OK DOC I need a little help.
We have recently started to see a dramatically, majorly, HUGE difference in Cara's insulin needs depending on where she is. I think it may have something to do with nerves/excitement when she is at school but it is getting out of hand now.
A little while ago we realized that Cara runs higher at school then she does at home.
The nurse looking at her numbers between home and school and asked "What in the world do you have Cara doing at home, running laps?"(she was thinking that extra exercise was dropping her low at home) NO! I replied. They do NOTHING at home. I think she is just comfortable at home and at school she has a lot of nerves kicking in which is raising her blood sugar. So we knew we might need a different basal rates for home and school.
BUT NOW IT IS GETTING CRAZY!! I think we are going to need 2 different basal and bolus rates depending where she is.
Has anyone ever experienced this? If so what did you do? and what was the cause?
Thanks so much for your help!! and of coarse we will be asking our endo what to do :)
10 comments:
I don't know about the pump you use, but with the pod we can set different basal programs. So on days Cara is home, you would run basal 1 (or whatever you'd call it), and days she's at school, run basal 2. Nothing else (I:C etc) should be affected. I've been wanting to set it up for Elise because she also runs really high when at school, but not on a consistent basis, so I'm still in wait and see mode. Good luck!
thanks Joanne, I know that our pump also can run a few different basal programs, I just never have. But I also think I might need more then that to get her down in range at school or to keep her out of her boots at home. For right now I'm just feeding insulin ALL day to keep her in range. I really think I might need to change bolus rates but maybe first I will try different basal rates and see what happens. THanks
I just took the basal fine tuning class at T1 University, and Gary explained that, with the exception of growth, basals are strictly set according to liver function and should not change from one day to the next. It's the bolus insulin that usually needs adjusting based on stress, activity, illness, etc. We do have a weekday and weekend pattern...mainly to combat the difference we notice in breakfast spikes and different breakfast times.
OK Wendy that is what I thought needed to be changed, thanks so much for that info. So I'm looking at making 2 different bolus ratio's for school & weekends. Thanks!
All I can think is does she eat a different type of food when at school that would cause her to be higher? Sorry, I'm no help. I just read and learn from everyone else!
you are tons of help, thank you!! The really only thing that is different is breakfast and I have thought about that because she eats at a different time and we usually have more carbs on the weekends.
We have different basals for school and weekend...mainly to combat recess lows, since that's really the only difference in the two.
Hope you are able to pin point what needs tweaking!! :)
thank you for posting this Nicole! I was just trying to wrap my brain around the fact that I think Emma's basals/bolus ratios need to be different based on weekend vs. weekday....she is the opposite though...runs high on weekends (except for saturday afternoon gymnastics!) and lower during the week. No idea how to even begin to figure out this...ugh
I have two different basal settings and bolus settings for school and home. Like you, my daughter tends to run higher at school. I have been trying to figure out why her needs are different and one thing dawned on me the other day: she has a snack basal set for the afternoon which is only a fraction of what she normally would get for an afternoon snack(because of high levels of activity during recess). This basal snack setting necessitates a higher bolus setting in the morning to offset the lower insulin amounts in the afternoon. I have found through the years that when you make an adjustment, it has a domino affect and it can get tricky.
So in our case, because my daughter is not at a point of giving herself an afternoon snack bolus yet, we really need to work the pump to keep things as stable as possible when she is at school. Hope this makes sense and it may help to explain what is happening with Cara.
RLP
Hi Nicole- the different basal rate options are a great suggestion but may not be the whole solution. I have been diabetic for about 40 years now and I tend to run low or high depending on where I am at with my emotions-rage and frusteration tend to be highs, fear and anxiety tend to be lows. Also once the low or the high gets ahold of me ----there appears to be a threshold you are correct you just end up feeding lows or highs. If you can help your girl identify the emotional patterns this might be of some help. As a side note hot weather tends to change insulin needs dramatically as does menustration or any hormone changes..so ultimately I just look for the overall patterns and focus on the larger picture of how I am feeling emotionally rather than obsessing about the day to day thresholds. Hope this helps. Sue
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