what percentage is background ?

[Matt1212]

Hello All,

In general for those on MDI what percentage of you total dose is your background ?
At present my daughter (5 yrs) is getting around 25% of her total insulin in levermir

I am thinking this is a little low and should be nearer 40% ?
I guess as a child grows her background will also need to increase (it has been static for the year on MDI)
Noticing a move from where she tended to drop from 10BG at midnight to 6BG 8.30am
To last night 6BG midnight (had a correction at 9.30pm) to 9BG 8.30am

Thanks
Matt

 

[cugila]

As this is a 5 yr old child I wonder have you discussed this with your DSN/Endo ? I also wonder why you think the level should be higher ? It is far better to air your concerns with the people who know your childs medical history and have due regard to all the circumstances.

I for one wouldn't like to give any opinion on this.

Ken

 

[Matt1212]

Hello Ken,

I belive the level should be potentially higher based on info I read when my daughter first went onto an MDI regime - an example being below.

1. Background Need: Insulin is required in the bloodstream all the time. This relatively steady background need is met when 45% to 60% of the total insulin dose is given as NPH, or better Lantus once a day, or as the basal rate on a pump. This insulin keeps the blood sugar steady when not eating

I am interested in the percentage breakdown from other people on MDI to see if this is a true reflection. All opinions are welcome hence my making the post.

If an opinion from the relevant specialist is required I will ask them , however at this point I am interest in the members views here.

thanks
Matt

Edit 22/07/2010:

The OP has consistently refused to give us the link to this information and more specifically as to whether or not it is aimed at very young children. The information cannot be verified as accurate so we would ask all members to treat the information with caution.
Contact your HCP for advice.

cugila
Forum Monitor

 

[cugila]

Do you have a link to that information please.......is it specifically aimed at young children ?

Whilst opinions are fine here, we also like to deal in facts which we can verify.

Ken

 

[cugila]

Here is a link to a small article about this in relation to pre-school age children, this is the sort of thing we would like to see from you if possible. It helps us to be sure of the facts.

http://pediatrics.aappublications.org/c ... 115/5/1320

Ken

 

[timo2]

Hi Matt1212,

As the strengths of the various types of basal insulin available will vary, you can't really work to a percentage dictated by your daughters rapid doses. Basal and bolus doses need to be treated individually according to need.

It could be that your daughter needs to split her basal dose, if she doesn't already do so. If she's already on two shots of background insulin per day, then she may need to tweak her AM/PM ratios.

Regards,
Tim.

 

[Matt1212]

All I hoped to see where some views and opinions of other type 1 diabetics and parents of type 1 diabetics as to background/short term split in insulin that they use.

It is not technical articles that are needed but experiences of actual day to day control , this will assist me in trying to care for my 5 year old child as best I can.

 

[cugila]

We know that , but we need to know that what gets posted is suitable for small children......that is why we want to see the original article you have quoted in the post. We don't doubt that there will be people willing to give you opinions, nobody is stopping that. We also have a duty to make sure it is factual as far as we can and would not be detrimental to your childs health. That's all we are asking.....a link to the article for us to follow up..........please.

Ken

 

[cugila]

I have pm'd you......

 

[jopar]

All insulin's used in the UK are U100 the same strength, you can import a U500 insulin from America but this has to be done under special licence for the individual patient.. I'm sure U100 is now world wide...

Percentage is really only a guide line, in common most people will fall into the 40-50% range somewhere, teenager can go as high as 60%... In the main when the health proffesionas work children''s out, they take several factors into consideration.. Previous TDD, current A1c's and weight of child then number crunch..

Another factor that plays apart in the percentage game, is activity levels, it's likely a more active person would have a lower percentage..

I would have a word with the diabetic nurse, she would be better able to explain it all

 

[ZACNEMMA]

Hi Matt

My 14 year old son gets 60% of his insulin from background. From what I can gather that is about right for a teenager. If your childs HBA1C'S are within range then perhaps it is right for your child to. I have always been advised not to change the background without speaking to Consultant first.

Not sure if that helps, Emma

 

[Jen&Khaleb]

My son (14kg and 4 in Dec) has about 65% Levemir and 35% Novorapid. His Dr wants me to try and even this up to 50:50 but my response was that he is unable to have a reasonable morning or afternoon on the lower levels.

In reality the percentage is slowly evening up, over time, as when he was 8 months old (diagnosis) he was on 80% Levemir and 20% Novorapid.

Depending on what short acting you are on would greatly affect your management and my vote is for the split that works. Guidlines are great but only as guidelines and not set-in-stone rules.

If you are doing quite a few correction doses I'd take a look at the long acting to see if it needs increasing. Most often when you change the long acting it changes the carb/insulin ratio at meals also. Sleepless nights and more testing ....

 

[Matt1212]

many thanks to Jen and Emma for the input
it would seem that potentially increasing the background and also increasing the ratios for carb to insulin may make sense and hopefully reduce the BG fluctuatuations.

I will discuss with the diabetes team , however her in Ireland making such adjustments is a decision which parents would be expected to make and then seek reassurance from the hospital.

 

[Jen&Khaleb]

Probably should have editted my post. When I was talking about reasonable morning and afternoon I was talking about him eating morning and afternoon tea without extra Novorapid. Must of been a bit on the sleepy side when I was typing.

Good luck with whatever you decide and remember, if you are making changes, only do small adjustments every few days and not do it all at once.

 

[cugila]

As a result of the OP's repeated refusal to provide the link or source posted here about levels and whether or not they are specifically aimed at young children this thread is being locked. The information cannot be checked out so is considered unreliable information.

As previous posters have stated it is imperative that any changes to medications in those so young are only made after proper consultation with the relevant HCP's and are not just carried out because the Parent thinks it might be a good idea. It makes no difference where you are located in the World, that's the best advice to any Parent thinking of changes.

We are leaving the thread so people are aware of how NOT to do it when you are asked for a source.

cugila
Forum Monitor