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Majority of insulin, should it come from basal? Or Fast acting?

Discussion in 'Parents of Children with Type 1' started by MamaBear, May 7, 2012.

  1. MamaBear

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    I posted here once before on another topic and I recall Wilf posting this
    . And that is still true, though since that topic we have increased his Lantus and Humalog both quite a bit. Our last endo visit the doctor we saw said that we need to bump his Lantus up and keep doing so until he is at 10 units, and that around 10 units per day is where you want to be. I suppose that works fine for some, but it doesn't for my son. I am examining this in my mind right now because we have had crazy lows this week, most of which were in the afternoon, and some of which were in the middle of the night. I am attributing this to the fact that the weather has suddenly become very hot, and this did happen last year as well. Last year with the increase in temperature is when we saw our first 20's and LOs. So as I am adjusting doses again, I am wondering, is most of his daily insulin supposed to come from basal? Or is this a YDMV thing? Isn't it a little dangerous for the endo to make such a generalization as 10 units of Lantus being ideal for everyone? We do have 4 endos in our practice and he is the first to suggest this. And now I feel like I am making these adjustments in totally the wrong way, even though knocking his Lantus down several units has finally stopped the lows. :confused: Any thoughts?
     
  2. Mommy To 4

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    We are still pretty new to this, but our endo said they usually see about a 50/50 split. She did say though that it is not uncommon for it to be different. My 6 year old gets about 40 percent of her insulin from basal and 60 from bolus. It was about 50/50 before she started her pump a couple of weeks ago.
     
  3. emm142

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    In the first two years of my diagnosis, the split was around 20/80 basal/bolus. When I was on Lantus and Novolog I was generally on 4-6U Lantus and a 1:10 ratio of Novolog, which worked out at a LOT more Novolog than Lantus. My a1C etc were pretty good at that point, and raising my basals would have caused nasty lows.

    Nowadays I get the same amount of bolus insulin as I did then (~20U per day) but my basal insulin needs have massively increased (also to ~20U per day). In this time my propensity for >400 highs and ketones has also massively increased. All of these things lead me to believe that although I never technically honeymooned (my insulin use was never consistently below 0.5U/kg/day) my own pancreas did help me out a little with basal insulin production for a long time.

    I think my point is basically that your son may be like me, and his basal needs might 'catch up with' his bolus needs at some point. Of course, he may also have very low basal needs forever - who knows?
     
  4. MomofSweetOne

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    My daughter needs about 68% of her TDD as basal and the rest as bolus. Our CDE says she has just never followed the books. This is a case of YDMV. They need what they need. Get his basals adjusted for him, and then tweak the bolus dose.
     
  5. LoveMyHounds

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    We heard the same.
     
  6. minniem

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    We were told for my son (9 years old) that his basal should be 35-45% of his TDD. They said it varies for age and gender (boys typically eat more and have a lower basal percentage). Of course YDMV.

    My son is currently on about 33% basal and I have tried to increase his basal over the last couple of weeks and we have had a lot of lows too. Which I attribute to the increased basal. So I have backed off our basal rates too over the last few days. We are back to around 35% (which for my son is around 9 units of basal/day on the pump.)

    Good luck...I am thinking it's a YDMV thing.
     
  7. mysweetwill

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    Our son's split is approx. 30-70 basal/bolus, we were told this will change as he comes out of his strong honeymoon, but I also suspect it differs for everyone.
     
  8. Christopher

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    I will say what I always say and what I believe. A PWD needs the amount of insulin they need. Period. You can't set an arbitrary amount and expect it to just work out that way.

    Danielle's endo has said several times that she would like to see a 50/50 split with the bolus/basal insulin. Danielle has always used more bolus than basal. So I tried to make it more 50/50 and it just did not work. And I never did get a reasonable answer as to WHY she wanted her to have the 50/50 split.

    I say do what makes sense for you and your child, you know better than anyone.
     
  9. hawkeyegirl

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    Yep. I agree with Chris. I don't pay the slightest bit of attention to Jack's basal/bolus split. As I sit here and think about it, he's probably nowhere near 50/50, since he's such a big eater.

