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Re: [IP] Bolusing at bedtime

> michael,
> do you do a correction bolus to get to 100 at bedtime? 
Usually she does. If she is high, say >> 150 and she knows she is 
going up (not a post prandial high) then a correction is in order. 
The farther away from the dinner bolus you are, the safer this is. 
Figure after 3 hours, worse case senario is that 30% of Humalog will 
remain in the tail (probably less, but YMMV). Likewise if she's low, 
the calculation works the other way and a small snack of toast + milk 
may be in order to insure that unused insulin will not cause a 
problem. Bear in mind that my daughter runs an artifically low basal 
rate until 1am and sets a temp rate when she goes to bed. This allows 
her a great deal of flexibility in tweaking her night time insulin at 
bed time. If she is high, she can pre-bolus her basal + set a temp 
rate if necessary. If low, she just leaves it at the lower setting. 
She's rarely "right on" since she works out 3 - 4 days a week and is 
sedentary on the other days. This produces a hugh swing in night time 
basal requirements.

> our endos
> say not to do a bolus after exercise or at bedtime.  but....if
One size does not fit all!

> geneva was 296 at 9 PM (like last night),  I feel compelled to
> correct to 150.  By midnight she dropped to 164.  this whole
> nighttime thing is so perplexing!
> I am not sure I am ready to deal with puberty!  that brings on a
> whole slew of basal quirks.
Not that bad. What you will probably see is big basal shifts that are 
pretty linear i.e. 20 - 40 % increase or decrease in all basal 
requirements for a few weeks at a time. Just be aggressive about the 
adustments. You can tell how much by the average high bg bolus or low 
carb intake requirements. It seems to be flat %wise accross the 
board. The carb/insulin ratios change by a similar (but smaller) 
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