Thanks everyone!
We will be upping his basal to .10 24/7 (minus nighttime where we will be dismissing basal and giving 1 manual .10 infusion around 3AM), starting tomorrow.
From there, if he doesn’t have too many lows, we’ll move to step b, decreasing I:C ratio until the spikes “hopefully” disappear. 1:22, then 1:20, etc.,
Okay, so take this for what it’s worth, but our son is 2.5 years, diagnosed March 17th, and weighs 29.4 pounds as of last doctor visit. His basal profile gets as high as .375/hr late at night and as low as 0.025 in the wee hours of the morning. His total daily dose is roughly 7.8 units of insulin, and roughly about 4 to 4.4 units of that is basal.
Obviously everyone is different, but based on what you have, your son gets 1.6 units of basal, which seems like what our son was getting when he was 5-pounds lighter and newly diagnosed. I would definitely look at increasing his basal.
i also wouldn’t shy away from upping I:Cs if you find a basal rate that keeps you nice and flat but he’s still spiking.
Also, there is a sad reality here, which I have never worked out the math for, but I suspect is true: There are some combinations of “true” or “appropriate” I:C, ISF and Basal needs that, with some foods, mean your child will have spikes above 200 even if everything is calibrated appropriately and you prebolus right, etc. Some foods require what’s called a superbolus: meaning you take some of the basal the person would get in the hours after a meal, give those up front with the meal, and then temp basal them 0 to make up for it. The total insulin dose is the same, but it’s given more up front, helping tame the spike.
His main foods consist of…frozen chicken nuggets (breaded), lowfat yogurt, milk, pizza bites. Unfortunately, at this point it’s about all we can get him to eat. He eats occasional fruits and veggies, but not as often we we would like. What does your son like and/or eat regularly?
You seem like you have such a good handle on your sons diabetes, which I admire and am a bit mystified how you’re doing so well, so soon! Are we just slow??? 
Knock wood, he’s not a picky eater. He has his preferences but does eat some veggies and fruits (things like cucumbers, broccoli, bell pepper and berries), and he doesn’t really like milk. Breakfast is oatmeal and lunch is some combination of fruit/veg/tortilla or toast/chicken strips or fish/nuts. It always works out to between 20 and 25 g.
We’ve found low-fat yogurt to be a very spiky food requiring a long pre-bolus. Also the same with milk, we use it as a fast-acting carb snack. And we’ve only done pizza a few times but it required more overall insulin than you’d expect for the given number of carbs, given how high it’s fat content is.
Now my other son: I think he’s part peanut butter sandwich, I praise God everyday that he wasn’t diagnosed as I think it would be much harder to control with such restricted and unhealthy eating habits.
I was a bioengineer in my past life and worked on mathematical modeling. Also I’m kind of obsessed to the point of being annoying to my husband. We’ve instituted “diabetes free” time in the evenings for a half-hour or otherwise I’ll be like “hey let’s do something fun…oh hey I was thinking about his basal rates and…”
I can totally relate. My daughter constantly accuses me of making her T1D my “hobby”. She’s probably right on a few levels…
I’m the obsessed one in our family (the husband)…and to that same point of annoyance to my wife. 
It’s funny how it works out that way. BUT…if both were obsessed, I would think that would be VERY unhealthy for the family. My wife helps balance things out and make me chill out when I’m too obsessed, or worked up about Liam’s BG’s.
One word: NO!
I sometimes think I have a strange hobby in diabetes. I never would of thought like that until I realized how complex it is and that it can be tamed. It’s always more fun to play the game, once you’re competent.
I tend to agree with everyone else. When I find that I’m having to correct a lot, it’s often basal issue. Also, maybe I’m reading the picture wrong (I’m legally blind), but it looks to me like one of those massive spikes is in the middle of the night?
I also don’t think 1:20 is a shockingly high I:C ratio. I actually think that 1:15 that the books recommend for adults is on the high end and many people end up working down from there. I read a study of well-controlled adults with Type 1 (average A1c of <6.5%) looking at pump settings and found that they had an average I:C ratio of something like 1:8, and they were not overweight. (I don’t have the reference, though, as I just stumbled upon it while trying to find another study that I was looking for.)
My ratios (until the next time they change) look like this:
R - 1:8 in the morning, 1:11 afternoon and evening
Fast acting = 1:12 in the morning, 1:16 the rest of the day
I’m a bit confused. It seems as though you gave him 1.5 units at 1:20pm (0.65+0.85U). Then by 3pm he had shot up to over 300 mg/dl. Then when you tried to correct you were told that IOB was 0.7U. The general rule from John Walsh (Pumping Insulin) is that after 2 hours 60% of your insulin would still remain on board. Yet your bolus calculation estimated that you had a meal bolus of 1 U and that 70% remained. (perhaps the 70% comes from it actually only being 1 hour and 40 minutes). But the question remains. Why is it saying your meal bolus is 1 unit? Is it possible that entering a second bolus overrode the first bolus before it could be fully delivered? Is it possible that all your son got was an extended bolus?
