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Would you do a +200% basal to drop a 490 fast!?

Discussion in 'Parents of Children with Type 1' started by ashtensmom, Oct 10, 2012.

  1. ashtensmom

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    Last night our DD had a super high number (489) 27 mmol. We did a +200% basal increase for one hour and she dropped to 288, 16 mmol in one hour. Another 2 hours later, she was (79) 4.4 mmol and we then gave her 4 carbs of juice.

    Anyway, to us, it seemed like we did the right thing and she came down nicely (a little too much, but trial and error, right). My question is whether it is "safe" to drop like that? I mean common sense tells me it is good to get her out of the high 400's quick, but is it harmful to drop BG so fast? Would it have been better to bring it down slower? Although I hate to see her ride that high, YKWIM. What do the experts here do? Thanks in advance.
     
  2. Tigerlilly's mom

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    I am not sure how "safe" it is to drop that fast, but I know that if my child dropped that fast, he would feel like crap, and then start thinking that he was low, and would want to eat, eat and eat, and then I would be dealing with chasing a high again later due to his overeating.... (sorry for the run-on sentence)
     
  3. Connie(BC)Type 1

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    I understand a slow drop is safer, also my preference, I'd feel crappy if I dropped that fast, for days. I aim for a 4-6 hour drop when that high and only coorect at the 4 hour mark. It usually works for me.
     
  4. Beach bum

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    Same here.

    In a situation like that, we would correct via the pen (also unplug and run through pump so you have IOB recorded), then run a temp basal of +100% for 1 hour. Then, check again and +50% for 1 hour. Check again, let it ride, check again in 90 min. and correct as normal.

    This is what works for us and helps my daughter from feeling really crappy. Granted, she's already feeling crappy from the high, but to bring her down that fast will make her feel worse. We actually had one situation where we got to aggressive in the correcting (aka Rage Bolusing:eek:) and she puked.
     
  5. hawkeyegirl

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    This is pretty similar to what we would do, except that we always correct through the pump.
     
  6. ashtensmom

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    Thanks all. Geez, we never thought about her feeling crappy with a fast drop. We have always asked her "how do you feel" and even with such a high number she has always said she felt fine (go figure). Even last night, we kept asking her how she felt and she said fine. She was slightly low still at the 2:00 am check, so we gave juice again, and she woke at 4.4 mmol. She was lively and cheerful, so we didn't even think of her feeling crappy with the previous high number.

    I don't know if having a low basal requirement made the difference as a +200% = 0.6 u/hr. When this happens again, we will for sure monitor how she "feels". I just don't want it to affect her health with such a fast drop, and of course, don't want her to feel crappy either. I know you shouldn't come down so fast when first dx'd and when you have been high for a long, long, time, but naive when it comes to fixing a high BG.

    P.S. we avoid the needle most times because DD gets all worked up and most times, it's not the site. Last night we figured that with a +200% we would be able to quickly see if the site was bad if the increase didn't budge her one bit after an hour. Sigh, here's wishing she doesn't have another one of these nights/days anytime soon.
     
  7. danismom79

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    I rarely rely on basal to intentionally bring down a high. I'll bolus through the pump first, and if she still seems resistant, I'll run a temp basal as well. And my daughter would also feel that plummet.

    ETA: Actually, the first thing I would do is recheck that number.
     
  8. Beach bum

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    Ya, when A gets that high it's as if the pump doesn't exist. We've found, for some reason, that her BG just won't budge when that high. We have to jump start with an injection (which when she's high, really pis$#& her off). But her body will respond to the increased basal. Strange, but it works.

    My daughter will say she feels fine too, but then after it all she's exhausted and the lousy feeling kicks in.
     
  9. 3kidlets

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    We use OmniPod and the max temp basal is +95%, and I have used that to bring down a high faster. She hasn't complained about it feeling bad coming down too fast. She does feel absolutely terrible in the high 200s/300s though. We check every 40 minutes to 1 hour. If she is dropping too fast, she'll have a snack or some juice to slow it up a bit.
     
  10. sarahspins

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    I almost always use a combo bolus instead of a temp basal to bring down a really high number because I've found that Apidra doesn't work as well for me if injected all at once, but I like the combo bolus because I can specify the amount over a given time rather than trying to figure out in my head how much "extra" basal I need.
     
  11. Mish

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    What I do depends on why he's high. We have good success with huge temp basal increases for highs due to high fat greasy food that linger around. So if we go out to eat I generally know that we'll be doing a temp basal later on. If he's high for any other reason (even food) I will generally bolus. On the other hand if we're stuck in a pattern of night time highs that become resistant all night I'll often do a temp basal as well.

    Usually we go 150-200% for 30 min. You have to remember, whatever you change now will probably take a few hours to hit, so if you're doing this huge temp basal with a boat load of IOB you may see it bite you in the ass later.
     
  12. ashtensmom

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    My husband actually did do a correction through the pump and he did a 100% temp basal at first (I was driving home from work when she checked and got the 27mmol). 30 mins later when I got home we checked again and she was 24 mmol and that's when we did the 200%. So, she did have a whole lot of IOB. I was nervous doing such a high temp for sure so I am glad she didnt go too low. In hindsight, 30 mins at 200 % would have sufficed since she went low overnight.
     
  13. jtolpin

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    Hmm....

    If Caitlin were 400 on one touch ping, and checked again.... and ketones, we'd correct by injection, and change the site.

    If no ketones, we'd correct by pump (or maybe by injection anyways) and change site....

    If we were to do something different? I dont know now. Probably injeciton, and change site... even if its not needed, and she had forgotten to bolus for meal.

    Doesnt help much. :/
     
  14. Mommy For Life

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    We don't use basal temps to bring bg down. If DD had a number in the 400s I would (obviously recheck) most likely change her ISF and give bolus via pump. If after 3 hours she still hadn't budged...we would give shot, change site, and make pump deliver same amount of shot so IOB was noted. We typically us temp basals for extended traveling in car/planes, high fat food and pasta. Glad it all worked out for your DD!
     
  15. Lenoremm

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    I am no expert and don't want to alarm anyone but I have it stuck in my head that when ds was diagnosed the nurse said they had to bring the high down slowly because bringing down a high quickly can cause a seizure. Maybe this is more of a concern after the child has been high for some time (as they would be at diagnosis).

    We have found temp basal does help nudge a high down better than a bolus alone. Glad it all worked out.
     
  16. ashtensmom

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    Just thought I follow up my post with info I got from our CDE. She reminded me that the 200% increase basal could not have brought her down from 27 to 16 in one hour as it takes at least one hour for a temp basal to take effect, and that it was the bolused correction and iob from dinner that brought her down. The 200 % did contribute to the low numbers later that night.

    I asked if bringing her down that fast would cause blood vessel damage or other concerns, as I too, have it stuck in my head that you should not be bringing a high blood sugar down that fast, but she assured me that short term highs are okay brought down fast, and in fact you want to not have bg stay that high for too long.
     
  17. Lenoremm

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    It is good to know that only long term highs are a concern with bringing them down quickly. I agree about not wanting them to run high for any length of time.
     
  18. Darryl

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    I've always wanted to know if there is any evidence as to whether large corrections / faster drops are a problem vs. leaving the BG high for a little longer while correcting gradually. Have there been any studies?
     
  19. wilf

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    This is not a concern for day to day D management. Bringing down a child at the time of diagnosis after weeks of being high and potentially dehydrated with electrolytes out of balance is a dicey affair, and they have to go slow and careful.
     
  20. Beach bum

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    I'm curious too.
    I know for us, the slow approach works better for my daughter from a physical feeling standpoint.
     

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