Recently diagnosed type 1 - clarification on the role of basal and bolus insulin

[Higgy65]

Thanks for letting me join the forum.

My 16 year old son has recently been diagnosed with type 1 and we're struggling to get him down to anything in the 5-10 mmol range. He's on Novorapid for his bolus dose and Tresiba for his long acting basal dose. We've managed to get him on the Libre2 which saves a lot of finger pricking and we've also moved from a sliding scale of insulin dose to carb counting, letting the My Life app calculate the dose of insulin.

My understanding is that the Tresiba basal insulin which he injects at night keeps the fasting glucose levels static at night/between meals and the rapid acting Novorapid is used as meal times to correct for carbs eaten or reduce glucose levels when he's high. His graph overnight is a nice flat line which suggests to me his basal insulin is correct but when he eats a meal he never comes back to where he started suggesting his insulin to carb ratio is set too high as we're weighing everything.

Contacting our diabetic team/consultant is a bit his and miss and the last time they just advised he ups his basal dose without any explanation of why basal and not meal bolus. If he ups his basal dose and that's already flat won't he start going down ? Should we be looking more at his insulin to carbs ratio so he comes down to a nice level after his meals ?

We're both very new to this and hope someone can throw some light on the situation.

Thanks in advance.

 

[Leadinglights]

Thanks for letting me join the forum.

My 16 year old son has recently been diagnosed with type 1 and we're struggling to get him down to anything in the 5-10 mmol range. He's on Novorapid for his bolus dose and Tresiba for his long acting basal dose. We've managed to get him on the Libre2 which saves a lot of finger pricking and we've also moved from a sliding scale of insulin dose to carb counting, letting the My Life app calculate the dose of insulin.

My understanding is that the Tresiba basal insulin which he injects at night keeps the fasting glucose levels static at night/between meals and the rapid acting Novorapid is used as meal times to correct for carbs eaten or reduce glucose levels when he's high. His graph overnight is a nice flat line which suggests to me his basal insulin is correct but when he eats a meal he never comes back to where he started suggesting his insulin to carb ratio is set too high as we're weighing everything.

Contacting our diabetic team/consultant is a bit his and miss and the last time they just advised he ups his basal dose without any explanation of why basal and not meal bolus. If he ups his basal dose and that's already flat won't he start going down ? Should we be looking more at his insulin to carbs ratio so he comes down to a nice level after his meals ?

We're both very new to this and hope someone can throw some light on the situation.

Thanks in advance.

Welcome to the forum, there are quite a few parents of kids of various ages here so hopefully they will be along to answer your questions.
But how long after food are you looking to see if his level has returned to the before meal level. It may be you are expecting it to do so too soon.

 

[Higgy65]

Thanks for responding, usually 4 hours so if he eats at 6PM we'd check at 10PM. In the weeks we've been carb counting he's never come close to the before level, the net rise is an average of about 2-3mmol per meal. Throughout the day he can go from 7mmol - 14mmol as each meal will put him up 2-3 mmol as he never comes down to pre-meal levels. We have to give a couple of bolus injections to bring him close to range (but even those calculated don't get him in range) but there aren't enough hours in the day. To me it suggests the insulin to carb ratio/ ISF correction factor are out but hopefully someone will clarify

 

[Inka]

Hi @Higgy65 How far in advance of his meals is he injecting? Different meals eg breakfast, usually need a different advance bolus time. That might be 10 mins, 15, 20, 30, etc.

A few points - early in diagnosis it’s usual to bring blood sugar down slowly (less risk of damage to the body); also, early in diagnosis he’ll still be making some of his own insulin. This often kicks in a few hours after a meal, so taking too much insulin for the meal could then result in a hypo as his own insulin kicks in. Early on it’s fat better to focus on avoiding hypos.

You’re basically right about how the basal and bolus insulins work. Basal is a background insulin, keeping the blood sugar in range in the absence of food, night and day; bolus is a fast insulin that deals with meals and can also be used as a correction dose in the event of high sugars.

Has he done a daytime basal test?

