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Re: [IP] HELP! Pumping and control (not yet)

> Do basal rates fluctuate a lot more at night?
> In children?

That has been my experience with my daughter. I would suggest fasting 
for as long as possible before bed time to help stabalize night time 
bg's  -- 4-5 hours is fine, but sometimes hard to do, particularly as 
they get older.

> I'm using the 500 Rule to set his Insulin to carb Ratio.  We have
> his basal rate set at 50% of TDD (0.5u/h X 24 hours).  We are using
> the 1800 Rule for Insulin Sensitivity Factor.

These rules are statistical models and only are accurate for 
"average" people. Spot checks among pumpers indicate that they may be 
off 50% or more.

MEASURE the ratios directly where possible. See the howto pages and 
the book Pumping Insulin for guidance.

> Supper is at 6pm, bedtime is at 8:30pm.  He tends to crash sometime
> between 7pm and 11pm.  Is it from the PE class once every 4th school
> day (9:30am-10:30am), the Volleyball practice every Mon and Wed
> (3-4:30pm), 

Our solution to this has been to set a loooonnnggg  temporary basal 
rate on days with maxed out physical activity. Lily will set hers 0.1 
or 0.2 lower than normal until 2am at which time I check her. If they 
are normal, we may leave them lower until morning as a precaution.

> the Outside play that he does now instead of watching TV
> in the afternoons (4:45pm-6pm)? It seems I've got him on a temp
> basal more often than a normal basal rate.  And I'm just GUESSING at
> the temp rate.  I never seem to get the right rate or duration to
> avoid the low at bedtime or the next morning.
> To do a basal rate test "Pumping Insulin" says to wait until 3.5
> hours after the last bolus and when your bedtime BG is between 100
> and 150. This is just not happening for us!!!  Should I be serving

Try starting the basal testing in the evening and skip dinner. Test 
every 2 hours until 1 or 2 in the morning and give him a snack and 
call it a night. Get that protion of the day stable then go on to 
nights in a few days. Bear in mind that ALL of the data needs to be 
repeatable before you make any basal changes unless you are 
ABSOLUTELY sure that it's good info.

> supper at 5pm?
> Pumping Insulin also says "Don't try this test following a day in
> which you've had a major insulin reaction, major emotional stress,
> or unusually strenuous exercise."  He's having insulin reactions
> every day (before breakfast and/or after supper) and unusually

If the lows and highs are repeatable, you can make adjustments based 
on the extra insulin give to bring down the highs and the the extra 
carbs used to cover the lows.

Basically what you are looking at is TOTAL carb intake vs TOTAL 
insulin intake. This must be balanced all the time. Look carefully at 
the records and extract the repeating patterns from each day. Throw 
out the upper and lower 5% of data (highest and lowest) and use the 
rest to calculate the average corrections -- this will give you a 
starting point to make adjustments up or down as necessary.

There is a simulator on the HOWTO pages at:

"Insulin Pumpers Basal Rate Estimator:"

might help

> strenuous exercise all the time.  (He just can't seem to get enough
> "play" now.  He has the energy so he uses it!)

Read the HOWTO -- you have to start somewhere.

> What do I do?  Stop the activity and get a "couch potato" basal
> rate?  What good would that do David? Help!!!!!!

No, don't make him a couch potato. The data would not match his 
normal activity profile -- you'd just have to do it again.

Be patient. It may take a month of collecting data every few days to 
get it right, but once you are in the "groove" it will be easy to 
just adjust things a little. It gets easier with practice.
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