Back to basal!

[SophiaW]

I don't think it's the bolus, he was having a hypo 7 hours after the extended bolus had finished delivering. The bolus might have caused a hypo for the 9.30pm reading but after that had been corrected I don't believe he should have had more hypos later on due to the bolus. How long does the insulin affect his BG for leggott? Jess has an IOB factor of 4 hours.

One thing my consultant and DSN did say was not to make changes on one-off readings, watch for a pattern and then make the changes based on a pattern. With this in mind, and as you say his readings previously were rising in the evening, you might want to watch and see what happens for another day or two and then make changes based on that.

 

[leggott]

Hi Sophia, I've made some adjustments now. I agree with your suggestions and were my thoughts too. We have reduced the basal down and moved it back to 8pm. We have also increased basal at 5am for one hour only to try and stop the rise at 7am. These are two small changes which we will run with for a few nights.

Fingers crossed!

 

[jopar]

What was his pre-tea BG?

The only concerns that I would have is if you look at his 3am which if his basal was correct would be on of his lowest bg reading of the night, but it's the highest so you need to work out the overall impact of his hypo correction to see if this has shuffed this reading higher than norm..

Hence the feeling of looking at the teatime bolus or attempting doing a fasting test..

But as sophia says give it a couple of days with any changes made to see how it pans out.. Then if you'll almost there perhaps try giving tea on a standard bolus and see what difference this makes..

 

[leggott]

Hi Jopar. He was 5 pre tea so a normal bolus given and quite a small one for him so wasn't expecting much of a lag. His pump would of also reduced the bolus a fraction as his target BG is set at 6. I gave him the extended bolus as he was five and was about to play in the garden. I thought his readings at bed and an hour or two later were good, with a big fall coming several hours after, which is why I'm leaning towards adjusting basal.

He has always been more erratic than my daughter so that slight fluctuation in the early hours wouldn't worry me too much. There is always a slight variation in blood readings anyway so I could of taken another reading at 3.30am and go a slightly different result. Unfortunately I slept through my alarm at 12.30 so didn't get a reading then which I'm not sure would have helped me much, but would of been nice to know.

I will test again tonight and see what happens.

Thanks Leggott

 

[donnellysdogs]

Hi Leggott

From levels yesterday. reading started dropping somewhere from 8.30pm onward.....so only from my own personal experience (as an adult), I would be lowering the basals from 5pm until 10pm.

To cope with the rise in the morning which is occuring somewhere between 4.30 and 7.30, you may well need to do an hourly check between these times for more exactness to fine tune.....however I would have been highering doses from initally 4am.

Initally I change things by 0.05 in either direction as needed,,,,and my consultant always said never to change any basal reading by more than 0.2 at a time......

I take it , that with your pump you can add in extra time periods so that you could set a time period from 5pm til 10pm and another one from 4am-7am or as needed.....

I know that others will be along with further advice, and with a child I am wary of the very small doses that are given. I am sure more parents will be along soon that deal with the small doses...

Also, do weekend readings vary from school days over night.

Finally.....you must be exhausted after all that testing, but well done....I know how much of a huge effort it is to do this......

 

[leggott]

Thank you donellysdogs. We have done early am testing and the rise seems to be from 6.30 /7am.
We can have another time slot and we will change his basal for these times.

We are only 2 weeks in to pumping and I guess it will take us many more weeks to fine tune everything and get to know what works for him. We do change his basal at the weekends as we find he needs far less when at school although his basal at the moment is set to the lowest during the day so at school he has to have a small piece of fruit mid morning to avoid dropping to low.

To be honest, I am so used to getting up every night! We always had poor night control on MDI and I would be up in the early hours to give a shot of novorapid to avoid the rise in bg in the morning. But having to get up hourly is taking it's toll so I would like to improve things soon.

A big thankyou to you and all the other replies. It is so good to have such great advice and experience at the touch of a keyboard!

leggott




:|

 

[donnellysdogs]

Hi Leggott

Just one other small thought.....how much is the active insulin time set up to????? Some people seem to be getting set up to 6 hours....and I believe most people seem to be running about 4-5 hours.....not so much as a worry now, but on a long term basis when fasting etc over meal times, this may well be another factor that could have an impact......