 

[rebrascora]

It sounds to me like you have grasped the situation really well, especially in such a short space of time. The important thing with any basal insulin but Tresiba in particular is that it keeps levels steady overnight, so if you are seeing that then adjusting that would not be logical. In your situation, with the information you have given us, adjusting his meal time ratios would be the obvious option and I am really not sure why they are advising otherwise. Ultimately, your(his) diabetes management is down to yourselves day to day and as long as you are reasonable well informed which it seems you are, then I think it is acceptable to do a little careful experimenting to see if cautiously changing the meal time ratios improves things. I would start with one meal and work on that but keep the others the same until you get that first meal sorted. Breakfast can be the easiest to adjust because most of us have the same or similar things for breakfast every day, so there is one less variable.
When experimenting, it is always important to keep one eye firmly on keeping safe and monitoring BG levels closely. Maybe choosing a weekend when you have more time to monitor things rather than weekdays when schedules are perhaps tighter etc.

Those would be my thoughts anyway, from the info you have provided.

 

[trophywench]

..... and also my thoughts FWIW.

Just considering this conundrum - I don't have a clue what effect growth hormones have at that age (though our Grandson now early 20s, certainly hadn't stopped growing at 16.) Plus though I know all too well what female hormones do to blood glucose, I have no idea whatever what male hormones do to it.

Add to that 'the honeymoon phase' so nobody has very much idea how much of it his pancreas is still producing at the moment and also the hot weather which increases everyone's sensitivity to insulin whether it's the natural sort or the injected variety - ie this weather can very easily cause hypos if we aren't extra careful. Hence, you will have to tread VERY carefully so where you might think I'll try an extra unit before evening meal - I strongly suggest you try half a unit instead, please.

Seriously - an extra 2-3 post eating on his meter, is not going to kill him anytime soon - and you're far better off being the tortoise instead of the hare - at the moment, at least!

Have you got this book?

Type 1 Diabetes in Children, Adolescents and Young Adults Seventh Edition: Amazon.co.uk: Ragnar Hanas: 9781859597989: Books

Buy Type 1 Diabetes in Children, Adolescents and Young Adults Seventh Edition Seventh by Ragnar Hanas (ISBN: 9781859597989) from Amazon's Book Store. Everyday low prices and free delivery on eligible orders.

www.amazon.co.uk

Older versions are cheaper, but please try to get the latest one!

 

[Proud to be erratic]

Hi @Higgy65 How far in advance of his meals is he injecting? Different meals eg breakfast, usually need a different advance bolus time. That might be 10 mins, 15, 20, 30, etc.

A few points - early in diagnosis it’s usual to bring blood sugar down slowly (less risk of damage to the body); also, early in diagnosis he’ll still be making some of his own insulin. This often kicks in a few hours after a meal, so taking too much insulin for the meal could then result in a hypo as his own insulin kicks in. Early on it’s fat better to focus on avoiding hypos.

You’re basically right about how the basal and bolus insulins work. Basal is a background insulin, keeping the blood sugar in range in the absence of food, night and day; bolus is a fast insulin that deals with meals and can also be used as a correction dose in the event of high sugars.

Has he done a daytime basal test?

I intervene here with some trepidation, you're getting advice from members who are themselves T1 and have considerable experience - unlike myself.

But, as I understand matters and I've tried to read around this topic, because Tresiba is a particularly long lasting basal insulin (typically 40 hrs) there is a limit to how much you can tinker with the doses. Firstly any changes take time to work - up to 3 days; then several days of leaving alone, to verify the change is working. It's akin to being the Captain of an ocean going container ship, course or speed changes take days to implement (BUT they are all controlled by sophisticated computers, analysing loads of meteorological data for the selected route, ship profile and weight of cargo). In practice the Captain is taking legal and commercial responsibility for a computer programme.

Secondly, it is not realistic to search for optimum 24 hour basal supply with Tresiba. Your insulin needs across the 24 hrs vary a lot. So I've optimised my Tresiba to give me flat, hypo free, nights (when I don't want to be taking bolus or jelly babies and I expect to manage my day by bolus doses on a response basis. If that means, on a bad daytime, extra bolus corrections or more aggressive food doses - so be it. Sometimes, not too often, I have to " feed the insulin" because there is too much on board; but I have an arsenal of snacks available in many, many diffferent forms of size, volume and varying reponsiveness (GI). Its necessary to experiment, but Libre allows me to safely monitor, understand and respond without excessive finger pricking. So, personally, now I've found that wholly acceptable 8 hr night solution I see no point in daytime basal testing.

This doesn't mean I never change my basal doses. Just sparingly and now only when a succession of nights are no longer satisfactory - either rising or falling.

With a shorter lived basal such as Levermir, I appreciate people can freely tinker with their basal doses, almost on a daily basis. But having moved from Levermir to Tresiba, which works well for me, I appreciate having one bit of the complexity of D management being out of the daily equations.

