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Re: [IP] Changes in Basal due to growth

> Michael -
> You were talking about Lily with respect to growth and basals.  Lauren (12
> yrs) has grown 5-6 inches since she was diagnosed 18 months ago.  I have
> had a real difficult time finding her basals. 
My experience also. I have found that the problem is not so much in 
the variability of the basal requirements as in the ability to 
provide a 'stable' starting point from a so-called standard day.

We have taken the approach of planning to do basal testing at least a 
week in advance. We pick a target day (or two) where activity is 
supposed to be 'normal' and then plan a late afternoo snack at around 
2:30 - 3:00 with no food or insulin after that. The snack/meal is one 
with relatively known carbo content without a large amount of protein 
(such as in 2 hamburgers, mac+ cheese or pizza). We start testing 
bg's every 2 hours at around 8 or 9 o'clock and keep it up all night 
if bg's stay in a 70 to 160 range. She usually sleeps in my room or 
visa/versa, to minimize the time either of us must be awake during 
the night. If she starts to go low, she corrects with straight 
glucose (no food) and I figure that into to the adjustment pattern. 
If she goes high, we terminate the test. This is repeated every few 
days or so, schedule permitting, until we get it right. Last time it 
took a month just to do the night time basals. BUT it works. Her 
schedule is soccer 3x week + games on weekends so that eliminates 4 - 
5 possible days because of the extra exercise. We work with the other 
2 days.

> I will find it then it
> disappears( or should I say changes).  What kind of patterns in basals
> needs do you find with growth?  i.e., (like you said) more insulin before
> 2:30 am.  irregularity? or just a consistent rise in need for basals for
> months?

The rises seem to come in spurts. This is coupled with a cyclic 
variation we have not been able to pin down - nope, no period here 
yet either so it is not that. Maybe insulin quality, phase of the 
moon, currency market fluctuations??? Who knows. 

If she see's highs in the night (or day for that matter) she cranks 
up her basal for that period by a tenth, waits a day or two and does 
it again until it's fixed. If she is low once or twice in the same 
manner we are more aggressive about turning down the insulin, only 
waiting 'til the next day to decrement a tenth. The last two weeks 
she has run high ( 200+) at 2:00 am so basals got cranked way up. 
This week, she was 40 - 50 two nights in a row, basals came down 0.2 
in 2 days. This morning she was 106 ..... maybe we have it right for 
> Last thursday til last night we had the basals down: to bed at 97 at 10:00,
> 126 at 1:00 and 105 at 7:00.  Last night, 124 at midnight and 391 at 6:00am
> !  I think the infusion site may have been failing but gave her 6 units and

Yeah, that kind of thing happens here also. Lily's insulin 
requirements are high enough that she uses up 3cc in about 3 1/2 
days. Since she normally changes twice a week, she has run out in the 
night a couple of times. She is more careful about that now and will 
refill her syringe on day 3 if necessary.

> she was 115 at 8:00 am.  (Her infusion did fail when I picked her up from
> school at 4:00. - at 267 and very crabby.... no she hasn't started her
> period yet  -  so she has PMS all the time!)  She is .5 to 2:30, .7 from
> 2:30 to 9:00 am and .5 til noon and .6 til 5:00pm then back to .5  By what
> percentage can we expect her basal to fall when she reaches her final
> height

Don't know.... but I get the feeling that most of the adults on the 
site are using less than Lily's 80 to 90 u/day 

> (I think her body is aiming at 5'9" or 5'10")?  I'll also admit that
> her pancreas may be complicating matters...... her basal since being on the
> pump has ranged from .2-.3 to .8-.9.

Sounds like you are doing OK, just assume that changes will have to 
be made on a regular basis. The best stability Lily has seen has been 
4 - 8 weeks without some kind of fairly large change. Now that we 
know this, it is not too hard to make the changes fairly rapidly. We 
only do basal profiles a couple of times a year at the most. Usually 
when there is a big schedule change, like BACK TO SCHOOL.

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