Quick set temp basals when BG is dropping?

Our educator suggested when my daughters BG is dropping according to her CGM that if it continues to drop consistently for a bit that we should go ahead and enter a temp basal at -50% to see if we can prevent a low. Wouldn’t it take awhile for the decrease in insulin to actually make a difference, wouldn’t she continue to drop based on the prior basal amount she’s had for say the last hour or so? Sorry if this is a novice question…we just started pumping last week! This morning we did drop the basal for about an hour from 10am-11am and she did not end up going low but then she was sorta high then after lunch and came back to a more acceptable level by dinner…seems like if I had just given her a few carbs maybe the whole thing would have been prevented and then there wouldn’t have been the spike later? So…much to learn! :slight_smile:

You educator told you to make adjustments based on the CGM? CGM technology is wonderul, but not always accurate. I would never make any correction based on my CGM. A whacky or unacceptable number there is a signal to do a fingerstick to check.
Make any corrections based on the fingerstick.

What kind of insulin is she using? Different insulins peak at different times. Changing a basal an hour before it’s needed sounds pretty reasonable. I agree that doing it in the middle of a drop won’t have any immediate effect, but will an hour or so later.

Are you keeping records? Look for patterns (I know it’s more difficult with a child). Find out what times of day she tends to go low or high, and adjust her basals accordingly. I have 7 different basal rates. Chart what she eats - you will probably find that there are some foods that are just not worth eating because they will raise her BG so much. Record keeping is a pain, but well worth it for seeing patterns, what works and what doesn’t, etc.

Without having all the info, I would agree that giving her some carbs for the low would have been way easier.

PLEASE keep asking questions, no apologies needed! That’s what we’re all here for. If not for asking tons of questions here I would still be in the dark ages :wink: Oh, and congrats on the pump!!

Thanks so much!!!

I didn’t word my message the best. Our educator said if her CGM is say for example 124 and an arrow down to check see if she’s 124 (or close) and then if so lower the basal at that point (after the finger prick) to -50% until her CGM reads that she is stable. It worked this morning but then we had the high after lunch (might have been the food, maybe it was the hour of -50% basal two hours prior). Tonight my daughter had the 127 and an arrow down one hour and a half after dinner. We finger pricked since she said she felt low and she was actually 80 (day 8 of her sensor). I treated her with 15 carbs of OJ, didn’t cover them with a bolus and lowered the basal -50% until she was back up, which was actually 10 mins later she was 127. Of course…now she’s high again and I’m sure we’ll be doing a correction here before too long, not sure though as I covered her bedtime snack so it’ll be interesting to see what happens over the next couple hours.

Naomi is on humalog. I am keeping good records, everything under the sun is in a log book and I keep a daily record of all her food intake as well. I have the info but making sense of it all lasts for about five minutes before I get overwhelmed or realize I’ve come up with about ten possible scenarios for what caused whatever to happen. :slight_smile: I was thinking her basals were pretty good for our start up but yes, it seems like we could add a couple more. She had gymnastics and a dance class both yesterday evening so maybe her dips today were a result of the evening exercise yesterday. I might need to just lower everything the day after her classes to see if that helps - guess I could try that next week and see what happens.

I didn’t mean to imply that you aren’t keeping records, just checking :slight_smile:

I would suggest that you try one thing at a time. Give her the OJ, leave the basal alone, and wait to see what happens. Your pump should have an option for calculating a bolus based on carbs and current BG. On my Ping it’s ezcarb. So, if you gave her 15 carbs of OJ, the pump would calculate how much (if any) insulin she has on board, how much she needs to cover the OJ, and figure in her correction factor. So… you might end up seeing not to give a bolus at all depending on what her target is. Did that make sense? LOL

I know I keep saying patterns…I would suggest leaving her basals alone until you see what happens over time. The exercise dropping her BG is a reasonable call; see if it happens again next time.

I can’t begin to understand how difficult it must be to handle all the regular childhood ‘stuff’ and then throw D in to boot!

Not to worry - I didn’t take your question about my record keeping in a negative way at all. I just wish I could see a more positive result from all my OCD record keeping that I do. The poor girl can hardly go potty without me writing it down. :slight_smile:

Thanks and I think you’re right. I will leave the basals alone for now, I think turning on the temp basals is adding more confusion than necessary when we’re just getting started and need to get the basic basals properly determined in the first place.

Ah…I should have used the ezCarb for the OJ. I’ll do that next time. I forgot it would consider the fact that it just had an under target reading and would calculate based on that. I forgot how smart the little pump is. I think I was in such a panic since she said she could feel herself dropping really low (it was freaking her out) even after the juice that I figured at that point I’d rather fix the high later than mess with giving her more insulin at the time. I just checked her and though she is high 212, she does have enough IOB that it didn’t want me to give her a bg correction so hopefully she’ll come down a bit over the next hour.

Thanks so much!!!

Hi !
My endo told my that if I am low (like 3.4) that I should set TBR to zero, now after about 15 minutes I should check and if it’s still falling then I should administer CH (15 Units).
If for example my sugar would be less that 3, I should do both. 15 Units should raise your BG for 3 units (5 g CH raises for 1 mmol/L (18 mg/dL)). You must use fastacting CH, so that change is visible in 15 minutes and so that BG raises fast.


Ahhh just looked at your page, she is SO adorable :slight_smile: Have you downloaded the dex? The graphing is great for us OCDiabetic types. If you look at the modal day chart, you’ll see each day in an overlaid line. The graph that shows average BG by hour is great for seeing trends.

I had to call dexcom last week, and the rep was able to see my downloads… she said OH, you do a LOT of downloads! Yup, every day LOL. The more data the better :wink:

You are doing a great job. Frustration is a problem. What works today may not work tomorrow, but will work again in two days…

It may activity or school or childhood stressors that are messing up the best laid plans of “ladies and doctors and CDEs”. << a little literary license and attempt at humor>>.

As far as the -50% goes. I am a retired school teacher, and I use -100% for 0.5 hours when I feel hypo after checking a BG then recheck a BG after 30 minutes. I keep all of the BGs entered in my Dexcom 7+ and watch the graph. However, I ALWAYS dose insulin from a finger stick.

My best two cents worth is work with your CDE and stick with your plan and make tweaks to the plan/formula.

Additionally, ASK NAOMI. Start involving her.

I remember a situation in a neighboring school district where a 1st grader pulled out a BG meter, did the BG, drew insulin with a syringe, and injected, then was seen by the teacher. “Syringe” possession was listed as drug paraphernalia with a mandatory, automatic expulsion from school. After the “dust settled” and the child’s management skills were clearly demonstrated to be excellent, life went on. ---- Bottom line, get Naomi and her knowledge of her body into the management plan. Let her learn percentages or “parts of the whole”.

Hope my ramblings help