Hello, my daughters blood sugars have been running high at her 10am check. She wears a pump and has her breakfast at around 8am. My question is do I up her morning bolus or change her 8am basal. I'm always a bit concerned when changing her morning bolus because at the moment when within normal range she gets 8 units to cover her breakfast as her carb ratio is 1 to 7. However if I knock it down to 1 to 6 it will give her 9.3 units. This just seems like an awful lot more. Does it really matter which one you change? Advice appreciated.x
Bolus or Basal
- Thread starter martina
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I'm always put of doing this when she is at school, but your right it is the only way to know for sure. thanks
irrationalJohn
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- Type of diabetes
- LADA
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First, I agree that doing a cautious correction bolus or temporarily cautiously upping her meal bolus manually seems safest until her morning basal can be rechecked.
But about her pump's carb ratio setting(s) ... I am confused. Doesn't her pump switch to decimal values when the ratio drops under 10? In other words, isn't 1 to 6.5 or maybe 6.7 an option? I thought all pumps allowed this extra granularity at that end of the carb ratio range for exactly the reason you described.
Gosh that would be so handy. No her accu chek Aviva doesn't switch to decimal values at all its all whole numbers and like I said 8.0 to 9.3 is and awful lot. I suppose I could reduce her carb so she doesn't get just quite as much. For instance her breakfast usually works out at 56 grams of carb for which when within normal range gives 8 when her carb ratio is 1 to7. However if I was to change the carb ratio to 1 to 6 I would then perhaps give her 53grams of carbs which would give 8.8 units. if I kept her breakfast to 56 carb it would give 9.3. Hope I haven't confused u more. Which pump goes up in decimal values. we have the problem a lot might be worth a look.
irrationalJohn
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- Type of diabetes
- LADA
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I have a Medtronic Paradigm Revel and that is how the carb factor works. The carb factor setting changes by one until drop below 10. At that point a decimal point is added so you get more granularity. I am not sure if all pumps do this. I simply assumed that they did because my Medtronic pump does.
But it sounds to me as though your daughter is on MDI and you are using the ACCU-CHEK® Aviva Expert Blood Glucose meter, yes? It also sounds like there is a design error in what carb ratio values can be entered.
For whatever it's worth, if you have a calculator ... or I guess any reasonably smart enough phone these days ... you can calculate the food bolus yourself. All you do is divide the grams of carb by the carb factor. Thus, assuming a meal of 56 g of carb, the bolus would be the following:
when CF = 7.0 bolus is 56 / 7.0 or 8.0 U
when CF = 6.9 bolus is 56 / 6.9 or 8.1 U
when CF = 6.8 bolus is 56 / 6.8 or 8.2 U
when CF = 6.7 bolus is 56 / 6.7 or 8.4 U
when CF = 6.6 bolus is 56 / 6.6 or 8.5 U
when CF = 6.5 bolus is 56 / 6.5 or 8.6 U
when CF = 6.4 bolus is 56 / 6.4 or 8.8 U
when CF = 6.3 bolus is 56 / 6.3 or 8.9 U
when CF = 6.2 bolus is 56 / 6.2 or 9.0 U
when CF = 6.1 bolus is 56 / 6.1 or 9.2 U
when CF = 6.0 bolus is 56 / 6.0 or 9.3 U
when CF = 6.9 bolus is 56 / 6.9 or 8.1 U
when CF = 6.8 bolus is 56 / 6.8 or 8.2 U
when CF = 6.7 bolus is 56 / 6.7 or 8.4 U
when CF = 6.6 bolus is 56 / 6.6 or 8.5 U
when CF = 6.5 bolus is 56 / 6.5 or 8.6 U
when CF = 6.4 bolus is 56 / 6.4 or 8.8 U
when CF = 6.3 bolus is 56 / 6.3 or 8.9 U
when CF = 6.2 bolus is 56 / 6.2 or 9.0 U
when CF = 6.1 bolus is 56 / 6.1 or 9.2 U
when CF = 6.0 bolus is 56 / 6.0 or 9.3 U
Not a really satisfactory answer, I realize, since the meter should be doing this for you. But it is another alternative.
Hello Martina,
Since your daughter has breakfast at 8 am and at 10 am her BG is high, could it also be a spike from breakfast? What does she eat for bfast? For most cereals I give my son bolus atleast 15-20 mins in advance.
You will only get to know this if you check after 4 hours, i.e, 12 noon. Do you check around this time as well? If her BG is back to where it was at 8 am then it could be a spike.
Or it could be the basal as CarbsRok has already mentioned. Teenagers basal needs change very fast...atleast that's what I have noticed with my son. There was a phase when my son needed 30-40% more basal upon waking for the next 2 hours ...with the pump it is easy to manage.
Since your daughter has breakfast at 8 am and at 10 am her BG is high, could it also be a spike from breakfast? What does she eat for bfast? For most cereals I give my son bolus atleast 15-20 mins in advance.
