Too much basal?

Hi…I need some feedback… My DD is still in a strong honeymoon (dx 8/26/11). About a month ago I bumped her up from .5u of lantus to 1u. Meal ratios have been for months a 1:45. Her BGs for most part have been good…3 or 4 out 7 days include some lows /highs…but nothing crazy. Waking #s are usually low 100s and keep throughout most of the day. At the 10 pm she is higher say 150+ >200 (no corrections unless above 200) So my question is now in the last week, I’ve had to really change the brkfst and lunch ratios 1:80 and lunch a 1:100 does this mean her basal is too high? Her tdd is about 4u (including lantus) I guess I wasn’t sure if ratios changed that dramatically. Thanks for feedback!

wow all i have to say is she is on a tiny amount of insulin, when my son was first diag and honeymooning, he was on a sliding scale which meant we tried to keep his carbs stable for meals around 60 ish and if his bs was under 100 he would get no insulin 100-150 1 unit or something, ... this was 3 years ago so i'm skecthy on it but for the honeymoon period he sometimes needed hardly any insulin or just a few shots a day including lantus just a thought good luck, so many compexities but this is a great place to learn, it sounds like you have your act together i cant image the math 1:100 and doing such small doses, if you are really struggling check with your endo about temporarily trying the sliding scale. is she good about eating some protein and fat with her meals that helps with stability.. hang in there amy

The sliding scale is a pretty outdated method of computing bolus doses. I do agree that the change in her ratio seems dramatic, but I know children's management changes a lot more than adults do. Yes, sometimes basal can be too high, which means you need less for bolus, but it's hard to think of 1 unit total as being high! Also if you bumped the basal up a month ago it shouldn't suddenly be causing problems 3 weeks later. If basal is too high or low, you should recognize it in what I call the "in between times" like before meals, waking and bedtime. But if she is going low at her former I:C of 1:45, sure, I would reduce it. I'm not sure how the heck you manage doses that small with a syringe, though! What I've learned through my insulin use is that "it takes what it takes". Sometimes changes in needs make sense, sometimes not. But the goal is to stay as close to target as possible whether that means more or less insulin, or altering carb intake.

Hi livy's mom, i hope the both of you are well today. I just wanted to make a suggestion, if you post a question in a specific group you tend to get more replies, like the group parents of kids with type 1, because the question goes out to everyone in the groups email. Just a thought, we only used the sliding scale technique when jacob was honeymooning as prescribed by his endo, it worked for us esp when we were first taking things in and might not have been ready for the complexity of carb ratio's ect. in any case wishing you well, this really is a good site for support and advise, best wishes, amy

This post was posted in the "children with diabetes" forum. But many of us just access "forums" which includes all the topics, and respond to anything that we feel we have something to share, even if it's just support.

THANK YOU Amy and Zoe for your replies! I really appreciate the feedback! I have done some basal testing and I haven’t seen any huge drops in Livy’s BG. Yes she is on a super small amount of insulin. I did use a sliding scale initially after dx, but now I just eye ball the syringe to get the amount of insulin needed. We are hoping to start pumping soon, Liv is getting a bit overwhelmed by shots. She is such a trooper. I know we have still so much to learn. For now we are just taking it one day at a time. Its so easy for me to get very emotional thinking of the big picture and Livy’s future. Thanks again for replies! (:

I was diagnosed at age 58 livy's mom, and I'm currently reading a book written by a woman who was diagnosed at age 12 in 1972. It's amazing how much better the treatment is today, but still, it's a lot to go through, for the whole family. I was thinking as I read that she's a good candidate for a pump, but didn't want to overwhelm you. There's a definite learning curve but it makes things so much easier and management so much more precise. The Ping which I have has a "meter/remote" so you could bolus her insulin without having to pull out the pump!

