Tuesday, March 3, 2009

ISF vs Basal changes

GOING-CRAZY. Here is my quick post to ask for HELP! I have been studying "patterns" (which there arent any) for THREE HOURS tonight and just thought of another thing to consider! I can't seem to get anything right with Maddison's numbers lately. Any help is appreciated! I think I am seeing a new "reason" for this, Maddison's diet has been crazy lately!! Poor food choices and alot of high fat eating out which we dont usually do. Ice cream, cookies, french fries, cake, pizza.......SO BAD! Such BAD, BAD eating! I'm embarrassed to even mention it!

So looking at Monday you can see her basal would be set right because she doesn't go up or down more than 30pts AND her ratio should be right because she just kind of STAYS around the same range. Right? This was the "good day" we have 2 days of the week. The rest of the days are either a tad low or 280's.

630am 135
815am 129 felt low (1hr 15min after breakfast)
841am 168 still feels low
1044am 182 (after 10am snack, before PE)
1237noon 185 before lunch
1230p (30 min after lunch) Feels low again!

Then, came french fries this night for dinner at 6pm......about 60c worth, and man....the highs from fat resistance just kept coming!

730pm 368 (meltdown) .7 correction should have done it for a non-fat high!
925pm 315 (oh boy, long night of french fry high!)CORRECTED according to pump
1136pm 149 (I think this was actually my BS and I used her meter in the night!)

121am 190 (.2 should have done it!)
549am 194 (.2 should have done it!)
7am 222 eating breakfast with 30 min pre-bolus!
936am 214 (snack time at school)
1018am 205 (1hr after snack, 15c protein bar)
1229noon 306 WHAT THE HECK? This never happens at this time of day!!
315pm 213 Corrected
511pm 175 corrected and set a 150% temp basal because corrections ALWAYS work this time of day!!
630Pm 198 (feels low)

Now, we shall see the rest of the night. I think that since this is a typical pattern lately of one "good day" and one CRAZY day...that I was going to consider changing ISF. BUT....the crazy days when the corrections dont work the basal seems fine. The corrections seem to not work on the day AFTER Maddison had a high fat dinner or "desert" before bed. I think she is having fat resistance 10-12 OR MORE hours after poor food choices! How else can you explain one good day of numbers, one crazy day, etc etc etc.....AH yes....DIABETES. I guess that just sums it up in one word. But seriously.....I really think poor food choices are more than just a one day effect. Anyone? I need some wise old experts here! Basal changes are not working consistently from day to day. We have had lows, good days, but then days that she stays higher she is still within 30pts of the starting test number, but just doesn't respond to corrections. UGH. I'm so frustrated. I think the solution right now is going back to our STRICT eating habits. Anyone seen this kind of fatty resistance one to the next day?


Scott K. Johnson said...

Oh dear. I can't say I've tracked my stuff in that detail to know if high fat stuff wrecks me for that long.

I know if I have a high fat dinner, that it's a gamble on whether I extended my bolus right or not. But I've not watched for longer than that.

Anonymous said...

High fat... I have been at this for three and a half plus years. My niece was diagnosed at 8. In our case, I can say with confidence that high fat has never lasted more than 8 hours. This has been put to the test twice a year with cheese fries from Outback (horrendous), but it is a treat for her on special occasions. Many corrections, many temp basals, takes about 8 hours. Most of the time high fat leaves her system in six hours; eight would be maximum. You know each child is different, so you will have to watch and chart what happens with your own. The varying basals that do not "hold" I can speak to that one. I tweak something almost every day; adjust almost every three. If I wait long enough for a three day pattern to emerge, her A1c would most likely be in the 8 to 10 range by now. Initially, I went with a two day pattern; now I can see by her numbers day of. If she is high before dinner (her growth spurts and/or high numbers kick in 6ish, and rise from there to 12; may or may not continue from 12 to 2am then there will be a sharp drop. If I see 265 before dinner where she is usually in range, I now know to increase temp basals till midnight. I do 130 percent,if too high at next check; up more, etc. I use temp basals the first night; if pattern repeats, I basal change the next evening. She is 12, in puberty since 10. Things have escalated this year, in other words, worse. I do not do this and go to sleep; however as what goes up does come down -- in other words she can crash. I am up 12 mid, 1, 2 and 3am checks these days. Ah, the joys of a pre-menstral preteen. Her A1cs, despite wacky numbers when I wait too long for a pattern to implement changes, have been 5.9, 6.1 most of the time; last was 6.5 due to my timidity. We have cgms, but it is painful and she does not want to wear it. She needs it; it will go on; waiting for summer when we are more relaxed. Main point of this post is the blood sugar changes are so quick and frequent, pattern way of handling D would not work.