Starting on a pump Basal/Bolus question

[egi]

Got the Cozmo for my daughter last Thursday with the hope of
starting the next day, but we had to wait for Monday (which
was very upsetting for me but it is water under the bridge now).

So the diabetes Educator started her on a 0.2/h basal and 1/30
ratio for bolus, even though her numbers from the night before
starting on the pump, with no Lantos, were constant - showing
her own insulin production (yes, still in honeymoon) is covering
for basal.

Over the last 2 days we saw these numbers:


12A 3A 6A 9A 10A 12P
Mon 92 86 124
Tue 150 132 108 199 134 84
Wed 172 142 118 233

12P 2P 4P 6P 7P 9P
Mon 124 129 95 72 107 163
Tue 84 144 70 118 179
Wed


To me, this shows that the bolus for meals (6AM, 12PM, and 7PM)
need to increase (we already did that and went from 1/30 to 1/25)
and basal reduce.

Any ideas/observations/similar experiences from anyone?

I would probably not make any drastic changes, at least during the
first 3 days on the pump, without the approval of the DE, but after
that...

Also, my daughter used to get twice the dose of Novolog in the
morning compared to the evening dose and now she was told to
use the same insulin to carb ratio throughout the day, which is probably
the main reason for her numbers. Any comments/info about this to
will be great.

Thanks

[aeromarv]

Egi,

Those numbers look fairly close to what I have seen for myself now that my basals are all ironed out. One thing that would help to give you ideas would be to see not only the blood glucose results, but also how many carbs are being eaten and what bolus is being given. How confident are you with the 1 unit per 30 grams carbs? Did you use this ratio previously with great success?

But those numbers look okay to me for just starting out on the pump. Most people see a rough period while moving on to a pump. I've been pumping for a week, and my educator told me today she was surprised at my progress because she usually has to make adjustments for people for a few weeks before the control really shows itself. Although my honeymoon period was over years ago!

[spike]

The numbers are great. I suggest you make no major changes whatsever for now. you need more days of numbers before deciding to make semi-permanent changes, anyway. looking good!

[Funnygrl]

I agree with Spike 100%.

[egi]

Thanks for the replies.

We do keep the same diet (not only the carbs, but exactly the same menu)
for the first 3 days to eliminate any variability.

I still have an issue with the 233 reading this morning which we gave a
correction bolus of 0.8 units (she has a ratio of 100/1 for corrections)
which should bring her to 153.

Based on the last 2 days, if she has a 9pm (2hrs after dinner) reading
of 163 or 179, and has a 6am reading of 108 or 118 respectively, with
no food intake, her numbers are dropping about 60 points overnight
with only the basal (and her own insulin) working - it looks to me that
her basal is too high.

I would want her to start the night between 100 - 130, which with the
current basal will push her way too low during the night.

Does this make sense, or am I missing something?

[spike]

Thanks for the replies.

We do keep the same diet (not only the carbs, but exactly the same menu)
for the first 3 days to eliminate any variability.

I still have an issue with the 233 reading this morning which we gave a
correction bolus of 0.8 units (she has a ratio of 100/1 for corrections)
which should bring her to 153.

Based on the last 2 days, if she has a 9pm (2hrs after dinner) reading
of 163 or 179, and has a 6am reading of 108 or 118 respectively, with
no food intake, her numbers are dropping about 60 points overnight
with only the basal (and her own insulin) working - it looks to me that
her basal is too high.

I would want her to start the night between 100 - 130, which with the
current basal will push her way too low during the night.

Does this make sense, or am I missing something?

100, for a child at bedtime? I dont' think so. that's cutting it too close. I strongly urge you NOT to be too perfectionistic with the numbers, or you will be risking hypos. It's fine to want to dampen down the really high numbers, but don't take it to an extreme at bedtime. and what about snacks? doing them or not, late at night?

[aeromarv]

Well, it seems that with the numbers you gave, then its possible the basal at night may be a tad high.

But I agree with Spike. 100 at bedtime, especially if you are still working out the pump set-up is a bit too close. When I started last week, my nighttime basal was too high. I dropped rather low overnight. If I had started at 100, I may have been in trouble. Once you feel the basals are set-up accurately, then I'd try to SLOWLY reduce the bedtime BG. If a drop of 179 to 118 was seen, then starting at 100 would have fallen to 39!

Are you getting up and checking sugars overnight?

[egi]

Our recommended bedtime number on MDI was 130, and I would probably
not go to a 100 anytime soon, before we have more night time data with
the pump.

However, if the basal is lower than the current number I don't see why
would she go low. The day before we started on the pump, she did not
take Lantos in the evening and injected only her Novolog, and she was
constant at 96 or so, at midnight, 3am and 6am.

Regarding snacks, we are not doing it now, during the first 3 days on
the pump. After that, I believe she will take snacks whenever she wants
and then cover it with the appropriate bolus.

I wish I could get a call from the DE after I left her 2 messages more than
4 hours ago...

[egi]

Yes, we are doing the 12am, 3am, 6am routine - took us back a few years
back, to the feeding/diaper changes days...

And we thought this was behind us (at least until we graduate with
grandparents degree, which is not for a loooong time, I hope)

[xMenace]

..
...
Also, my daughter used to get twice the dose of Novolog in the
morning compared to the evening dose and now she was told to
use the same insulin to carb ratio throughout the day, which is probably
the main reason for her numbers. Any comments/info about this to
will be great.

Thanks

A typical pattern IMHO. My morning rates are even higher. But we're all different. Go slowly; be sure.

[Cyborg]

Make sure you do some basal testing by skipping a meal periodically. Once the basals produce a fairly constant bg without food, then the insulin to carb ratios can be adjusted and the overall target bg can be lowered.

[egi]

Yes, the plan is to do that especially for breakfast time, on days
she doesn't have school (like tomorrow), since it looks like she is
very insulin resistant in the morning.