 

[Higgy65]

Hi @Higgy65 How far in advance of his meals is he injecting? Different meals eg breakfast, usually need a different advance bolus time. That might be 10 mins, 15, 20, 30, etc.

A few points - early in diagnosis it’s usual to bring blood sugar down slowly (less risk of damage to the body); also, early in diagnosis he’ll still be making some of his own insulin. This often kicks in a few hours after a meal, so taking too much insulin for the meal could then result in a hypo as his own insulin kicks in. Early on it’s fat better to focus on avoiding hypos.

You’re basically right about how the basal and bolus insulins work. Basal is a background insulin, keeping the blood sugar in range in the absence of food, night and day; bolus is a fast insulin that deals with meals and can also be used as a correction dose in the event of high sugars.

Has he done a daytime basal test?

Thanks for the reply, he usually takes his insulin 20-30 mins before his meals and I can appreciate the need to bring his levels down slowly. He's not done a basal test and one's not been suggested by the tea. That's really helpful to know there is a test and I can mention it to the team next time I speak to them about how we go about doing one.

 

[Higgy65]

It sounds to me like you have grasped the situation really well, especially in such a short space of time. The important thing with any basal insulin but Tresiba in particular is that it keeps levels steady overnight, so if you are seeing that then adjusting that would not be logical. In your situation, with the information you have given us, adjusting his meal time ratios would be the obvious option and I am really not sure why they are advising otherwise. Ultimately, your(his) diabetes management is down to yourselves day to day and as long as you are reasonable well informed which it seems you are, then I think it is acceptable to do a little careful experimenting to see if cautiously changing the meal time ratios improves things. I would start with one meal and work on that but keep the others the same until you get that first meal sorted. Breakfast can be the easiest to adjust because most of us have the same or similar things for breakfast every day, so there is one less variable.
When experimenting, it is always important to keep one eye firmly on keeping safe and monitoring BG levels closely. Maybe choosing a weekend when you have more time to monitor things rather than weekdays when schedules are perhaps tighter etc.

Those would be my thoughts anyway, from the info you have provided.

Thanks for the advice, we did do a couple of days slightly changing his ratio for breakfast with very good results (the rest of his meals were the original ratio) but we were told by the diabetics team to revert the changes but with no explanation. This confused me as he was going in the right direction (albeit slightly by 1-2 mmol ) with flat overnight and then coming down nicely after breakfast. I thought I was missing something when they said to increase his basal and revert the changes I'd made to his bolus. I even asked "if he's flat now overnight won't the increase in basal send him down and how would the basal correct his meal by 5-6mmol"

 

[Higgy65]

..... and also my thoughts FWIW.

Just considering this conundrum - I don't have a clue what effect growth hormones have at that age (though our Grandson now early 20s, certainly hadn't stopped growing at 16.) Plus though I know all too well what female hormones do to blood glucose, I have no idea whatever what male hormones do to it.

Add to that 'the honeymoon phase' so nobody has very much idea how much of it his pancreas is still producing at the moment and also the hot weather which increases everyone's sensitivity to insulin whether it's the natural sort or the injected variety - ie this weather can very easily cause hypos if we aren't extra careful. Hence, you will have to tread VERY carefully so where you might think I'll try an extra unit before evening meal - I strongly suggest you try half a unit instead, please.

Seriously - an extra 2-3 post eating on his meter, is not going to kill him anytime soon - and you're far better off being the tortoise instead of the hare - at the moment, at least!

Have you got this book?

Type 1 Diabetes in Children, Adolescents and Young Adults Seventh Edition: Amazon.co.uk: Ragnar Hanas: 9781859597989: Books

Buy Type 1 Diabetes in Children, Adolescents and Young Adults Seventh Edition Seventh by Ragnar Hanas (ISBN: 9781859597989) from Amazon's Book Store. Everyday low prices and free delivery on eligible orders.

www.amazon.co.uk

Older versions are cheaper, but please try to get the latest one!

We have noticed in the early morning he get's a slight boost in glucose which could be due to cortisol/growth hormone. We definitely want to take it easy but at the moment we're not seeing any progress which is rather frustrating. Thanks for the link to the book, I'll have a read of that, the more I learn the more I'll be in the position to ask questions of the diabetics team.

