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Re: [IP] that darn dawn phenomenon - HELP!


Looks like Barb and Michael have terrific technical info but, as I am playing
surrogate mom for my 10 year old niece this summer, it suddenly occured to me
that those are pretty complex instructions to assimilate and keep track of a
small child and etc all at once.  I found the How To on the Insulin pumpers
home page nice b/c all you had to do is plug info into it.  That leaves you
with the mere problem of collecting the right data.  You definately need at
least 2 sets of #s at each rate -- sometimes 3 -- to tell the difference
between slight variations and wrong doses.  Actually, the #s look pretty
good.  You don't have far to adjust -- only to figure out what is happening
in the evenings.

Good job!

Michael wrote:

> > We had her on a .2 basal from 9:00pm through 9:00am then tried a .3
> > basal for the same time period.  The results were:
> >
> >      .2 basal                    .3 basal
> >   9:00pm  - 148               9:00pm  - 235
> >   12:00am - 266               12:00am - 101
> >    3:00am - 214                3:00am - 47(gave 2 glucose tabs = 80pts)
> >    7:00am - 190                7:00am - 70
> >    9:00am - 186                9:00am - 150
> >
> Hi Kasey,
> I don't know over what time frame you are doing the testing, but you
> need to get data every hour or so. It can be on different nights but
> you must stagger the test times so you can develop an overlapping
> data set. The finer data set must be collected using the same basal
> rates on each collection run. The purpose is to make sure there are
> no hidden lows/highs and to provide enough data to accurately set the
> basal. The data set should be normalized to the starting bg of the
> first data set. Make sure that she has fasted for at least 5 hours
> and no boluses prior to starting the test period.  Don't try to do it
> 2 days in a row, it is to hard on the 'victim' and will mess up the
> data collection. Allow at least 1 or 2 days of rest. The basal rate
> will probably not be flat as you have set it. Try to keep within the
> guidlines of
> not less than 70, not more than 170
> 70, you are headed too low. However, if you know her carb/bg ratio
> fairly accurately, you can still get meaningful data by bring her
> bg's up into the 120-150 range with glucose tabs and adjust the
> subsequent readings by the shift produced by the glucose.
> Over 160 or so, healthy kidneys spill glucose easily and will lower
> the bg's more than you might expect, thus perturbing the readings.
> This can take a while for a child. They don't necessarily tell you
> when they are too tired or don't feel well enough to do it. I allow 2
> to 3 weeks to get a pair of good data readings from Lily and she is
> 14 and communicates her physical feelings/wellness tjo me fairly
> well. Profiles for days are a snap and can usually be collected in a
> day or two unless the bg's stray.
> Be patient, get good data. I will help you with the data reduction if
> you wish, just copy the data to me.
> Need to collect.
> Kind of insulin and mix ratios if applicable
> Time of last food
> Time of last bolus
> All basal rates from at least 2 hours prior to bg test start time
> until test end time.
> Bg's every 2 hours max (may be taken over several days)
> With this info, you can make a reasonable prediction of where the
> basal rates should be set.
> I am cautious. I have checked Lily every night between 2 and 3 for
> almost 4 years with only a few misses. It is our 'midnight meeting'
> It is necessary as her basal rate triples at 1:00 am and a timing
> mishap usually puts her bg's over the edge (usually a little high
> thankfully). She's rock solid from 2:00 until anytime in the morning.
> As her body changes and she matures, you can expect little suprises
> like this from your daughter as well. They are nice and stable for
> the longest time then bang, everything changes, then is settles down
> again.
> My guess is that you need to shift 1 or more times during the night
> between 0.2 and 0.3.
> Try the basal projection tool on the HOWTO web page
> http://www.bizsystems.com/Diabetes/howto/basal.cgi
> This will assist you in estimating the necessary basal rates.
> Use the tool to produce flat bg's, don't worry about the absolute bg
> reading, only the flatness of the curve.
> If you like, I will be happy to assist you with the data reduction
> but will be away on vacation next week. Email me the data if you
> wish.
> Michael
> Michael <email @ redacted>
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