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?
As a parent of a Child with Type 1 Diabetes, I must "Learn from Yesterday, Live for Today, HOPE for Tomorrow." ~ Albert Einstein
When I spoke with our Endo the other day he was saying the same thing about total daily humalog should equal (or be close to) total daily lantus. We are pretty close right now. She gets 8 units of lantus and a little more than that for her humalog (but that also depends on how much of a correction she needed). So it seems like it would be hard to make it exactly 50/50. We seem to be on the increase as well lately.
ReplyDeleteAll of this I'm still learning, and I'm always fascinated. It was only recently that I read how the basals help eliminate lows -- because you're depending less on fast-acting, which obviously brings sugar down fast. I hadn't thought of that -- and the puzzle started coming together. I'm getting why that basal is so important! I, too, didn't want to increase basal for the same reason as you -- I was not having to feed in the middle of the night! But, up went the basal. The feeding in the night continued. Oh well!
ReplyDeleteNOPE...for a younger child...our endo sees more of a 35%/65%. This is where Joe has been through the years. I am unsure when he starts to convert to more "adult like" settings, which are more the 50%/50% variety.
ReplyDeleteSounds like you are doing great...keeping an open mind and trying new things. You are a Pancreatic COUGAR!!!
Reyna's answer intrigued me...hmm...
ReplyDeleteWe see a pediatric endo, and he, too, says a 50/50 balance is preferable.
Grace's ratios are closer to 35/65 too. I've asked our endo about "aiming" for 50/50. She wasn't at all concerned about that. We've actually just raised all of her basals in an effort to get rid of more unexplained lows than we should be seeing.
ReplyDeleteGood luck!
Reuben has always been on 80 percent basal or there abouts. When we were on lantus it was 100. I guess it was age and eating habíts. He was Only consuming 5g cho in a sitting.
ReplyDeleteWe just had this discussion with our pediatric endo. I asked if we should aim for a 50/50 ratio and she said no. It varies by child and our average 40% basal / 60% bolus was perfectly fine for our child.
ReplyDeleteAnd of course this could vary from day to day because if your child has a huge meal, or cupcakes at school, or a high for whatever reason, the bolus is going to make up a larger percentage.
I wouldn't worry at all right now about trying to get to 50/50.
(BTW, hello! I wanted to stop by and introduce myself. Joanne at Death of a Pancreas mentioned you.)