 

[Proud to be erratic]

Thanks for the advice, we did do a couple of days slightly changing his ratio for breakfast with very good results (the rest of his meals were the original ratio) but we were told by the diabetics team to revert the changes but with no explanation. This confused me as he was going in the right direction (albeit slightly by 1-2 mmol ) with flat overnight and then coming down nicely after breakfast. I thought I was missing something when they said to increase his basal and revert the changes I'd made to his bolus. I even asked "if he's flat now overnight won't the increase in basal send him down and how would the basal correct his meal by 5-6mmol"

Excellent closing question. Increasing his basal will alter his night profile.

But one point to keep in mind is that your body sees any insulin on board as just insulin! It doesn't know that the insulin is slow or rapid release, may not be available in 2 hrs or about any other characteristics that have been created artificially. It just uses what exists, ie what insulin is on board at any moment. So I can imagine there is a consequence of changing both basal and bolus; but I'm not sure I can speculate how that would work.

I think you were correct to gently challenge the basal change, even though that is the medical advice from a distance.

 

[Thebearcametoo]

You’ve got a good understanding of basal so I won’t add to that.

With bolus there are two calculations. If he is in target then you just need the correct ratio for the carbs he eats which may vary at different times of day. If he is above target you also need a correction. The correction is worked out on how much insulin it takes to bring him down to target. Does the Mylife app have a setting for that? It may be that the carb ratio needs a slight tweak but that the main change needed is with the correction to bring him back into target as he’s going progressively higher as the day goes on. We still use the expert meter when we’re on injections instead of the pump and it works it all out for us. Your team should really be able to give you advice and tell you what changes are needed. We tend to upload the data and get them to email back if it’s between clinics.


Within all of that there will be some foods that give you weird numbers or the weather a butterfly in the Amazon. But if you can get the algorithms close then you get reasonable HBA1C. For what it’s worth we can have lots of higher than target days and still come out with a good HBA1C so try not to get dispirited if you can’t achieve target all the time.

 

[trophywench]

Aha - sorry but you're wrong about the increase in BG during the night/early morning.

The human body has these pre programmed circadian rhythm thingies which date back to primeval days when we morphed from wherever we morphed from and to survive we need to hunt, gather or both.

So we sleep during the hours of darkness and at 2am(ish) the body has it's lowest natural BG since that doesn't need to be enormous when everything is at rest (although all our innards are actually still rather busy doing what they do, so all their cells still need insulin overnight in order to function properly) the body doesn't require things like eg physical movement or thinking) then as it starts to get light again - knowing that the body will soon need to go forth hunting and/or gathering, there's a natural increase in BG to guarantee by the time we actually wake up to start the next day, we'll have enough energy to do that thing. This starts to happen whilst still asleep for people with normal lives who are not working permanent night shifts. Still happens even though hunting the woolly mammoth for brekkie died out quite a while ago now. (Aside - did it perchance become extinct along with the mammoth?) It's known as Dawn Phenomenon and 99.9 out of 100 people have no clue whatsoever it even happens - just the 0.1% of us who're forced to take an interest! But anyway as long as it isn't a ridiculously vast reduction or increase - you're on a hiding to nothing really trying to completely eliminate it.

Here endeth that lesson!

 

[Higgy65]

You’ve got a good understanding of basal so I won’t add to that.

With bolus there are two calculations. If he is in target then you just need the correct ratio for the carbs he eats which may vary at different times of day. If he is above target you also need a correction. The correction is worked out on how much insulin it takes to bring him down to target. Does the Mylife app have a setting for that? It may be that the carb ratio needs a slight tweak but that the main change needed is with the correction to bring him back into target as he’s going progressively higher as the day goes on. We still use the expert meter when we’re on injections instead of the pump and it works it all out for us. Your team should really be able to give you advice and tell you what changes are needed. We tend to upload the data and get them to email back if it’s between clinics.


Within all of that there will be some foods that give you weird numbers or the weather a butterfly in the Amazon. But if you can get the algorithms close then you get reasonable HBA1C. For what it’s worth we can have lots of higher than target days and still come out with a good HBA1C so try not to get dispirited if you can’t achieve target all the time.

