Sam, you understand that basal means the “base” dose for those on a pump, right? The point of it is to keep insulin in the body on a consistent basis. Constantly changing the basal (or base) pretty much negates the whole point of it.
And, I don’t think anyone said they only get a low from their basal. It doesn’t sound like you understand the difference between basal vs bolus, IOB, setting the duration of the bolus or the way calculations and ratios are used to program pumps to provide dosages.
Stuart, do you have a child with type 1? Before we started using the Dexcom, we woke up at least once if not twice depending on our 8 year olds activity level that day and our control is far from tight. He only goes low once or twice a week, but frequently goes high and needs a correction. Letting your child run high during the night just so you can get some extra sleep isn't a solution either. For my wife and me, peace of mind is worth way more than the luxury of uninterrupted sleep. Regardless just because you wouldn't/don't do it that way doesn't make someone who does wrong. I understand it's merely your opinion, and you most definitely are mistaken. Mistaken in believing that your approach is the only correct way and that everyone who sees it differently is not sane.
Most kids with Type 1 are not trying to achieve a super-low A1c like 5%. They are usually just trying to get an A1c of 6.5% or 7.0% and minimize the number of highs and lows they have. I'm in much the same boat (Type 1 since childhood). Just lowering basal rates would mean running quite high overnight 95% of the time just so that the 5% of the time we might have a massive, unexpected drop wouldn't result in dangerous lows. For kids with Type 1, who will have had diabetes for many decades by the time they hit their 40s and 50s, this puts them at very high risk of serious complications and an early death. How is this possibly preferable to waking up at night to check blood sugar levels?
Thanks, I happen to be quite well read on these subjects actually. I think that the child's safety is paramount, and because of the very instability that you describe, and I understand full well exists, that those particular people are safer using less basal and having a higher 'average' baseline to ensure that they are kept safe during erratic swings.... this is accomplished by taking less basal. If you think your child is better served by more insulin and closer around-the-clock monitoring, then by all means you get to make that decision and are the one who has to do the hard work to follow through with it.
Taking less basal and more corrections would not resolve the problem. The same increase in insulin sensitivity that caused the basal rate to suddenly be too high would affect corrections just as much - so corrections might be fine for many nights but then suddenly drop blood sugar way too far another night.
I don't understand the difference between basal and bolus? What? I've clearly forgotten more about both than you will ever know.
While one is sleeping, which would be some significant period of time after one has last consumed food, and bolused, basal insulin "base" dose would be the only insulin in the body, hence the only insulin contributing to a low.... unless for some reason you are bolusing right before you go to bed.
I have read almost every book ever written on diabetes management and honestly do not need to be taught the difference between basal and bolus. Clearly you think I'm an idiot so go ahead and disregard anything I have to say and don't feel obligated to respond to me in the future.
I sort of avoid talking to people about CWD as I think kids are different in that growth and growth hormones seem to blast BG out of control. My daughter is 16 now but I recall how when she was younger, and would hit a point where she was growing, which we'd see on the doorframe growth chart thing a couple weeks later, she would turn into a food disposal and out eat me. And this is when I was uh, quite a bit chunkier. These things would come and go but a lot of things my friends with CWD post seem like they might be in line with that. I don't think that it's totally the same as the "easybetes" I've ended up with.
It bother's me ****TREMENDOUSLY**** that there's not widespread acknowledgment of this in and by the medical community who seem to act puzzed and as if parents or kids w/ diabetes must have screwed up the doctor's genius plan when their BG is off. I don't think that it's as simple for kids. I suspect growth is a big culprit but I'm not a doctor nor am I well-versed in the literature. I also don't think that many scientific studies have probed deeply into the efficacy of different tactical approaches to diabetes, irrespective of age, to really prove that anything works at all. Doctors take credit when we kick ■■■ but, at least in my N=1 experience, haven't done a whole lot to get me there. I'm the one lighting the candle...
I think there actually is a lot of acknowledgement (at least in my experience) from endocrinologists that hormonal changes (growing, monthly hormones for women, menopause, diseases causing hormonal inbalances) have a huge impact on blood sugar. My endocrinologist certainly has said that monthly hormones (which are changing for 2-3 weeks out of every month) are probably a part of my difficulties. But, you are right, "acknowledging" is not the same thing as actually having studies out there (which I think there are almost none) about these issues, or that doctors will have any idea how to handle them besides just adjusting insulin as-needed and closely monitoring things. I definitely do not think running a higher average blood sugar (for people who are not running an A1c of 5%) is the answer.