Yes treatment has changed by leaps and bounds! I am hopeful that bigger strides and possibly a cure will be available to all D patients in the near future. I am reading Thinking Like a Pancreas, Pumping Insulin, and Type 1 Diabetes: A Guide for Children, Adolescents and Young Adults – and Their Caregivers…I am on information overload…but the more I learn the better pancreas mama I can be for Loo. We are getting the Ping too. It really is Livy who wants this pump…I am on the fence. We have been doing so well on mdi, but this is her body and her life with D. I know going on a pump is a big learning curve…I hope our curve is small. (;
Thanks ~Allison

Hi Allison, how old is livy? it sounds like you are doing a great job. the one day at a time approach can be best, when i am feeling overwhelmed it sometimes helps me to think of all the nonD things i love about jacob and how well he handles everything... treatment is so much better and a cure is not an unreasonable expectation for their adulthood years, although i am not holding my breath on it, a pump may be good because you can fine tune things and if she is asking for it that is huge, it was 2 1/2 years before jacob showed interest in a pump, it was the right time for him, it has been a little challenging but overall the benefits outweigh the negatives, i dont know about you but i find people not affected by D have a hard time relating to my fears and struggles, that is when i sought out tudiabetes, it has been a real help to me, hang in there and enjoy your sweet livy loo! you have everything you need to succeed as her mom, just as you always did pre D, hang in there, and don't hesitate to vent or ask for help whenever you need it! amy

Hi Amy

Thanks for the supportive words! Livy is 8 yrs old…turning 9 in the next few months. It has been rough the last few months getting adjusted to our new life with D. It is difficult for even the most supportive friends/family to really get what the daily struggles are with a CWD. I am lucky to know a few other moms in my town that have T1 kids. Do you know any other moms of CWD? How is Jacob handling D? How is pumping? I am really nervous to start pumping. I just keep telling myself that it is like shopping at Costco…it will be crazy at times, lots of obstacles, some frustration and when the learning curve is over we will be set for the wonderful world of pumping! (:
I am really liking this forum…I have been on another one that didn’t quite have the same supportive vibes as TuDiabetes! ~Allison

Hi Allison,

I like tu as well, so many nice people, honestly, if you werent having the struggles with dosing livy with such small doses, i wouldnt switch to a pump to early, it is like learning diabetes all over again.. however, you really are in learning mode already and if shots arent working so well for her it is challenging but doable, jacob only wanted the omnipod, the hardest part for me was checking him at night, he hates it and doesnt go back to sleep well, he has never had night type hypo, only afew 50'a or 60's in the am, i check on him everynight visually but not with a lancet! plus the first week we did saline so we were doing pump maneuvers and needles that was rough, once we settled in it wasnt so bad,( maybe you could hold off until summer vaca? we started in march and i wish we had waited, but when he was ready, he was ready so we jumped!) just new and certainly nice to celebrate the last lanus shot as well as the others! jacob does pretty well with his D, he isnt totally open with everyone at school but his close friends know, i guess he is a typical 13 year old, but more wise and sensitive i would have to say, if he is down about something else then his D comes up and all is bad but he wakes up his ussual happy self, i guess the key is to try to treat them normal and support the other parts of their lives, it is so easy to get to caught up in what they are eating and what was their number, i want to be all over that stuff, but i want him to feel that i have this for him, with him and he can just be himself.. hoping for success in high school, so far he is not very social and that has helped with my comfort level! how is livy adjusting, i would suggest being as open as possible, this has caused more anxiety for jacob with it not being totally out there, best of luck and keep asking we all have been there, when you dont feel so alone, it all seems more doable! amy ( i hope my rambling, no capitals doesnt drive you nuts, it is my email shortcut!)

I would also like to add that sometimes a T1 will go through periods where they require less insulin shortly after diagnosis. Sometimes the reduction in insulin is drastic and this sounds like it might be your case.

The prevailing idea is that the T1 gets healthier after diagnosis and exogenous insulin gives their pancreas a break. The pancreas recovers slightly and starts producing more insulin, which in turn decreases the amount of exogenous insulin you need.

Please be aware that these changes are only temporary and your daughter is still diabetic and requires insulin. The best advice I can provide are for you to carry hypo treatment with you everywhere, check on her at night, and adjust to her insulin needs as quickly and accurately as you can. It sounds like you are already doing this so good job and good luck.

It also sounds like you need some very small syringes. I am not sure of the smallest size (and dosing increments)syringes available, but you may want to double check that you have them.