Yes using MyLife it calculates the insulin to counter the carbs plus a correction factor to get down to the target mmol. Currently he's at 3mmol per unit of insulin for correction in the app but in reality he's no where near that and closer to 2. We can see from all the correction doses we're giving him at night t(10pm - 4 hours after a meal) that he'll only drop 6mmol for 3units of insulin instead of 9mmol he should be dropping based on the setting in the app. This has also been mentioned to the team but again we've been advised to leave it alone. The reason for my post is I'm trying to understand why the diabetics team are suggesting a 1 unit raise in basal insulin when everything I look at suggests insulin to carbs ratio and the correction factor not basal. I was hoping there would be a good reason even it's because insulin requirements can vary dramatically in the first couple of months but I'm getting no explanation on why from the team. I'd love to speak to the consultant but unfortunately it appears the next appointment we can get isn't until September :-(

 

[Proud to be erratic]

Aha - sorry but you're wrong about the increase in BG during the night/early morning.

The human body has these pre programmed circadian rhythm thingies which date back to primeval days when we morphed from wherever we morphed from and to survive we need to hunt, gather or both.

So we sleep during the hours of darkness and at 2am(ish) the body has it's lowest natural BG since that doesn't need to be enormous when everything is at rest (although all our innards are actually still rather busy doing what they do, so all their cells still need insulin overnight in order to function properly) the body doesn't require things like eg physical movement or thinking) then as it starts to get light again - knowing that the body will soon need to go forth hunting and/or gathering, there's a natural increase in BG to guarantee by the time we actually wake up to start the next day, we'll have enough energy to do that thing. This starts to happen whilst still asleep for people with normal lives who are not working permanent night shifts. Still happens even though hunting the woolly mammoth for brekkie died out quite a while ago now. (Aside - did it perchance become extinct along with the mammoth?) It's known as Dawn Phenomenon and 99.9 out of 100 people have no clue whatsoever it even happens - just the 0.1% of us who're forced to take an interest! But anyway as long as it isn't a ridiculously vast reduction or increase - you're on a hiding to nothing really trying to completely eliminate it.

Here endeth that lesson!

Yes, I deliberately, but wrongly really, ducked complicating this by discussing the DP phenomena. I used to think, because I had no pancreas, I didn't (couldn't - no Glucagon) get DP. Libre reveals that I do experience this, sometimes; no discernible pattern as to why sometimes (so far). But my rises are modest, 1 or 2 mmol/L and seem to dissipate naturally after I get going; and because I have no Glucagon the trigger to the liver to release glucose might come from the adrenaline glands (adrenaline or cortisol). But I wanted to clarify that the behaviour of Tresiba is a bit different to other basals and if DP is happening, but there are still undisturbed nights, then response to DP is just another daytime BG change to be managed by bolus - in my view.

Curiously, currently recovering from surgery and Covid, DP hasn't been evident these last 3 weeks.

 

[rebrascora]

I hear your frustration and can totally understand it. You have grasped things really well but for some reason your team or DSN is holding you back from taking more responsibility and learning by adjusting things yourselves and not giving you an appropriate or logical explanation as to why they think you should do something different, when what you were trying was improving things but they want you to do something different which doesn't seem entirely logical. I know they err on the side of caution but it just sounds like they are adjusting basal to try to take up the slack of lack of bolus, rather than the other way around which is often necessary with Tresiba. With a twice daily dose of Levemir you can fine tune the basal doses a lot better and then the bolus insulin is just dealing with food.

 

[Proud to be erratic]

Yes using MyLife it calculates the insulin to counter the carbs plus a correction factor to get down to the target mmol. Currently he's at 3mmol per unit of insulin for correction in the app but in reality he's no where near that and closer to 2. We can see from all the correction doses we're giving him at night t(10pm - 4 hours after a meal) that he'll only drop 6mmol for 3units of insulin instead of 9mmol he should be dropping based on the setting in the app. This has also been mentioned to the team but again we've been advised to leave it alone. The reason for my post is I'm trying to understand why the diabetics team are suggesting a 1 unit raise in basal insulin when everything I look at suggests insulin to carbs ratio and the correction factor not basal. I was hoping there would be a good reason even it's because insulin requirements can vary dramatically in the first couple of months but I'm getting no explanation on why from the team. I'd love to speak to the consultant but unfortunately it appears the next appointment we can get isn't until September :-(

I would email and gently, politely challenge their advice. Also, no point in leaning on an app to do calcs if it is clear that the ratios are wrong.

My Endo told me to soften, lower, my correction ratio to 1:3. I did this for 3 or 4 days, it didn't work and reverted to my harder 1:2 ratio which previously worked and still does. I think they have starting parameters which means one size fits all and which actually isn't the case.