    This is one of those times where I would smile, nod politely, and completely ignore the advice. ;)
     
  10. Connie(BC)Type 1

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    Even in the old days with NPH, my basal was always minimal,with bolus insulin covering food and corrections. Mum never listened to the doctors unless what they said worked. I also didn't need to snack for NPH, unless I wanted to and then I got a shot of regular . I take about 25% of my total as basal!
     
  11. MamaBear

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    He may be like you a bit. With the lows going on I have knocked his Lantus down to 5.5 units. Breakfast is 1:10 and lunch and dinner are 1:12, this week. ;) But yes more Lantus then that and we are having nasty lows. I have been lowering his insulins all week. Friday it was all day, 6 or 7 lows, I didn't even have enough room in the log book for entries. I lowered Lantus again and he still dropped 3 times overnight. Lowering it to 5.5 Saturday stopped the lows. I just keep reflecting on what the doc said, and wanted opinions here. Theory VS practice makes a huge difference to me with my son's D.

    I agree with Chris and everyone who said he needs what he needs, as well. I may need lessons in smiling politely though. I did reply to him that if my son is dropping X amount overnight I am going to lower the Lantus before adjusting Humalog. He didn't argue, but not sure he appreciated my saying so. :p Funny thing, when we see his wife (she's one of the other 3 endos) she has never said a thing about where his insulin should or shouldn't be. Just asks where it is at the moment and how that is working for us. I guess your practice may vary too.:cwds:

    I just don't see this as a cookie cutter situation. Thank you everyone for your replies.
     
  12. MomofSweetOne

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  13. slpmom2

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    My dd has always been around 70/30 or 80/20 basal to bolus. Our endo has told us, and we've read, that it's usually closer to 50/50, but when we've tried shifting it things fall apart. So every time we go to see the endo, she chuckles and shakes her head and comments wonderingly that dd has got the lowest basal rates of anyone in her practice, and acknowledges that you just do what works, in spite of what the books and experts say. We love our endo. :)
     
  14. MamaLibby

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    My daughter's needs have shifted dramatically over the years...She's had tiny boluses, when she was tiny and honeymooning and we had a week or two we didn't cover for most carbs. Right now, she's a big it's probably about 60-65% basal and the rest bolus.
    The only time I can think of when she was close to 50/50 was when she was so sick a couple years ago...Running higher basals to combat the steroid treatments, and constant boluses to try to keep down the highs from stress and chronic infections. So at that time 50/50 was not a good thing! :rolleyes:
    I agree with others...While it's interesting, the CWD needs what they need!
     
  15. jessicat

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    this is what I have been told
     
  16. Stacey Nagel

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    jesse gets about 35% of his TDD as basal
    the rest is from bolus's...
    he eats a lot....
    50/50 never worked for him...
    and its been this way for him since puberty...
     
  17. wilf

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    There are so many things that play into the basal/bolus percentages, such as:
    - a more active child will need less basal insulin than a pretty sedentary child.
    - a lower carb diet will need less bolus than a higher carb diet.
    - a child who is cold will need less insulin than a child that isn't.

    I will say this about increasing Lantus - if you're increasing Lantus on the advice of your doctor, then you better be reducing boluses by a corresponding amount or else lows are guaranteed.

    Also, if you're having trouble with lows overnight, then give the Lantus in the morning.

    Good luck. :cwds:
     
  18. MamaBear

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    I have only increased his Lantus when I felt it was needed, no matter what the doctor has said. I was just remembering the doctors words and wondering if 10 units not working for him, was because I wasn't doing this correctly. Second guessing myself I guess. :(
     
  19. GaPeach

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    What he said!

    Our DD was at 60 basal/ 40 bolus for a while. After puberty - 70 basal/ 30 bolus is working much better. We use a daytime target of 100. Endo changed it to 120 at Dec. appt. When A1C was up dramatically in March, I changed it back to 100. Much better meter average now without significant lows.

    You know your child's needs much better than endo most of the time because you see the daily numbers. But communicate well with endo at appts to stay in tune to each other.
     
  20. ashtensmom

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    Our DD is another child that doesn't do well with 50/50 basal/bolus at the moment. She is more 20/80 or 25/75. I often wonder whether we need to make adjustments in the split, however her basals seems to be fine whenever we basal test (or try to basal test).
     

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