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How soon to change dosing?

Discussion in 'Parents of Children with Type 1' started by samson, May 13, 2016.

  1. samson

    samson Approved members

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    I'm wondering how quickly people change dosing when it seems like you're consistently running high/low. Our son recently switched from MDI to an Animas ping. He's been running super high with the deliberately conservative settings the ENDO gave us. What she didn't tell us is how quickly and aggressively we should move away from those settings when it's clear his blood sugar is just hanging out in the high 200s, 300s and 400s for most of the day. It's the weekend so we can't call in anymore.
    What do we change first? His carb factors for breakfast, lunch and dinner? His basal rates? How many days of data do you need before you make a switch? I want to make sure I get the initial settings of at least basal right, even though I also know things change so much. On the other hand, I'm worried this consistently high BG may kill of whatever Honeymooning period he had left and put him at risk of DKA.
    Before this, he was getting frequent (sometimes 3X a day) lows.
     
  2. dpr

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    The same thing 3 days in a row and I'm changing it. Every now and then I'll get bit and it will change back after the 4th or 5th day but more often than not 3 days works for us.
     
  3. nebby3

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    If he's consistently high I'd change basal first. I'd likely only give it two days. It sounds like you are still adjusting pump settings. Normally I would give it 3 or 4 days if you had things balanced right to start with. One exception is in puberty (esp with a girl) I change things quickly cause I know that the patterns turn quickly.
     
  4. Mimikins

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    I typically wait 3-7 days (shorter if it's me lowering a dose due to lows, longer if it's me raising a dose due to highs. I don't want to mess around with lows) and will play around with temp basals prior to "locking it in" and updating my pump profile's basal rate.

    Do you have John Walsh's Pumping Insulin? The book is really useful in learning how to basal test (the "gold standard" for determining if BG trends are basal or bolus related and how much to modify basal rates based on the basal test result) especially when you're first getting everything straightened out.
     
  5. Just Jen

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    We don't use the Ping, but I imagine the feature set is similar to the TSlim. What I do if there is a consistent pattern of highs over three days is to try an across the board temp basal in small increments. Try a 105% the first day and see what effect it has. Try 110% the next day and compare. Easier to see the differences if you keep their food intake and exercise routine similar on those days. Works the same in reverse if you have a pattern of lows. At least it will give you somewhere to start rather than simply guessing. Good luck!
     
  6. samson

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    Thanks everyone -- I'll take a look at his basal, as it is set really low: it's about 10 percent of his TDD, whereas "Pumping Insulin" suggests it should be around 45 to 50 percent. So we do think that needs to be raised. On the other hand, the past two days his blood sugar has stayed pretty much on a straight line all night, dropping only in the early morning -- so at least his nighttime basal seems okay.

    .... And we just had a super scary near-miss hypo where he was at 300, we gave him the conservative correction dose suggested by the Bolus Wizard (which had been running him consistently high for days), and he started dropping 30+ mg/dl every five minutes (Thank you Dexcom!). We had to give him 40 grams of carbs to head off the low, but he was just hanging out in the low 70s, mid 60s for an hour or two. His carbF is 1 unit to 50 grams of carbs and the dose we gave him when a finger prick showed him at 314 and rising was .5 units. Really not sure what happened, as the math makes no sense -- but I guess that's diabetes for you.

    So now I'm worried about changing his ratios given that he had such a scary low. Ugh.
     
  7. wilf

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    We move to adjust dosages if DD is stuck high for more than a day. In your situation I'd up day-time basals for sure (try doubling them), and see if he drifts back into range.. :cwds:
     
  8. msschiel

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    Children's of Pittsburgh recommends a 10% change of basal if you see the same pattern 2-3 days in a row. My son used quite a bit less basal when he started the t:slim back in November. We were about 40% basal/60% bolus. We have been running near 50/50 for quite some time. I am sure things will change once he is done with puberty, but he just turned 13 and grew 1" between January and April, so I know he isn't done growing yet.
    h
    There are so many things you can adjust with the pumps, that is confusing as to what changes to make. Last appointment we had to change his bedtime snack I:C ratio, as he was dropping after snack. We just got dex in March and have caught quite a few scary lows that I am sure we missed before we got it. If you aren't sure, call the endo. When we got our pump, we had to call our numbers in just like we did after diagnosis, to make and adjustments. We can still call in any time and they can take a look at our uploaded information and give us a call back with suggestions.
     

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