For me it's something to discuss when we next meet. But for me I need to be careful and not encourage him to think I don't still need his help and support. I do. My goal is to get pumping, but I don't meet too much of the NICE eligibility criteria at present.

 

[Thebearcametoo]

Yes using MyLife it calculates the insulin to counter the carbs plus a correction factor to get down to the target mmol. Currently he's at 3mmol per unit of insulin for correction in the app but in reality he's no where near that and closer to 2. We can see from all the correction doses we're giving him at night t(10pm - 4 hours after a meal) that he'll only drop 6mmol for 3units of insulin instead of 9mmol he should be dropping based on the setting in the app. This has also been mentioned to the team but again we've been advised to leave it alone. The reason for my post is I'm trying to understand why the diabetics team are suggesting a 1 unit raise in basal insulin when everything I look at suggests insulin to carbs ratio and the correction factor not basal. I was hoping there would be a good reason even it's because insulin requirements can vary dramatically in the first couple of months but I'm getting no explanation on why from the team. I'd love to speak to the consultant but unfortunately it appears the next appointment we can get isn't until September :-(

You shouldn’t need the consultant to be able to get the numbers explained and changed. The nurse or dietician will be able to do it. Care does vary a lot in different parts of the country and I know the system is struggling so over with cuts but even so paediatric care should be much better than you’re getting.

The suggestions to up the basal isn’t necessarily wrong and may be a quick fix instead of messing with all the different ratios so don’t dismiss it completely. It’s very normal for ratios and basal or change with kids and there will be a lot of fiddling around but the team should be supporting you better.


It’s worth mentioning as we’re in the middle of a heatwave here that excessive heat can have a big impact on BG. For my kid it sends him high, some people go low. So it may be the heat that is complicating things at the moment too. We’re having a day of 14+ despite corrections because it’s so hot. We’ll catch up with it and then the weather will cool and we’ll be dealing with hypos. It’s part of the changeable nature of diabetes. I’ve learnt to go with the flow a lot but it is a lot of mental energy that goes into these blasted numbers.

 

[Higgy65]

I would email and gently, politely challenge their advice. Also, no point in leaning on an app to do calcs if it is clear that the ratios are wrong.

My Endo told me to soften, lower, my correction ratio to 1:3. I did this for 3 or 4 days, it didn't work and reverted to my harder 1:2 ratio which previously worked and still does. I think they have starting parameters which means one size fits all and which actually isn't the case.

For me it's something to discuss when we next meet. But for me I need to be careful and not encourage him to think I don't still need his help and support. I do. My goal is to get pumping, but I don't meet too much of the NICE eligibility criteria at present.

You shouldn’t need the consultant to be able to get the numbers explained and changed. The nurse or dietician will be able to do it. Care does vary a lot in different parts of the country and I know the system is struggling so over with cuts but even so paediatric care should be much better than you’re getting.

The suggestions to up the basal isn’t necessarily wrong and may be a quick fix instead of messing with all the different ratios so don’t dismiss it completely. It’s very normal for ratios and basal or change with kids and there will be a lot of fiddling around but the team should be supporting you better.


It’s worth mentioning as we’re in the middle of a heatwave here that excessive heat can have a big impact on BG. For my kid it sends him high, some people go low. So it may be the heat that is complicating things at the moment too. We’re having a day of 14+ despite corrections because it’s so hot. We’ll catch up with it and then the weather will cool and we’ll be dealing with hypos. It’s part of the changeable nature of diabetes. I’ve learnt to go with the flow a lot but it is a lot of mental energy that goes into these blasted numbers.

Thanks for all the good information and advice. It's given me more knowledge which I can now use to to ask the right questions of the diabetics team and hopefully move forward with getting his levels down.

It's also helped with my stress levels knowing there are knowledgeable people out there who have gone through what my son's going through and are willing to give up their time to help 🙂

 

[trophywench]

I'm sorry Roland - having T1 diabetes is nob all like having T3c. The SOLE bit of our pancreas that has ceased to function are our Beta cells. I can't comment whether DP is one to be dealt with by bolus insulin with T3c, except to seriously wonder how you can successfully do that when you're asleep? Like I said, as a T1 as long as DP isn't a huge increase (and it actually starts rising at least 2 hours previously to when it's at its height, anyway) it is normally treated by adjusting basal insulin. But anyway - it's very very early days for the lad and his parents to be juggling imponderables on their own. Far more sensible to take things more slowly in my view.

Let's concentrate on education.