Hello All, I having been having a few problems controlling my daughters blood sugars over the xmas holidays. Some of the readings make no sense at all. I have started to use the temp basal and a few times over the past couple of days the temporary basal has had to be set at 200% in order to get the levels down. However when she was on a temporary basal of 200% this morning for 2hrs her levels did not come down at all. I have no idea why the temporary basal wouldn't work as she has had a full set change. Does anyone have any idea's? The holidays are always hard for us. Her levels are very high during the night and again I set the temporary basal at 200% which did bring her down but now I'm a bit worried about making the changes to the basal. It may sound silly but I would be doubling her doses and it just makes me nervous as I am used to changing by 0.05 or 0.10. Any advice would be greatly appreciated.
Temp Basals
- Thread starter martina
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mrman
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MarkbUK
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I would support what Brett has said, and would add, it might be useful to check for ketones as well, and, if you have it, look at the information they provided about corrective doses, as whilst you can use a Temp basal for correction it's more common to use a correctly calculated bolus as a correction
Although sneaking carb without doing a bolus would cause high bg levels, doing a tbr increase of 200% should lower them. If fo
food eaten over Xmas has caused weightgain, then the basal need will change and need to increase so that the tbr will start to work as it should. Try and do a basal test for a few hrs just to see
food eaten over Xmas has caused weightgain, then the basal need will change and need to increase so that the tbr will start to work as it should. Try and do a basal test for a few hrs just to see
Do you have separate basal patterns for school days and holidays? If you don't then consider it a must. Has your daughter been a lot less active during her Christmas holidays? Are the foods she is eating higher fat is she snacking a lot and are the snacks being bloused for?
All the above need to be considered from the other posters as well.
All the above need to be considered from the other posters as well.
irrationalJohn
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Really too little information to feel comfortable making any suggestions. Questions which come to mind are things like your daughter's ~age, how long these unexpected BGs have been persisting, if it is only basals or (as I would expect) it also happens with her meal/corrective bolus? Why did you not say anything about how your daughter's BG is responding to meal/correction boluses?
It's also not clear (to me) what you mean by "she has had a full set change". If I have a bad site, simply inserting a new infusion set into a new site does not always fix it. It should, yes. But sometimes you can get really unlucky. Around this point I might very carefully try administering a correction bolus via injection rather than using a new site. (You don't want to push her into a hypo in case both the injected and pump delivered insulin actually do simultaneously kick in.)
I might also disconnect the pump tubing and prime 5 or 10 units just to make sure the insulin is coming through the tubing. I expect that it is, but sometimes it's best to try to go step by step by step in order to rule things out. Perhaps?
Hello Martina,
As Carbsrok has already suggested, your daughter will need to have different basal profiles for weekdays, weekends and holidays. For my son, we have further 2 different profiles for holidays as active holidays (when he is active, plays sports/goes to the gym) and inactive holidays (when he just sits at home and is mainly inactive). From our experience (you will need to test and check what works for your daughter), my son needs about 30-40% more basal during weekends/holidays as compared to weekdays. However, I have noticed that when his basal changes then it also has a spill over effect on his bolus ratios. e.g.my son needs 1:9 for bfast during weekdays, which changes to 1:8 during weekends as he needs 30% more basal during active holidays/weekends. Also, his inactive holiday basal is further 10% more than his active holiday basal, and when he is inactive his bfast ratios change to 1:7...So in a nutshell, you will have to test, judge and adjust for your daughter's bolus ratios as well as basal rates during weekends/school holidays and set the basal and ratios accordingly. But first set her basal right and then adjust the bolus ratios accordingly. Also, I have found some kind of routine during holidays to be very helpful in terms of food and exercise. Also, if she could follow similar sleeping patterns (e.g. consistently wake up late/early during holidays) that could also help.