You don't want to risk hypo's for the sake of being a little bit high...and certainly not being excessively high, me personally, I would be changing by levels by 0.05. Don't forget with a pump you don't have to wait 2-3 days to see the impact as we have NOT got long acting insulin in us.....All the insulin should be out of us pumpers at the most within 6 hours.....and the next time is a true reading if altering the basals.....

You will get there.....me personally I don't use extended or multiwave for much, although I have an exercise 1 set up to give me 80% of my bolus on weekdays at lucnhtimes when I walk the dogs, apart from that I really don't fafff around too much with all the different bolus settings...especially initally because I wanted to see just how I do react to a normal bolus first, and only change when I think it is necessary i.e pizza once or twice a year at max!!!!!

Keep positive....those readings are very, very good....there aren not any massive swings off the scale.......despite being the hypo's to eliminate......but that will be done within a very short amount of time...and during these times.....at least they are at home with you.....

 

[jopar]

I see where you coming from now, yes his tea one is pretty good..

HIs levels being more irratic than his sisters isn't a suprise due to boys being having a slightly more dymamic way of play than girls in general.. And for any child for parents it's a night mare, has how does one act in a proactive way when the very nature of a child acitivty leves is very unperdictable..

You might find some of his night time problems might stem from a glitch in an earlier basal setting, hard to tell at the moment.. Lets wait to see how these adjustments pan out

 

[leggott]

Looks like I'm almost there!

8pm 6.7
9pm. 8.8
10pm 9.3
11pm 9.9
1.30am 7.8
4am. 7
7 am. 7

basal 5pm. - 8pm. 0.10
8pm. - 10.30pm 0.30
10.30pm- 5.am 0.05
5am - 6am. 0.15
6am - 7am - 0.05

Seems to be a rise early evening. He had tea at 5pm, so the bg at 8pm was a good 3 hours after what was a smallish tea. I think perhaps I need to increase the basal about 7pm? Also lower basal around 9pm ish as he falls a little in the early hours?. I just think that if I reduce the 0.30 basal he might start to creep up a bit. I can only reduce it down to 0.25 or should I add another time slot and do this for a shorter period if that makes sense?

Slept through the midnight check again!!!!

 

[ams162]

looks like some pretty good results there, its hard work but def worth it those first weeks i felt like a zombie with little sleep but the first night i slept through was lovely lol.

a thought on the treatment of hypos my dsn told us to give just 15g of fast acting carbs but i found that pushed dylan far too high so i did a little test where i gave dylan 2 glucotabs so 8g and watched how it affected him and found this was enough to get him into reasonable numbers without going hyper it does depend on what the hypo numbers are to what i give but if hes in the 3s 2 tablets are plenty if its in the 2s i may give an extra one it just depends may be worth a try at some point.

i think u are doing a fab job ur son sounds like mine with his irratic control i have shed many a tear of frustration but the pump while it has not given him perfect control its alot better than it ever used to be. we still have hypos and hypers but not hypers in the high 20s like it used to be more like 12s and alot of the time he is in target so im happy.

my son needs more insulin when hes at home so we have set up a secong profile fot the holidays instead of moving everything around again so i just switch profiles and everything is ok.

keep up the excellent work ur doing and give urself a huge pat on the back

anna marie

 

[donnellysdogs]

Hi Leggott

The readings from 1.30am to 7am were very good with minimal fluctuation in them....

From 8pm to 11pm-ish the levels rose by 3.2....which compared to the previous readings when they dropped quite significantly is a big difference....and yet as I read things you kept the basal from 5-8pm as 0.1? is that correct?

What was given for tea yesterday??

I'm trying to look at both pages of this posting to see what readings were at and to do a precise comparison, but I can't scroll back to page 1 whilst typing this....so I will end now, will scroll back, write down readings and basals etc and will revisit!!!!!

 

[leggott]

Hi. his basal from 5pm - 8.30 was 0.10 going up to 0.45 from 8.30 - 10.30pm.

We changed this yesterday eve to 8pm - 10.30pm 0.30. The amount from 5pm until the change remained unchanged at 0.10, but I think that perhaps this needs to be increased to stop the increased between 8pm and 9pm?

