Basal Adjustement and Bolus effect - help and advice needed

[Penfold_Dad]

Hi

My daughter has been suffering from lots of night time hypos which I have posted about on here and the general consensus along with info from think like a pancreas is to lower the basal which we have been doing over a week or so. It has worked and levelled the night time but however has completely messed up the carb ratio and she is now hyper all the time in the daytime. I have just adjusted the ratios to hopefully claw it back but it's a bit of a finger in the wind guess as to what to adjust to. Is there a more specific or scientific way of adjusting or is it guess work. Also will the carb sensitivity need adjusting ?

Please help with this one ASAP as three days of sky high bloods is scaring me

Thanks

 

[ewelina]

Adjusting basal is the first step to get everything under control. From here you can work on ratios which will change now. Its all balancing act, so if you reduce basal you will probably need increase boluses. Does your daughter take one basal injection or two per day? if two, maybe she needs higher basal taken in the morning. If one you need to increase boluses. I don't think there is any scientific way to do it. Record the readings, carbs eaten and adjust ratios

 

[azure]

There is a rule that gives an estimate but only experience shows the correct ratio for the individual - that is, recording carbs eaten and blood sugar results.

Err on the side of caution always. Obviously that's especially important with a young child and with one newly diagnosed.

You could try giving her the same meal and see how the ratios are working by testing frequently. That's how I adjusted my ratios. But always cautiously and not leaping to change everything after one high result.

As Ewelina says, getting the basal right first is best as that's the foundation you're building on.

 

[Daibell]

Hi. It sounds like the Basal is now nearer to what it needs to be. The Bolus ratio is really best found by trial and error starting around 1 unit to 10 gms. Any changes should be small ones and the meter 2 hours after a meal will help guide you whether it the ratio is about right. If in doubt start with a lower level of Bolus and gradually increase it over several meals until the ratio seems right. Many find they have different ratios for different meals; I've never found that for myself. I'm not sure what you mean by carb sensitivity as the Bolus ratio is effectively what you adjust to suit your insulin sensitivity?

 

[Penfold_Dad]

So I have just adjusted carb ratio from 1:18 to 1:15 for breakfast and lunch and also 1:20 to 1:17 for evening meal and then it is much lower in the night to avoid hypos. Our machine (Avila expert) has an insulin sensitivity programmed in to it at 1:12 which means every unit of insulin should bring the blood sugar down by 12 points. This sensitivity I find confusing as you are right it is he carb ratio which works out the dosage???? It's a lot to learn!

 

[azure]

Is that the correction dose you're talking about? (I don't use that meter)

 

[ewelina]

So I have just adjusted carb ratio from 1:18 to 1:15 for breakfast and lunch and also 1:20 to 1:17 for evening meal and then it is much lower in the night to avoid hypos. Our machine (Avila expert) has an insulin sensitivity programmed in to it at 1:12 which means every unit of insulin should bring the blood sugar down by 12 points. This sensitivity I find confusing as you are right it is he carb ratio which works out the dosage???? It's a lot to learn!

I think you may got confused a little bit.1:12 is probably a ratio which means you give 1 unit for 12g of carbs. Maybe I'm wrong?? 12 mmol seems a bit high. I mean 1 unit bringing down by 12 mmol? Are you in UK? Even if it was in mg it wouldn't sound right

 

[Penfold_Dad]

No I think I'm right. This isn't me this if for my daughter who has just turned five and only weighs 16 kilo's. Her ratios ar as I stated and her sensitivity is set at 1 unit to lower by 12 mmols. She is small for her age as she is one of twins who were quite premature

 

[MISTY10]

Hi Sam I basal rates change throughout the day and quite new to the pump at my night time is 675 and before I wake up it increases to 120 for a couple of hours to cover breakfast and the dawn phenomena and then it goes down to 875. My basal rate increases to 975 after lunch until mid afternoon and it goes down to about 825 for teatime then after tea about 6:30 it raises to 975 before midnight to 675.

My Ratio in the morning is nine my carb ratio at lunchtime is 12 and my carb ratio at teatime is 16. (Ie 1 unit to 0.8g 1 unit to 12g and 1 unit to 16g).

My sensitivity is set To 3.5 so when calculating a correction dose 1 unit lowers blood by 3.5 mmol.

This has all been raised this week as got a stinking cold :-/. Gotta watch it when I start to recover !!

Misty x

 

[MISTY10]

I have been fasting to get basal levels right.
So no food or insulin and test every hour or so, then make changes according to the trends. A couple of days of fasting should show a pattern. I cracked fasting in the morning til lunch. But the afternoon is tricky, you've gotta have lunch maybe a bit earlier then wait at least 3.5 hours so no active insulin in, then fast for the 4 hour period monitoring to see what the levels do. It really is the best way of cracking the basal. Thing is, life gets in the way !! (Tea, exercise, work, you only need a hypo to throw things a little so be careful not to over correct).

Misty x

 

[Kazza63]

I split my lantus and have the lower dose at night and higher when I get up. This seems to work for me. I was told that if your morning reading is within +1 or -1 of your before bed reading then your basal dose is right. Good luck