Insulin requirements for weekends/holidays

[Kristina13]

Hi all

Our son (11yrs) has been diagnosed with Diabetes Type 1 last November and we are slowly getting into a routine. His levels are usually quite good during the week, but we still struggle with weekends and holidays, when he is a lot less active.

We upped his insulin requirements for half term by 20% and had a good start. But by mid week his levels went up again and we adjusted the basal, which brought his levels down again. This weekend we went up with his bolus requirements by 40%, which worked fine on Saturday, but his levels were high again on Sunday (over 10). This is just so frustrating!

When do you usually adjust the requirements? Friday evening or Saturday morning? Do you adjust Bolus or also Basal? By how much do you adjust? We have been told by the care team that it can take 2 to 3 days to see any change with a basal adjustment. If this is correct, it probably does not make much sense in adjusting the basal over the weekend?

Hi is on Novorapid/Lantus and will hopefully get a pump in August. His basal requirements went from 12 to 34 since dx, so does this mean he is out of the honeymoon period or is it just him growing a lot?

Thanks for your help!

Kristina

 

[SB2015]

Hang on in there until August, when he gets his pump, which will give a lot more flexibility.

Diabetes is frustrating. We are not robots and just when you think things are sorter it simply does something else. Whilst my honeymoon is definitely over there are still odd days when perhaps a few little beta cells get active again .

In answer to your question is it the end of the honeymoon or is he just growing. It could be both. I found that whatever changes are happening in levels the important thing is to sort the basal rate first. This is easier if I have done a fasting test first. Then checking carb ratios and sensitivity ratios. It sounds as if he needs different basal rates at the weekend, and possibly different for Sat/Sun.

It may be worth keeping a record of what he is doing over each weekend and matching these to his highs and lows. Doing this will also help when he starts on the pump. I now have different basal rate profiles for different levels of activity, and his records may help him to get theses set up more quickly.

I hope that things settle down and that the pump will make things easier. It may be useful for you to look at the pumping thread where there is a lot of advice on the use of pumps and the benefits that people have found with this change over from pens.

 

[shirley]

Hi, certainly agree that we notice a difference in insulin needs for my son during the holidays and weekends, if he is less active. It also sounds as if you are coming out of the honeymoon period but growing and hormones, I understand, can play a huge part. The way that we start to try to assimilate whether it is necessary to change basal or just increase the bolus is when we see that the bolus will have run out. I know that you can do some basal testing but imagine this might be difficult to sell to a hungry young person. We first notice basal needs changing late in the evening when the numbers start to rise overnight. We try to resist making immediate changes as we have identified that some foods, usually proteins, seem to increase blood sugars about 5 hours after eaten, but if it becomes a persistent pattern we would start to increase the background gradually. We have also noticed that different types of activity have impact, either more immediately, or sometimes hours later and I believe that there is a suggestion that mental activity isw also relevant. Sounds like a pump will work much better.

 

[trophywench]

It will work better! - it always works better than MDI and Lantus is notoriously slow to show the full effects of any change (about 3 days - so if you adjust it on Friday night this will have not much effect until Sunday anyway!) whereas Levemir, you can see results within approx. 12 hours, usually. OK it's one more jab a day - but how can that be a downside - if you get better control? I don't think it's worth changing to Lev now though!

What you get on a pump, is an exaggerated 'Levemir effect' - but it's another learning curve for all of you cos apart from bolusing when you do a 'standard' bolus, it is simply quite different! I was gobsmacked since prior to getting mine I just hadn't realised how much I did 'automatically' - and it wasn't automatic any more since I actually needed to think about every flipping move. Very very similar to how I felt just after diagnosis in fact - 'lost, alone and unloved!' - as I always joke about it. However it is partially true - so after a month I was sick of not knowing stuff and would have happily binned the pile of useless c**p. But nobody said 'You can do that if you want' - and about a fortnight after that I started to love it again cos I could 'do' quite a lot of it by then without referring to the 'Manuel' or asking somebody else.

So Be Prepared like the Scouts - and stuff will start to improve all round and you'll wonder how the heck you managed before!

 

[Kristina13]

Thank you for all your input and encouragement so far. We can't wait for the pump!