I’m just sayin. Maybe other podders have a better understanding of why this anomaly.
That’s a very interesting observation and something I’d love to hear more about? Any pod users have any info on this? This could very well be happening because, sometimes, I DO give additional bolus if 2 hours have passed and the numbers are still spiked way up over 300. Could @Brian_BSC be correct? Could the new bolus be “writing over” the extended bolus?? If this is the case, how does one work around this occurring?
You are correct! His sleep patterns have been out of whack for weeks now and we’re trying to get this under control, but diabetes has thrown off his sleep cycles drastically. One night he’ll sleep fine all night, then the next night he doesn’t want to sleep and he’ll be up until 5AM. This is one of those nights he was awake…and eating because he was hungry, at 1AM.
Am I understanding correctly that you bolused him for a meal, but extended a good portion of that bolus, and then he went high? If that’s the case, I would ask, why are you extending the bolus?
We are still in testing phase for pretty much everything - figuring out what works and what doesn’t. As indicated in the original post, though, we’ve tried pretty much all combinations with current basal/bolus rates and are now at the stage where we’re doing actual bolus/basal adjustments. Right now, we’ve changed I:C to 1:22 and we’ve also changed basal rates from .05u/hr to .10u/hr.
But, we’ve tried extended, not extended, extended for .5, 1, 1.5, 2, 2.5, 3…the test above was just one iteration of what we’ve tried (and continue to try) to figure this out.
I think the general consensus here is that the basal/bolus (but more than likely basal) rates are just too low. Testing this and will continue to test until we get that happy medium of where he doesn’t go too low while still not spiking to high after meals.
Thanks!
I’m impressed you are able to keep everything straight. It’s great to experiment, but it’s also important to give each trial some time to see if it works.
I’m still not clear if you are giving food boluses as extended boluses. Maybe I just need to look back through all the detail. I got to the extended bolus in your example, and felt pretty strongly this could be the issue. I would deliver all the meal bolus upfront until you see that you have a ratio that is avoiding the spike.
Particularly when you are in the phase of establishing proper dosing, you really have to watch, adjust, watch and adjust, but to work with one variable at a time when possible. We have this as a recurring issue. Caleb goes through growth spurts and it’s somewhat like starting all over again bc all his settings need to be adjusted. We just went through a period where we could not correct numbers - as if we were delivering saline. Time and time again, however, I see us get to the point where we’ve adjusted things and we’ve got him back in range, but inevitably we will need to back things off before it completely settles. His body always show some resistance during these phases - so what it took to get him back in range is greater than what he needs to keep him there once he’s been there for a solid day or two.
So trying to get back to your specific concern - it’s meal spikes. So deal with meal spikes alone until you see them settle. You adjusted basal and saw some success there. Focus on just the meal spike and keep it simple. IC ratio needs to result in more insulin. Period. Once the spike is improved, move on to the next wrinkle. And you may be seeing a large IC ratio bc of a bit of insulin resistance. Once you get the spike dealt with, the insulin ratio can be adjusted, particularly if you are not giving him all his insulin with his meal.
What is the insulin duration set at in the PDM?
The screen notes that IOB is .70, however, there could be more than that. The screen will show up to the amount of the suggested bolus until it gets to zero on that screen. The home screen may have shown a greater amount of IOB.
We probably should be giving more than 1 or 2 days to test each variable, but that’s what I’ve been doing so far. Maybe I should test 1 thing over a period of 1 week and get that average instead of only a couple days.
Right now here’s where he is:
I:C ratio: 1:22
Basal rate: .10u/hr
With this, his BG’s have NOT dropped low at all; rather, have stayed between 90 - 150. The meal spike thing is still an issue, though and NOT using extended bolus. His BG was 118 at 12:24. He was then bolused 1.0 units to cover 22 carbs (all at once - not extended). We waited 15 minutes. He ate. Now it’s 1350 and he’s at 263, double arrows up. It’s the meal thing that just seems impossible to put UNDER 300, no matter what set of variables we try. The rest of the day is really good.
So, based on this I have been considering one of two things as the “next” tweak in testing.
First, change the I:C from 1:22, to 1:20.
Second, change the basal rate to .15u/hr.
Which to test first? Something else all together?