Sorry if that's a bit confusing! I seem to be meeting myself coming backwards at the moment!

I'm off out now, but will be back later.

Thanks

 

[donnellysdogs]

Hi Leggott

As I have read it:

Initial concern:

Basal: 5pm-8.30pm was 0.1 and then from 8.30pm-22.30pm was 0.45
Readings went low from 9.30pm throught to 11.30pm....

Now:
Basal 5-8pm is still 0.1 and then from 8-10pm 0.3 and then 0.05 till 5am
Readings went high from 9pm - 11pm and then dropped significantly through to 1.30am.

Without any changing of the basal which has peak acting time 3 hours later the readings have significantly changed in the opposite direction....

So first off, need to know really what was ate last night for tea......and if this has been ate before with the same impact of going high 3-5 hours later...this sometimes happens with things like bread, potatoes, pasta for me.....

I personally would be adding in another time slot...Reasons being.... from 8-10pm basal is at 0.3 and then sinks to 0.05 for rest of the night.....I think adding in another time slot would be more benefical.....I would be considering putting in another time slot at 9.00pm to 11pm and lowering the 0.3...

I can only go from my own basals and how mine fluctuate of course...the accuchek pump allows very, very easy set up of changing rates on an hourly basis...rather than having to add them in all the time.....I don't know how many different time slots your pump will allow???? We have 24-every hour...not sure whether your machine has a maximum number of time slots that can be set up..

I know you said that the tea was a little one, but what type of food was it??

Sounding pretty complex here....sorry.....just that you may be getting some foods and carbss that actually last longer...or that (and definitely not accusing here!!!) was any other food 'sneaked' in??
Sorry I got to ask, and not being detrimental, wouldn't dare....but to go from one night of low's to another night of higher readings with the same 0.1 basal and I am assuming the same bolus ratio there has to be a reason-and at the moment it isn't jumping out to me......

 

[leggott]

Hi Donnellysdogs,

His tea last night was a bread roll with small sausage and a small piece of birthday cake as we had a BBQ party. His pre-meal reading was in the 5's. Again I don't think it was down to this although I can't rule it out. Tonight we are going to try and do a non carb tea and then test from tea time every hour until 8pm.

I think the dramatic fall on Sat eve was down to the basal of 0.45 as it was so high and hAving an impact around 9 - 10pm.

I can add more time slots very easily and I agree with your suggestion of adding another time slot later on in the evening to stop him falling in the early hours. The later part of the night was good so the 0.05 at that time seems to be working.

Thank you.

 

[SophiaW]

I'm having the same thoughts as Donnellysdogs. Personally I wouldn't make any changes to the early evening basal just yet, I'd get some testing done over the next day or two to make some comparisons. A fasting test through the hours from 4pm to 8pm would be useful. I also agree about adding a new time slot from 9pm for now to deal with the early morning drop. Later in the morning up to 7am is looking great, well done

 

[leggott]

Thanks Sophia. We have decided to fast between 4- 8pm today and not make any changes to basal for now just to see what is happenging early evening. Based on our findings will determine any changes we make tomorrow. Thank you.

 

[jopar]

I agree that a fasting test is a good idea..

Sugar Free Jelly is a friend when it comes to these as it doesn't impact on the blood glucose, just double check the flavouring doesn't give carbs though!

You both doing well indeed..

 

[donnellysdogs]

Agree with everyone....will be good to do some basal testing around that time....Leggott, you are both doing so fantastically with being just two weeks in to it all. I do not envy parents of children on pumps...and admire all of you so much.....

 

[leggott]

Hi again!

After a tea of sugar free jelly, salmon flakes and cheese his blood slowly went up from about 6pm onwards, we've just done the last check and his blood has gone up a little each hour. Although this does confirm that basal is too low and should be increased from about 4pm, it still doesn't rule out the fact that the rise later may also be down to the digestion of carbs.

We haven't made any changes this evening, but plan to increase basal at around 4pm and then reduce the basal at 9pm. We will then get him to do another fasting test at tea in the next few days.

I will let you know how we get on tomorrow night!

leggott

 

[donnellysdogs]

Good Leggott....

If you at least get and the know the starting place of basals being ok, then that eliminates one thing out of the equation.....

Sharon