mostly over 250. That's the first question should I change basal in middle of night??(little scary to me)
    But then, I started giving bolus before she eats. I give her breakfast at 745am, and then a uncovered 10g snack at 10. I have been checking her before snack at 10 and she is mostly always 300... Is this a bolus issue or a basal issue. I don't fully understand which one is changed first or more or more often....any help will be great......
     
  2. cdninct

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    A lot of factors go in to determining why she is going high after breakfast. FWIW, it is a difficult time of day for many kids, so you're not alone!

    We start with the basal rate. For that, you need to perform a basal test, which involves not feeding her any carbs and then tracking her BG regularly (30-45 minutes, depending on whether there is a lot of BG movement) to see what happens when no food or bolus insulin is introduced. In theory, a child should eat nothing for best results, but in practice, it is pretty difficult to starve a preschooler, so we allow our son to eat no-carb foods for breakfast, like bacon and eggs (the fats might skew results a bit, but it's the best we can do), and for snack if he feels he really needs it. He does dinner/bedtime snack as usual the night before, and as long as I don't have to correct or give carbs after midnight, we proceed with the morning test. If he goes lower than 80, we stop. If he goes higher than ~200 or stays there for any length of time, we stop. If his numbers stay in range, we keep going until about 1:30, or until he gets really insistent about needing lunch.

    Then we analyse the numbers to see where his basal needs are not being met, and when he is being overdosed. The tricky bit is to figure out how long it takes for a change in setting to take effect. I know some books say 1 hour, and many people say 2 hours, but for my son, it is more like 4 hours, so if he starts to spike at 9 am, we raise his basal rate at 5 am. This was really just trial and error and testing to see how long corrections take to take effect in general.

    Once basal is correct, then we look at his carb ratios.

    Good luck! The pump is so great because you can fine-tune insulin deliver, but the fine-tuning is a real pain!
     
  3. danismom79

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    Why is she getting an uncovered snack on the pump?

    How are her numbers upon waking? Is she waking high or coming down from over 250 by then?

    If she's not waking already high, the 300 is likely the breakfast hitting her. A lot of people have a hard time keeping that first meal of the day from spiking. You could give the bolus earlier, so the insulin matches better. I have to pre-bolus my daughter by at least a half hour.
     
  4. Mom2Will

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    The others have given you good advice and I will only add that you should probably know your fast acting insulin duration. Is it gone in 2 hours? The morning is very difficult and in fact Will has the highest basal in the morning hours. That is what is so nice about the pump, the ability to raise or lower the basal according to what you are seeing.

    Basal testing is important and difficult I will admit but it will give you so much insight to what is going on. Hang in there it will get easier.
     
  5. Williamsville mommy

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    10g or under when she was on mdi was uncovered...should everything now be covered? She is usually in the high 100 or low 200 upon waking
     
  6. Williamsville mommy

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    They tell me three.... So I am learning that I should try to play with basal a little bit at a time right now??
     
  7. nanhsot

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    I'm always leery of giving advice to children this young as I have no experience and things are very different in little ones.

    A few things did jump out at me, first question is what is your target at night? It does seem as if your night time basal needs a TINY push, in my son a leap from 100-250 would mean a big change but since you've also seen a 104 I would be very very conservative with it.

    For breakfast, you don't mention her wakeup number, so it's difficult to give advice on that one, if she's waking up high we're still talking about nighttime basal as the problem, which is what I suspect.

    BUT, I also notice you are now giving LESS insulin for breakfast, do you know why? This seems counterintuitive to me personally as most kids need more insulin in the mornings, generally.

    Finally, why an uncovered snack for a kid at 300? Is this per your endo or just a habit?

    Pump transition can be scary, and I know when we did an across the board (and for us it was radical) basal change I was really nervous but it was exactly the right thing. For my son his basal needs on pump were about 1/3 more than there were via lantus, so analyze numbers and try to figure what was before, it may be very different now.
     
  8. nanhsot

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    I didn't see this before my reply, sorry. Yes, on pump everything should be covered.

    EDITED: everday snacks should be covered via pump; of course sometimes you'll give uncovered snacks for lows, exercise/activity that is known to cause lows, and you can lower the basal during exercise/sports, etc. On pump you can fine tune your basal such that in general scheduled/uncovered snacks are no longer necessary.
     
    Last edited: May 13, 2012
  9. mysweetwill

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    Well, not always. Many kids still need uncovered carbs when active. My son does, even when we disconnect or suspend his pump. Probably obvious, but just wanted to add that caveat.
     
  10. nanhsot

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    Yes, you are correct, should never use the word always! There are of course situations like lows and activities that require uncovered foods. I was referring to scheduled snacks and such, generally on pump you can fine tune things a bit more.
     
  11. Sarah Maddie's Mom

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    I'm confused. She not still getting lantus while pumping, is she? Maybe you meant basal?

    Larger point, you appear to be pumping now but still thinking like someone on MDI.

    If you are consistently seeing high numbers overnight it could be her dinner ratio is off so the !:20 maybe needs to become 1:18 or 1:16. Are you correcting her in the night? If you don't, what are her morning numbers like? Then if she's high are you correcting with the breakfast bolus?
     
  12. Williamsville mommy

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    Sorry..no lantus! She really has no consistent pattern. We were instructed not to correct in the night, but yes with er morning bolus I correct...I just changed her basal rates from a total of 3.125 to a total of 3.3... May be this wil help?? Did I mention I hate diabetes??
     
  13. Sarah Maddie's Mom

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    Well, a basal rate change will only work if you've adjusted the right basal, at the right time. :cwds:

    Two quick thoughts... if you're not correcting highs overnight and she's still high in the morning it's going to mess up the whole next morning and make it very hard for you to get a handle on her actual insulin needs.

    I'd talk to the endo about adjusting the dinner I:C ratio and see if maybe that is the cause of the middle of the night highs. If it is, and she's then sitting high all night your morning correction probably isn't enough to get her down, add a breakfast spike and then an uncovered snack at 10 and you've just got a really muddy situation on your hands.
     
  14. Williamsville mommy

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    I just don't get it I guess. It's so confusing and overwhelming. I guess I will see what endo wants to do, but her before bedtime numbers are usually her best of the day...something happens at night that makes her run high, usually.....
     
  15. Mommy For Life

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    I hate diabetes too! :mad: That said we do love pumping! We were initially doing great when we started pumping, but soon we started seeing highs at night. This is the time when kids grow...hormones are going wild and insulin resistance (at least for our DD) is in full force. If we saw a high (at least 2+ days) around 10pm...say over 200, I would change the basal rate for 8pm and give a correction). Basal rates effect the numbers 2 hours after the time on the pump. I hope that makes sense. I would ask your endo if you can start correcting highs at night. You should be able to set up several correction factors for various times of the day. I have noticed both on MDI and the pump that the higher the BG the more aggressive I am with correcting. I also use the temp basal...but that may be more advance for you right now. In your situation, I would first get those night numbers back in range. Like Sarah mentioned waking up high and then going higher because of breakfast/snack can just make the numbers for the day wacko. I know this is hard, but it will get easier. Just take it one step at a time, and do your best not to get overwhelmed. Good luck! :cwds:
     

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