Thanks Guys, I do already have a different profile for school days and weekends which usually works fine. I think we are just going through a period where changes are needed xmas just makes it harder to get right. I did basal testing on her morning levels and they were very good therefore I think she needs more insulin with her breakfast. I am finding that she wakes up around 11 and despite the breakfast bolus and the correction that would have been added to it was not bringing her down at all and she was still high at lunch. then the exact same thing was happening at lunch time. I'm just having trouble working out whether its bolus, basal or the correction factor. Probably a combination of all 3. Am I right in thinking that it may be the basals set to low to let the correction work. I have just become so confused with the whole thing as patterns seem to change from day to day making it so difficult to get understand what the problem is. I appreciate the advice.x
Hi,
From my experience, the weekdays and weekend basals work very well but only during term time. However, it all just goes haywire when the long school holiday break starts...and that's when you need to think about another basal profile i.e. inactive holiday basal, which might be slightly more than the weekend basal. As mentioned earlier, this will also have a spill over effect on bfast, lunch and dinner ratios!
Also, I noticed from your reply that your daughter wakes up at 11 am. What I have experienced with my son is that when he wakes up late he needs a very high temporary basal for 2 hrs atleast....may be some kind of a liver dump happens!!. The best way to find out is to test as soon as she wakes up, and then test again right before bfast ...For example yesterday my son woke up with a perfect 5.2 at 11.30 am and was 7.8 right before bfast around 12.15 p.m....within 45 minutes!!! I know that it is not a basal issue as the same basal profile worked fantastically well the day before and even today....not sure why this happens only on a few days...may be to do with how active/inactive he has been the previous day, etc. But I have noticed this on a few odd days during long holidays, and didn't come as a surprise. Only because I make him test right before bfast as well as when he wakes up (only during holidays...as i know this is a lot of testing especially in a short span of 30-45 minutes), it was easy to detect and correct so his levels were ok before lunch. Depending on the difference between his waking up levels and levels before bfast, we also then adjust the bolus ratios accordingly as well as the basal.
Yes, I think you are right in thinking that if the basal is too low then the correction doesn't work...atleast I have noticed the same as well!
You might want to try the method suggested above before bfast, and then try temporary basal rates(a % increase over and above the weekend basal) for the rest of the day...and depending upon what works you may then set that as the holiday basal.
Unfortunately, it is all a bit of trial and error, which may be due to teenage issues to do with puberty, hormones, etc. Hope this helps!
From my experience, the weekdays and weekend basals work very well but only during term time. However, it all just goes haywire when the long school holiday break starts...and that's when you need to think about another basal profile i.e. inactive holiday basal, which might be slightly more than the weekend basal. As mentioned earlier, this will also have a spill over effect on bfast, lunch and dinner ratios!
Also, I noticed from your reply that your daughter wakes up at 11 am. What I have experienced with my son is that when he wakes up late he needs a very high temporary basal for 2 hrs atleast....may be some kind of a liver dump happens!!. The best way to find out is to test as soon as she wakes up, and then test again right before bfast ...For example yesterday my son woke up with a perfect 5.2 at 11.30 am and was 7.8 right before bfast around 12.15 p.m....within 45 minutes!!! I know that it is not a basal issue as the same basal profile worked fantastically well the day before and even today....not sure why this happens only on a few days...may be to do with how active/inactive he has been the previous day, etc. But I have noticed this on a few odd days during long holidays, and didn't come as a surprise. Only because I make him test right before bfast as well as when he wakes up (only during holidays...as i know this is a lot of testing especially in a short span of 30-45 minutes), it was easy to detect and correct so his levels were ok before lunch. Depending on the difference between his waking up levels and levels before bfast, we also then adjust the bolus ratios accordingly as well as the basal.
Yes, I think you are right in thinking that if the basal is too low then the correction doesn't work...atleast I have noticed the same as well!
You might want to try the method suggested above before bfast, and then try temporary basal rates(a % increase over and above the weekend basal) for the rest of the day...and depending upon what works you may then set that as the holiday basal.
Unfortunately, it is all a bit of trial and error, which may be due to teenage issues to do with puberty, hormones, etc. Hope this helps!
