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Ideal basal patterns

Discussion in 'Parents of Children with Type 1' started by jenm999, Jul 12, 2016.

  1. jenm999

    jenm999 Approved members

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    I know this has been talked to death on this board, but I found this article recently which I think is the most lucid description of what a "good" basal pattern should look like:

    https://www.diabetesdaily.com/blog/basal-insulin-adjustment-rules-282652/

    I'm trying to find an optimal pattern for my son and have discovered, for instance, that I was using basal at meal times to mitigate spikes, which works only if you eat the same thing at the same time, and can have a domino effect throughout the day. I have gone from 9 segments to 3 (might need 4) and things are much more predictable.

    Not going to make my 8 year old fast, though. That's too much. :)
     
  2. Christopher

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    Thanks for the article.

    The thing that I find challenging is that on Monday morning her bg can be in range from, lets say 1am till 8am. So I think, great, that is a good basal. On Tuesday, however, she is high at 1am and since I didn't wake for the CGM alarm (bad Dad), there was no correction and she woke up high at 8am. Clearly on this day the basal was not working like it did the day before.

    So what is the issue? Really delayed food effect? Teen female hormones? An issue with the pump delivering the insulin? Because it's Tuesday??????

    Not looking for answers here, just venting on the "challenges" of this lovely disease. :tyrannosaurus:
     
  3. samson

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    Amen to that! I aim for a not-totally-wrong basal and expect to use temp basals frequently.

    Basal testing probably works better with adults, who don't have so much change happening in their bodies and don't mind fasting to get their basal just right.
     
  4. MomofSweetOne

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    ^^^Yes!! But you forgot delayed onset hypoglycemia which is the story of our summer with a job that has her on her feet for hours at a time and continues to affect over 24 hours later, and the more days worked in a row continues to drop the amount of basal needed, but two days off in a row will suddenly require more.

    "And she's stabilized, right? Because you've been doing this for years now and have things worked out?" Sure. Not.
     
  5. rgcainmd

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    And why am I not surprised to discover that the author of this article is none other than the Great Gary Scheiner!
     
  6. Nancy in VA

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    It not really that big of a deal to basal test. I've done it even when Emma was 2. For breakfast, its easy. You can give them a no-carb meal - meat and cheese and water. And that should sustain them until an early lunch.

    The next time, do a really early breakfast and you should be able to basal test the 10-3 timeframe, then give a snack.

    Then, you can do an early dinner (like 4:30) and do a "post-dinner" basal test.

    You don't have to starve them. Just need carb-free foods and eat a bit of a different meal.
    It's really interesting to see what basal is hiding if you do a basal test.
     
  7. cdninct

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    Until recently, I would have agreed with you, but at the moment protein is affecting my son's BGs quite a bit (3 1-carb hot dogs with no other carbs at all appeared to spike him almost 180 mg/dL last week!). While I think other things are factoring into his current wacky numbers, I am no longer convinced that our bacon-and-eggs basal testing is giving us the most accurate information, and I haven't been able to steel myself to do a full-out no-food basal test yet, even though I know it's where I've got to go!
     
  8. jenm999

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    My son is 9 and growing at a breakneck pace (his dad was 6'4" by 7th grade). He needs to eat and he needs to eat carbs; he doesn't find protein as sating though he will comply begrudgingly when high. So I'm testing more through trial and error. High after dinner? Try increasing basal. Oh, he drops low after a light meal, or goes really high after a particularly large meal? Then it's probably the carb ratio. Try that the next night.
     
  9. rgcainmd

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    This, more or less, is our approach. While my almost-14-year-old daughter, who now towers over me and whose growth curve is plateauing (per her endo) could likely tolerate extended basal testing, I have no doubt that she would refuse to do so based on principle: her current principle of "I'm not going to let my Type 1 make me do anything I don't want to do!" Unfortunately, she's fast approaching the "Cutting off one's nose to spite one's face" point. Adolescence: the fun never stops...
     
  10. jenm999

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    Guys. I'm down to two segments. midnight to 7pm and 7pm to midnight. I was relying on basal rates to tame spikes, and my carb ratios were quite high and pretty similar (now ranging from 1:10 to 1:16). Now the spikes are higher but they come right down, and he's steady between meals. Will try to be better about pre-bolusing, but average glucose for the last 7 days is 138 according to Clarity!
     
  11. forHisglory

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    Sounds like your hard work paid off, those are fantastic results! We have noticed the same thing with the spikes. It's nice to not have him crashing between meals or with increased activity though right? Hoping you can find a new way to tame those spikes! Way to go Mom.
     
  12. jenm999

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    Thanks! I'm pretty psyched that things are going so well. Of course I want to reduce spikes if possible - this relates to one of the other active threads about the risks of temporary highs ("excursions") - but if his averages are below 150ish (and therefore A1cs are <7%ish) and he's a happy kid, I'm going to try not to sweat them. When I'm preparing his meal I can pre-bolus but he won't do that for snacks or when serving himself breakfast or lunch.
     
  13. Joseph

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    This is exactly our situation. Our son is growing, constantly hungry... And as tonight we are having his basals from midnight to 6:00. Hope it works...
     
  14. jenm999

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    Bumping the thread. It's been an interesting summer and I've had a chance to experiment a lot. My son is still on many fewer patterns than before:

    12a - 5a = .45u/hr
    5a - 9p = .55u/hr
    9p - 12a = .85u/hr

    Carb ratios:
    Breakfast = 8
    Lunch and dinner = 12

    Earlier in the summer this pattern was working great, but lately he's been experiencing a dawn phenomenon and his basal is really too low for the morning hours. It does not seem to be consistent though. This morning I got up with him and he was 199 and going up by 7:30 (which on previous mornings I attributed to him eating everything in sight with no prebolus). Do I create another basal pattern with, say, 5-8am higher rate, and change it back when he starts bottoming out in the morning? Continue to give correction as needed upon waking?

    And, Gary Scheiner says your basal pattern should have just one peak. Does everyone find this "rule" to be true?
     
  15. susanlindstrom16

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    Thanks for bumping and sharing what's going on with you guys. I'm revamping basals a bit too, we are kind of similar to what you have and I've been contemplating a big increase in the evening hours like you have but hesitating since that's what I seem to do. Right now we have:

    12a-4a: 0.5 u/hr
    4a-7a: 0.45 u/hr
    7a-12pm: 0.55 u/hr
    12pm-12am: 0.5 u/hr

    But I am noticing that lately she is rising right before I go to bed, and I'll do a correction, but it hasn't been enough bc I'm correcting again at 2-3 am. She has always dropped in the early morning hours and then had crazy breakfast spikes but we seem to have mornings down pretty good with this pattern, just our nights are screwy now.

    Sorry! I have to read a little more about the peaks referred to by GS. Does that mean the peak in basal rate or blood sugar?
     
  16. jenm999

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    Peaks in basal rates - see the GS article in the first post.

    This morning I increased 5-8 am to .6 to manage that dawn phenomenon and the day has worked beautifully. But now I have one big peak at 9pm and one smaller at 5am. Gary would not approve. :)
     
  17. quiltinmom

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    Maybe he would look the other way if he saw a beautiful trace that happens because of it. ;)
     

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