I read in “Pumping Insulin” that normally for an adult is something like 60% TDD as basal and 40% as bolus.
I know everyone is different and this likely depends on the quantity of food you are eating. But I noticed that my child’s basal/bolus ratio this month was 33%/67% and I also noticed that we need a slight tweaking. Sure, you’re probably thinking 7%…what’s the big deal?
Any parents out there willing to share your basal/bolus ratio? Just want to see what’s common for children under age 10.
Not a parent, but a type 1 for 22 years. Those ratios sound find to me. I am currently 68%/32% basal/bolus. I think the most important factor is BG control by far. If child is achieving A1C goals then that ratio is great. Keeping a normal BGs (good A1C) is the best way to keep a diabetic healthy.
A few extra thoughts. I wonder if we have different editions of “Pumping insulin”. From what I recall my book said start pumping pretty close to 50/50 and you will likely end up between 40/60 or 60/40 when you get the numbers down right. Then he mentioned a few exceptions like highly athletic (possibly a child), obese, low carb, and other health problems might change the ratios out the 40/60 or 60/40 range. I eat slightly low carb and have a large DP which boost my basal percentage. I have a good A1C and have no interest in adjusting my basal/bolus ratios to fit into some manmade average.
Also, I would bet that your child is honeymooning or still has some endogenous insulin production remaining due to the low basal ratio.
The honeymoon factor you mentioned is what I"m 'thinking. When does the honeymoon end?
I remember exactly when the honeymoon started. Then, she became ill with a common virus, croup, and immediately ended honeymooning at that point. It was very abrupt the change in insulin requirements from that day on and I was certain that was the end of the honeymoon. This was many months ago. But I wonder if she is still “sort of honeymooning”. Is this possible? Like I mentioned, it seems we need to do some tweaking and I think it’s the basal that needs adjusting suddenly. Of course the weather is changing and I swear that affects things.
There is no telling when a honeymoon will end. From what I recall sometimes endogenous insulin production just stops all at once and sometimes it fizzles (on and off for a while) out for T1s. I do not believe it is well know how long a T1 will honeymoon. The only correlation I have drawn is that (in general) the younger you are diagnosed the shorter the honeymoon period, the older you are diagnosed (especially adults or LADA) the longer the honeymooning.
Here is a reputable link: http://www.isletsofhope.com/diabetes/problems/honeymooning_1.html#what
Sort of honeymooning sounds like the islet cells are off and on like a light switch maybe? That would be similar to how my mom describes the end of my honeymoon and it certainly happens to some. If your child is ending thier honeymoon phased make sure they always have fast carbs around. You will have to do some educated guesses on boluses or basals at times. Sometimes your guess and their endogenous insulin production will not agree and cause hypos and hypers.
Basals likely do need adjustment consideration. I end up adjusting parts of my basals every week or two to maintain good control for reasons I can sometimes barely guess. I would imagine that a child would have much more rapidly fluctuating insulin needs than I do. And if your child is heading back to school the decrease in activity may require basal increases. Hot weather (heat) certainly reduces my insulin needs and many T1s agree that the changes in season affect their needs as well. Another factor to consider is weight gain. As your child gains weight they will need to increase their doses to compensate.
The ratio also depends on how many carbs you eat. Someone who eats a high-carb diet will have a lower basal percentage of their TDD than someone who eats lower carb.
Exactly for that reason, in order to understand the real "basal/bolus numbers" connection, I suggest to compare two different numbers:
1) the units of daily basal insulin divided by your weight
2) the average value of insulin you need as a bolus for a fixed amount of carbohydrates
For instance, my son (he is twelve) has these numbers:
1) is "21 units / 40 Kg",
2) is "1 unit / 18.5 grams"
(sorry for the units, I live in Europe...)
I remember a conversation on CWD that someone posted a link to a study saying that the lower basal percentage seems to work better. The parents over there said that they already knew that.
When I was doing about 85 grams of carbs a day, my basal percent was about 40%. Now that I am doing 55 grams a day, my basal is 65%. Although the basal itself hasn't changed much, my TDD go down because of the lower carb amount.
I'm not a parent but someone with T1 and these ratios are fine provided that your child's control is fine. Basal/bolus ratios are guidelines but not rules, and they differ for everyone depending on diet, activity level, hypo sensitivity, etc. For example, I eat a fairly low carb diet so I tend to have a high percentage of my daily insulin dosage covered by my basal rates. When I eat more carbs, my bolus amounts increase. Also, because I am prone to experiencing the wonderful dawn phenomenon, I up my basal rates during the early morning hours. My basal/bolus ratio is generally around 60/40, but this changes if I have a period where I'm really active (and it will get closer to 50/50). My basal rates also increase during the colder weather, thus making this percentage even higher sometimes.
For a child who is constantly going through growth spurts and experiencing changes in routine (i.e., school vacations, etc), expect that basal rates will need to be changed frequently. Again, don't worry so much about the split between the two, provided that overall control is good. If your child is experiencing a lot of lows or highs, that is a sign that basal rates may need to be changed.