You will only get to know this if you check after 4 hours, i.e, 12 noon. Do you check around this time as well? If her BG is back to where it was at 8 am then it could be a spike.
Or it could be the basal as CarbsRok has already mentioned. Teenagers basal needs change very fast...atleast that's what I have noticed with my son. There was a phase when my son needed 30-40% more basal upon waking for the next 2 hours ...with the pump it is easy to manage.
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Thanks, I did some basal testing and there were spot on which meant it had to be the bolus so I have made the changes however even that isn't working great at the moment. For example yesterday morning she work at 6.8 and was 5.0 at the 10am check. She had her snack but by 12pm she was 10.4.The same this has happened today. She woke at 6.9 and I gave less bolus then yesterday. Come 10am she was 6.3 and had her snack as usual. She then did a test at 11.1at the start of an hour of P.E, she was 4.7 so she took another snack only because we thought one would be needed for the exercise. 12pmshe was 9.4. I think I need to give less at 9am to stop it being so low at 11am but also a bit more at 10am to stop the rise at 12pm. would you agree. To be honest her levels are very erratic and I am struggling to get them under control even with the pump. She suffers from hypo unawareness and has never been able to pick up on signs of lows, hence lots of checks. If you have any advice on controlling the sugars during puberty etc I would love to hear it as right now it feels like we are fighting a losing battle. Martina
How about daughter eating less carb in the snack if bg is lower than you would like?
Also, using the Combo bg meter, it's possible to change the carb ratios to add another 0, like
10u to 70g instead of 1u to 7g. By adding another 0, you can get a bit more manipulation on how much bolus gets calculated in the wizard. You could use 10u to 71g or You can change the units of insulin and the grams of carb to suit.
Also, using the Combo bg meter, it's possible to change the carb ratios to add another 0, like
10u to 70g instead of 1u to 7g. By adding another 0, you can get a bit more manipulation on how much bolus gets calculated in the wizard. You could use 10u to 71g or You can change the units of insulin and the grams of carb to suit.
Yes, I fully understand what you are going through, as controlling levels during puberty can be a nightmare! As I mentioned earlier, their basal needs could also be erratic! What might work this week may not work the week after! In such cases I have experienced that some kind of routine/discipline as regards food and exercise helps!
As mentioned by you, if she is 6.9 at 8 am and 4.7 at 11 am then clearly the bolus is too much as the difference after 3 hrs should not be more than 1.7!
If her basals are spot on, then next time why don't you give her the original bolus ratio, and then check after 2 hrs, 3 hrs and then 4 hrs (without any snack in between)....as I have mentioned earlier it could be that the original bolus and ratios were correct, but the timing of the bolus needs tweaking as it could've been a spike at 10 am (as noticed in your original post).
Also, if she could have a clear gap of 3 or 4 hrs in between any meal/snack, that might also help! So if she has to have a snack at 10am then you might want to give her the bfast by 7 am...so that by the time she has her snack, you clearly know if the earlier bolus was right or not. Because after 2 hrs of eating, it could either be that the bolus was not right/ it could be a spike! If she keeps eating within 1-2 hrs intervals, then unfortunately this kind of a problem may keep recurring. Hypos could also result from insulin stacking!
Also, it might help if you keep a detailed diary for a week, and see if there is any particular bfast/ snack that causes such problems. For example, no matter what I do, if my son eats crisps for snack then his BGs are always erratic...but with fruit/9 bar (cereal bar) there is never a problem!
As mentioned by you, if she is 6.9 at 8 am and 4.7 at 11 am then clearly the bolus is too much as the difference after 3 hrs should not be more than 1.7!
If her basals are spot on, then next time why don't you give her the original bolus ratio, and then check after 2 hrs, 3 hrs and then 4 hrs (without any snack in between)....as I have mentioned earlier it could be that the original bolus and ratios were correct, but the timing of the bolus needs tweaking as it could've been a spike at 10 am (as noticed in your original post).
Also, if she could have a clear gap of 3 or 4 hrs in between any meal/snack, that might also help! So if she has to have a snack at 10am then you might want to give her the bfast by 7 am...so that by the time she has her snack, you clearly know if the earlier bolus was right or not. Because after 2 hrs of eating, it could either be that the bolus was not right/ it could be a spike! If she keeps eating within 1-2 hrs intervals, then unfortunately this kind of a problem may keep recurring. Hypos could also result from insulin stacking!
Also, it might help if you keep a detailed diary for a week, and see if there is any particular bfast/ snack that causes such problems. For example, no matter what I do, if my son eats crisps for snack then his BGs are always erratic...but with fruit/9 bar (cereal bar) there is never a problem!
Thanks for this. Our nurse has always told us that the difference you mention is after 2hrs, hence the only reason we do the10am checks that we do. She doesn't always have a snack at 10am, it really just depends on what her level happens to be. We already tend to stick to the foods we know work for her. However with things changing and her hitting puberty perhaps I need to take another look.
