Please have a look at DDs graph

[shivles]

DD 17MO is now on split basal dose, 0.5 units morning and night. It seems to me like she needs more? She was on 2 units a day single dose a couple of weeks ago and I felt that worked well during the day but she had night hypos (dose given at 7pm).

What do you think is it a basal or bolus issue?

 

[tim2000s]

I know she's just a little 'un, but have you tried basal testing in short stints? This will tell you for sure. As she's so small, probably no more than 6 hrs at a time, and using sugar free jelly as food. Often, if basal is out, it throws the bolus amount out too.

www.mysugr.com/basal-rate-testing/

 

[shivles]

I know she's just a little 'un, but have you tried basal testing in short stints? This will tell you for sure. As she's so small, probably no more than 6 hrs at a time, and using sugar free jelly as food. Often, if basal is out, it throws the bolus amount out too.

www.mysugr.com/basal-rate-testing/

It's not something I want to do, she has a good appetite and would not be happy about only being able to eat jelly lol

 

[tim2000s]

It's not something I want to do, she has a good appetite and would not be happy about only being able to eat jelly lol

Sadly, if you don't, then you can't really get a good lowdown on where the problem lies. Catch 22 situation.

 

[Juicyj]

Morning @shivles - I would contact your team to discuss these readings, because of her age she should be given priority with care. It is difficult for us to really advise on this because of her age, can you call them this morning to discuss ?

 

[shivles]

Morning @shivles - I would contact your team to discuss these readings, because of her age she should be given priority with care. It is difficult for us to really advise on this because of her age, can you call them this morning to discuss ?

I'll be calling later I just like to have an idea before I do because they always seem reluctant about changing things

 

[Juicyj]

I'll be calling later I just like to have an idea before I do because they always seem reluctant about changing things

Hey be a pushy parent, that's the only way forward, make them stand up and listen, their job is to support you fully, remember your daughter is dependent on you so getting the best for her and parents intuition is telling you something needs to be changed so make sure they fully understand this, they shouldn't be reluctant to change anything and should realise a small one's needs will change frequently so it's normal to need to review this regularly. Call them as much as you need

 

[azure]

@shivles I second the advice to check with her DSN. I would ask if it was sensible to try 1 and a half units of basal, split in the way they advise. You could, if you think it's appropriate, also ask their reasons for dropping her basal down from 2 units to 1 unit.

If you compare the chart above with the charts you got when she was on 2 units of basal, you may get more clues as to what's going on. We can only guess, and none of us are medical experts. It does seem like it might be the basal, but I would discuss with her team.

@tim2000s I believe artificial sweeteners aren't recommended for children under 3 and aren't permitted to be added to foods for them.

That aside, I quite understand why you don't want to do a basal test, Shivles. I wouldn't think its right for such a young child, and I wouldn't do it to my son if he was diabetic. You should be able to work out appropriate doses without doing a basal test - with the help of your team and your thorough records

 

[shivles]

I think they dropped it down to 1 because 1.5 is an impossible split, the smallest I can give is .5

I'll be ringing in as I say it's just always good to have fresh eyes looking at the numbers, you lot pick up on stuff we miss

 

[azure]

I think they dropped it down to 1 because 1.5 is an impossible split, the smallest I can give is .5

I'll be ringing in as I say it's just always good to have fresh eyes looking at the numbers, you lot pick up on stuff we miss

The split might not have to be exactly in half @shivles Ask if it would be possible/appropriate to split into 1 unit and 0.5 of a unit - making a total of 1.5 units per 24 hours, with the smaller and larger 'halves' placed as most appropriate eg the smaller one at night if she's prone to hypos then, and the larger one to cover the daytime when she tends to go higher.

 

[shivles]

The split might not have to be exactly in half @shivles Ask if it would be possible/appropriate to split into 1 unit and 0.5 of a unit - making a total of 1.5 units per 24 hours, with the smaller and larger 'halves' placed as most appropriate eg the smaller one at night if she's prone to hypos then, and the larger one to cover the daytime when she tends to go higher.

This was what I was thinking myself

 

[donnellysdogs]

The highs and drops to me look to be from a bolus.
If I read right the graph shows a high about 6am and then a significant drop? Was there a bolus given o correct that high? If so looks like the correction bolus was too much.

The high on waking may be due to a low at 3-4am but can't see readings for that time..

Hope u spoke to DSN?

 

[shivles]

The highs and drops to me look to be from a bolus.
If I read right the graph shows a high about 6am and then a significant drop? Was there a bolus given o correct that high? If so looks like the correction bolus was too much.

The high on waking may be due to a low at 3-4am but can't see readings for that time..

Hope u spoke to DSN?

Yes I gave correction before her breakfast and eventually she came down to normal range after peaking again from the breakfast, why do you think it was too much?

I spoke to DSN and basal and meal doses have been increased

 

[donnellysdogs]

To drop from 13.9 to 4.9 in two hours was too much.
To increase from 7.4 to 15.8 was too much increase after food....
As basal testing isn't an option it is fine tuning the bolus and correction to stop the quick highs n lows.. Thats why I would be looking at bolus and corrections first.

 

[shivles]

To drop from 13.9 to 4.9 in two hours was too much.
To increase from 7.4 to 15.8 was too much increase after food....
As basal testing isn't an option it is fine tuning the bolus and correction to stop the quick highs n lows.. Thats why I would be looking at bolus and corrections first.

How would you fix those things though?

 

[donnellysdogs]

To me, I would be lowering the insulin for bolus and corrections so I was not having such big drops....
The bolus for breakfast wasn't enough.. But was there any correction between 9am and 11am? If so it looks like the correction was too much.

The rises and drops too me are too much after a bolus.. So increasing basal rates as well as bolus is going to put things in a harder place.

To me it looks like a raise in basal at night time only at the moment and to get bolus and corrections sorted for daytime. Ie if 1 to 9g for breakfast put to 1 to 8g.....