We've been on what seems to be an never ending adjustment since Bean's appointment at the end of January. She sees a Nurse Practitioner...there's no pediatric endo in our area and so far we've done just fine without one. (Granted there is an endo at the clinic we go to, so if the need ever arises there's one available.)
We started by adjusting insulin to carb ratios, going down by one carb each week to see how that affected Bean's numbers. That went pretty well and we settled into a nice groove.
We scheduled a six week follow up instead of waiting three months since we were going to be 'playing around' with things. At that appointment (mid-March) we adjusted the timing of the ratios from one ratio for breakfast thru afternoon snack and another for dinner and bedtime to one ratio for breakfast thru lunch and the other for afternoon snack thru bedtime to see if we could get Bean's afternoon spike to lessen.
At this appointment there was also the discussion of adjusting Bean's overnight basal...something I didn't want to do because we had just gotten to the point of not having to give her a snack in the middle of the night to keep her from taking a nose dive before breakfast. I was happy with doing corrections...well, not happy, but they were way easier than convincing a sleeping kiddo to eat/drink something and Bean sleeps hard!
What our NP told us was that in a 'perfect world' Bean should be getting half of her insulin from her basals and half from her boluses. Bean was around 25% for basal and 75% for bolus.
Well, in the weeks following that appointment, I have been playing around with her overnight basals. It was a tough decision (a) because I had been so adamant about NOT changing them at the appointment (and to our NP's credit she was OK with that...love that about her!) and (b) I was afraid of Bean crashing at night because she had been so much more sensitive to corrections at night than during the day. But, I started
playing and after about two weeks we seem to be in a nice groove.
So, we have an appointment week after next with our CDE (love her, too!) and we'll be doing Bean's A1C. From the numbers I have, it should down significantly from January due to all of the adjusting we've been doing. (I have to be cautious though because I don't want to be disappointed. Any decrease, even if just a smidge, will be great!) Plus, her basal/bolus ratio is looking closer to 40/60 and we've even had a day or two of almost 50/50.
A Perfect World? I don't think it exists, but if we can visit from time to time I'm all for it!!
Just out of curiosity...does your CWD get close to that 50/50 balance of basal/bolus?