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My 7 year old son has high carb ratio and low basal rate - normal for T1D?

Discussion in 'Parents of Children with Type 1' started by my.son.is.my.hero, Dec 3, 2016.

  1. my.son.is.my.hero

    my.son.is.my.hero New Member

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    My son was diagnosed about 2.5 years ago. He is now 7. We used MDI for first 2 years and have now been on Omnipod for past 5 months.

    With both MDI and omnipod we discovered that his basal rate is very small and comparitively his carb ratio is high. He was only using about 0.5 to 1 unit of Lantus daily on MDI. He is now only using about 3 total units of Humalog daily of basal on the Omnipod. His carb ratio is 15 carbs / unit for all meals. We have studied his basal by giving no carb meals to determine the basal and carb ratio settings.

    We are seeing our best numbers with these settings. From my conversations with Endo and other parents we are abnormal. Is this true? Is he abnormal for T1D? Does this indicate any other issues like Celiac?

    I appreciate your help.
     
  2. Theo's dad Joe

    Theo's dad Joe Approved members

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    How much does he weigh.

    My son, about 50 pounds, used 1 unit of Lantus and 3-4 humalog for the first 6 month of his honeymoon. His carb ratios were about 30:1 because he had "help"

    His ratios dropped quickly to between 11:1 and 16:1 after 6 months but he still came down at night with minimal basal (1-2 units), so he was basically where you are in numbers.

    His ratios went down to about 9:1 to 12:1 at one year and his Lantus needs became more important. Prior to that, he had enough of his own insulin that he would eventually come down at night, but at that point, he suddenly would start to rise at night 15-20 points an hour if his basal was too low. I went from having him trend low with more than 3 units of Lantus to needing 6-10 units.

    And at about 18 months, with a pump, his basal need were still pretty low, about 8 units, and his carb ratios are between 7:1 and 10:1, and even lower on the weekend (about 5 to 6:1 for breakfast) but if I raise his basal rate during the day he will trend down. We are at 23 months now.

    I thought that my son had some other problem like celiac because of his low carb ratios with low basal needs. If my son eats literally low fat for 2-3 days, his carb ratios rise to about 20:1. I won't get into the theory but the mechanism is well known in other fields. I will say that about 1/3 of my son's bolus ends up being based on the fat and protein content of the meal, but there are two different issues. One is that higher fat and protein meals need more insulin than meals of mostly carbs. The other is that if you eat more or less fat on a regular basis, your carb ratios MAY change because of how your muscles burn them.

    But the main message I would give is that you should avoid worrying that something is wrong based solely on the insulin ratios that your child needs. I have talked to parents of small kids who have 10:1 ratios. Dr. Ponder, who is himself T1D, and who wrote sugar surfing (and answers facebook PMs very readily by the way) currently uses 12 units of Lantus with 1 shot a day, but has certain meals where he takes more than 12 units (upfront and extended) and typically sees that he gets a 50 point correction from 4 units. That is absolutely inconsistent with standard T1D texts. If you use the tables in Think Like A Pancreas and Using Insulin, then someone with 12 units of basal and 50% TDD as basal would have carb ratios of about 20:1 and a correction factor of about 60:1. Conversely someone with a correction factor of 12.5:1 (as he typically uses) would have a 50% TDD basal of about 60 units. I just want to point out that there are experts who don't let non-textbook ratios bother them one bit.

    So the only thing that is unusual is a TDD of 4 units through 2.5 years post dx. Consider yourself lucky but get ready. We doubled needs at 6 months, doubled again at 12 months and have gone up another 20-30% over the second year. Oh, if you don't have a CGM and you have the opportunity, get one! The lag time in dealing with changes without a CGM I would imagine would have prevented us from ever really catching up.
     
    Last edited: Dec 3, 2016
  3. dpr

    dpr Approved members

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    Some kids don't fit in the typical "box" for their insulin needs. My daughter at one time was 80/20 basal to bolus. The clinic would tell me it's all wrong and to back it down closer to 50/50. I knew it was wrong for her but tried it for one day. It was just a roller coaster ride trying to replace basal with a bolus. If youve got it worked out for him don't worry about it or think twice about changing what works. Listen to what his body tells you, that's the only thing that matters.
     
  4. my.son.is.my.hero

    my.son.is.my.hero New Member

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    Thanks for you response. I appreciate it. He weighs about 45 lbs.

    I am suspicious and confused about the content (fat/protein) of his food and how it could be impacting his BS. Can you please recommend a formula for dealing with the fat/protein? Do I add them to his carb count in some way?
     
  5. Cheetah-cub

    Cheetah-cub Approved members

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    My daughter was diagnosed 3 years ago, and she has always had a low basal rate. We are still at about 80/20 ic to basal.

    We have attempted a few times to bring up her basal, but it just does not work for her. She will go low all day, and we had to dial her basal rate back.

    We have heard that most T1D are about 50/50, so, I guess you can say that her insulin needs are "abnormal", but we don't consider her "abnormal" at all. She needs what she needs, her current low basal rate setting keeps in good range most of the time, and she has good A1C numbers. Her settings does not bother us a bit.

    My daughter does have celiac, but I have not heard that celiacs tend to have low basal rates before. If this is true, that would be something interesting for me to learn. If other parents with t1d and celiac children have noticed similar tread, please share.

    I rather thought that low basal might be contributed to honeymooning. My daughter's TDD of insulin is still low enough that her doctor thinks she is still honeymooning. Her body is probably still kicking in insulin, so her basal is low.
     
  6. my.son.is.my.hero

    my.son.is.my.hero New Member

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    This link has interesting information about fat/protein calculations. http://www.practicaldiabetes.com/article/fat-protein-counting-type-1-diabetes/
     
  7. Theo's dad Joe

    Theo's dad Joe Approved members

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    I would say that a CGM is very helpful with figuring out the later post meal effects of protein and fat. Without one, it is very hard, and with one, it may not even come down to a formula as much as taking an instinctual guess and watching carefully. Usually as protein and fat (and meal size) go up, a larger portion of the bolus is given as an extended bolus over at least 2 hours. For example, for lunch and dinner, I can't bolus for more than 25-30 grams of carbs ahead of time. Everything above that gets put into an extended bolus.

    Some will create a carb ratio that also includes half the grams of protein-to be extended, but I personally count carbs and assume that the first 10-15 grams of protein is "standard". If he eats something with virtually no protein I may reduce his bolus by about half a unit and if he goes over 15 I may add half the grams of protein to the carb count and extend everything that is above his prebolus threshold (about 3 units at lunch and dinner and maybe 5 at breakfast, depending a little on BG).
     

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