Looking for help for ISF for 47 lb 5 year old

We've had a few impossible nights lately where I just can not get any night time corrections to work for Charlotte. I think several things may need tweaking, but I'm starting with the ISF.

Currently, for the evening it's set at 300. (it's been a while since I changed it) In Pumping Insulin there's a chart that estimates ISF, but it starts at 18U TDD and Charlotte is only getting 11-12. But looking at the chart, I'm guessing a TDD of 12 would have an ISF of about 180? That seems really low.

I just need a jumping off point... right now even if I give 20-30% more than the correction suggests, she's still even higher 2 hours later. And I don't think it's a basal problem. B/c if her bg for the evening starts out in range, I have to turn her basals down 30% for a few hours to keep her from dropping even more.

 

For olivia (4yrs old 34ish lbs) we use 1 unit for every 200 points. We have been discussing lowering this to 1 unit for every 175 but still up in the air about it. Seems to overcorrect for lows but under correct for highs (150 +/- 50 target on the ping) Currently she gets about 10-11 TDD.

Best advice is a quick call to the Endo to bounce it off them.

 

My 40 something pound 6 year old also has a TDD of 11-12. His ISF at night is 1:250, during the day it is 1:200.

 

Hey Danielle!

Adam is 5, and weighs about 57 lbs. His ISF is set at 150 at night, and 110 during the day. He recently went through a period where corrections were not working at night, and Dr. H. changed the ISF on his pump and for the last 3 months, corrections have been working great again. Oh, and for reference, his TDD is about 22-23 units.

 

I use the I:C and BCR to compute my ISF. If you have a good I:C from that time of day, given your kid's size (which gives me an idea as to BCR), you'd want to multiply by 10 to get an estimate of the of the ISF.

 

Thanks for the replies. Either she's super sensitive to corrections or we need to do some adjusting... and we probably need to do adjusting. I do need to do some basal testing for sure, but I'm pretty sure the main problem is the ISF setting.

What's the BCR? Her ratio in the evenings in 1:44.

 

Blood to carb ratio- how much 1 gram of carbohydrate raises blood sugar. This has a lot to do with weight but can still vary between people who weigh the same amount. The BCR times the I:C is the ISF. At 57 pounds, I would expect her BCR to be at least 7, but probably higher. If it is 7, and if 1:44 is really the I:C she needs, then her ISF would be 308.

If an ISF of 300 is clearly not enough insulin, then I suspect the I:C of 1:44 is also off.

 

That's possible. Her breakfast ratio is 1:27, but her breakfast ratios have always been considerably higher (lower?) than the rest of the day.

Also, in the last month or so I did some basal tweaking and it went up quite a bit, so it's possible she going through a growth spurt and everything needs to be changed again.

 

We see him next week and I have a feeling I'm going to get raked over the coals for my constant "SWAG"-ing.

 

It does. Except that if she's on the low end of "in range" I have to turn her basals down or she goes even lower. If she's on the higher end of "in range" they work better. If she's high, it's just a lost cause. I will try to do some evening basal testing to make sure though.

 

LOL! Well, I got dinged again for Adam's carb intake....oh well! Good luck! And if it helps any, when he changed Adam's ISF, he did change all of his basal settings as well. I was nervous about it, but dang it....he was right.

 

The calculations never have worked for Kaylee. She currently has an ISF of 280. She's 8, almost 9, and 60lbs. We drop it by 25/50pnts at a time. It use to be 400 .

I did test her ISF a little while ago. I made sure her basals were as good as they could be... watched her for a few nights with no fatty foods. I then waited for a night where she would need a 1u correction. I corrected her 1u and then tested every hour, when I got to 3hours (her active insulin time) I took her starting number and subtracted her ending number, the number I got was her new ISF, works fantastic! I also checked her at the 4 hour mark to make sure she didn't drop anymore, and to check to make sure her active insulin time was 3 hours. I had to up her ISF after this, I think it was down to 250, or 225, a random number her endo pulled from thin air.

 

Caroline is 5 and 47 lbs also, but she's still honeymooning with a TDD of 3.5 right now. Her ISF is 360 during the day and 400 at night.

She isn't responding predictably to corrections at night though, so I don't put too much stock in that night number right now...we're tweaking things a bit and her basal may be off.

 

FWIW I think you're compensating for an incorrect bolus with a too high basal or a wrongly timed basal, kwim?

*ducking*

 

Our DD's ISF was off for a long, long time. First we were way too aggressive, then we realized we had not adjusted it since our pump start. Her current ISF is 1:160, which we recently changed (in steps) from 1:175.

One rule of thumb for calculating ISF is to divide 1800 or 1700 by TDD.

We find that this gives us a benchmark, though DD's ISF is still higher (or is it lower) than one might expect using the formula.

 

No need to duck. I don't throw stuff.

Last night, much to Charlotte's chagrin, she had eggs for dinner. Her bg started rising before she even ate, which made me think her basals were too low. So I adjusted the ISF and the basals and corrected, and I overdid it, because an hour and a half later she was back in range with a lot of insulin on board. I turned off her basals for 2 hours and she went down to 80 where she hovered for a while before I gave her juice when I went to bed.

I really should try the basal testing again tonight, but Charlotte's going to freak out if I tell her we're eating carb-free again tonight. Seriously, how do people do regular basal testing with kids?

ETA: So you think her basals are too high and her I:C is too low? Like she needs more meal insulin? That would make sense, except that we're talking 9-11 at night when her meal bolus is nearly over and her bg is still rising, despite corrections. That sounds like a basal and/or ISF problem to me. I know it doesn't make sense, but it's almost always consistent... if she's low, she just goes lower, if she's high, she just goes higher.

 

definatenly need more testing.

How about tonight delay dinner by at least an hour to see if the rise is basal issue, more of a delay if possible. ( well not tonight, but after the hoilidays.)

alternate the low/no carb dinner with delayed eating and you might be able to gt it down.

Also my dd has a sleep induced spike, but if she stays up late I have to feed the insulin and then correct later.

My dd's basal doubles if not more for a few hours.