That sounds like a good policy AR... I think I just learned to do the same
but the directions to people with kids is pretty much to run your BG higher, because the lows are so hairy. And insulin is a seriously wicked drug. I've, uh, partied a lot but have seen seriously %*&$#& up $#!+ on insulin, like my family turning into space aliens, orange people with plaid hair, etc. when I've been "checking out" with hypoglycemic reactions. It doesn't always happen, I've metered in the teens and pulled out of it but the whole "what are you doing?" thing (and, frankly, I've had a lot of practice being loaded...maybe an edge but maybe too a recipe for stupidity...) can figure into things. And to do it for someone else, deserves medals and salutations but, what they probably get, is crap from their doctors and insurance companies. Grrrr....
But try to support them too Sam, you are one of the uber-kick-■■■ D-guys in the universe, commanding ships. Kids need to know you exist. Share your story but avoid tactics...
No comment on whether or not you’re an idiot, only you know that answer. You do seem to have some seriously flawed views on how to manage children with T1. And, if you didn’t have it as a child how have you become an expert on it in the few years you’ve been diagnosed as an adult? I know people who have lived with it, from childhood, for many years and they don’t take such an arrogant stance on knowing how everyone is doing it wrong except themselves. BTW, if someone reads a lot of cookbooks that doesn’t make them a chef.
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I think that it's a mistake to aim at a number. It might be better to aim to do better, but better might not always be a number, it might be happier/ smoother/ do an activity you haven't done before. I'd like to see big diabetes/ medical organizations take steps to try this out, test it and prove that it's right and that it works.
Hmm, maybe it's different here, but in Canada they recently lowered all the A1c goals for kids, and at least for me (diagnosed at age 9 in '91) doctors were always going on about keeping as tight control as possible even before the results of the DCCT came out. I think maybe it's different for really young kids like toddlers, though. I had my share of crazy/scary lows growing up (lowest I tested at was 0.6 mmol/L or 11 mg/dl once, or just LO many times), but fortunately never saw any aliens!
You’re right im an idiot. Give her as much insulin as her body can handle without dying and check her every hour. When she’s older and wants to learn how to actualy manage insulin dependency I’ll be here and would be happy to help her
Well, I don't know how much parents "aim at a number" so much as try to keep blood sugars within the target range. I think it's kind of hard to separate diabetes from aiming for a certain target/goal as everything is so tied up in numbers. The A1c numbers are out there as guidelines. I've rarely had an A1c within the clinical target range (<7.0%) since I was a kid, but it's something I keep aiming for in addition to trying to keep blood sugars within my target range as much as possible. I think it's sometimes ultra hard to tell if you're doing better/worse when your blood sugar is all over the place. I'll see one week that my average has gone down or that I have a greater percentage of readings in range and think I'm doing grat, but then the next week I'm running high again and/or have less percent in range. But if my A1c goes up or down, it's an indication that over the past few months I'm running higher or lower than I was before.
I think we are all different. And I know that I sometimes feel lucky that as a T2 adult with some insulin production remaining I can go through my life with little worries about overnight hypos.
But I know others have a greater struggle. And it is a mistake to think this is just about getting your basal right. For some of us, our bodies go through wide metabolic disturbances. And this can cause wide fluctuations in our blood sugars, both up and down. And many of us who became insulin dependent as adults don't always appreciate the difficulty kids have. Their bodies are smaller and inherently more sensitive, they go through all kinds of hormonal changes as they grow and mature. And most of all, they have far more active and variable lives. One particular thing that affects young children with T1 is called Post Exercise Late Onset Hypoglycemia which can cause sudden lows 2-48 hours after exercise.
My heart goes out to everyone who has to deal with unpredictable overnight lows.
I perceive some variance in the efficacy of pumped insulin, w/ Day 1 being livlier and more responsive than day 2-3. I think my settings are probably based on Day 2-3 so, when I hit day 4 and it seems to be less zippy, I will see some swings. I am totally too lazy to track it but while I have run very flat lines on many occasions, I still get days where it will run up, something got me to 190 this AM (Day 4...hmmm, also unclipped my pump which seems prone to elevated BG in the AM...hmmmm...mystery?) so I'm correcting and waiting to hop in the shower for a bit. I don't think fluctuation is necessarily bad but my goal tends to be finding things in it. As I've got 18U left in the tank, I'll stick a new site in before I go to work and then see how the dregs of the tank do.
I agree that exercise is challenging and it's harder for a kid who's running around to say "head for the border" or eat a fried chicken like I do after a long run! Some of my kids-w/ diabetes acquaintances sound very smart and engaged. Most of them tend to be way more in touch with their docs than I am. I was annoyed the last time I keeled over, I went to the doc and they said they'd look at my numbers and call w/ a recommendation and then, 2 days later, they called and suggested something I'd already done. "Here's $400, call me in two days?" sheesh.
I agree too that things are likely more challenging with kids b/c of their size but, because of growth hormones, many of the teenagers with whom I'm acquainted take more basal than I do, even some who look to be about 1/2-2/3 of my size.
We’ve noticed those similarities too. Different sites tend to change how the insulin works for her as well.