Hello, my son is 13 and probably inching into puberty and his appetite has increased and his blood sugars seem to be rising in the am. We just had a disheartening visit with a new endo (his other left the practice) i asked about the approach to the problem and she basically didn't answer, i am looking for a new doc for him because apathetic medical care is unacceptable to me, but anyway. my question is with increased growth and appetite have basals increased significantly for your children, his carb ratios seem ok because it is the overnight that seem to be rising, he hates it when i check him at night so i need to adjust slowly but i wanted to post his settings and get some feed back if anyone wants to share, any info would be greatly appreciated!

12a-3a .8
3a-7a .95( increased 4 nights ago from .90, endo suggested this)
7-9 .6
9-11 .45 ( lowered for gym but seems to be working on non gym days)
11-1 .60
1-8 .55
8-12 .8

his total daily insulin is 40-50 avg. bolus/basal is 65/35 ( a refection of corrections but also for more eating!)

i did check his bs last night at 230 am because he got up to go to the bathroom a good sign that he is high and he was 250 he went to bed at 200 with a good size bolus for his snack, ( dad gave him a burger and fries for dinner which does not help me with figuring things out!) i gave him a small bolus so i'll see in a bit what he is this morning, i think his 8p-3a needs to come up a bit, like i said any thoughts would be great! thanks! amy

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My son Jonathon is 13, and his last a1c was terrible--even with what we thought were really high basal rates! He's been using apidra (per insurance request, since it's cheaper) but we're in the process of switching back to humalog. We had LOTS of blocked tubing with apidra, and Jonathon has been VERY insulin resistant at night. We don't know yet if it's the apidra, or just insulin resistance in general. His current basals are:
12a-2:30a 1.525
2:30a-4:30a 1.650
4:30a-5:30a 1.800
5:30a-6:30a 2.050
6:30a-10:00a 2.000
10:00a-12:00p 1.200
12:00p-1:30p 1.350
1:30p-3:00p 0.900
3:00p-5:30p 0.850
5:30p-7:30p 1.575
7:30p-9:30p 1.675
9:30p-12:00a 1.500
That's a total of about 36 units just for basals. His insulin to carb ratios are 6-8 most of the day. He's using somewhere around 90-100 units per day, so he's adding insulin pretty much every day. I don't know what to expect when we switch back to humalog, but we'll be doing a lot more checking for the first few days. Jonathon does use a cgm, so that should help some. The doctor said that as much as I'm adjusting, she would have thought his a1c would be better. She even looked at his bg's, and couldn't find any type of pattern throughout the day or night where I should make adjustments. Puberty's tough!

Dawn

wow jonathan is requiring alot of insulin! thanks for sharing, jacob is on the omnipod and it only holds 200 U for three days we ussually fill to around 175 and have more than enough, yesterday i had to change his pod early because he had a low resevoir alarm, he really has been eating alot and stuck over 200 saterday, ( i suspect his site was getting tired because he improved after his pod change) i am thinking we may eventually have to switch to every other day changes to accomidate his growing needs, i'll field that one out on the omnipod group, but anyways, i have upped his basals a bit but he is still at around 17 U, slightly better control, not looking foward to the rollercoaster but glad there are others to share with ..best of luck sounds like you are on the ball with him, how is his attitude? best wishes, amy

He's got a good attitude overall. He's also had to deal with epilepsy since his type 1 diagnosis, so he realizes how much better he feels when his numbers are in range. He gets frustrated when he can't keep his numbers down, but he knows it's something that is often beyond his control. We're now trying to get everything in place for this fall's change of attending a small parochial school to attending a large (for us!) high school of about 1200-1300 kids. He has grown at least 1/2" every 3 months since his diagnosis 5-1/2 years ago, so we've always adjusted his numbers a lot! He's starting to get the hang of figuring out what to adjust and when, but he doesn't make those changes by himself.

Dawn

that is a big high school! jacob is planning on attending a technical high school with about 700 kids much bigger, but he is really interested. is jonathan totally out about his D at school, jacob really isnt, he was diag. at 10 and I feel that i should of gone into school to educate the kids and all, now it is sort of to late and more up to him.. he came home upset about having snacks before his state testing coming up.. i knew something was going through his head and it finally came up, then he went into i wish they had a pill for diabetes.. downward spiral i hope he perks up it is hard dealing with him when he has sadness over this, he usually is better in the morning but still... sounds like you guys have a good handle on things.. thanks for your input and support! amy

My son is 18 and his basals are similar:

9p - 12a: .95
12a - 3a: .85
3a - 6a: 1.0 (like Jacob's 1.5 over the previous period)
6a - 9p: much lower due to the activity at school (3 and .35 and .45)

He targets a bedtime BS of 120 and usually eats a bedtime snack with a correction to that #. If he has sports in the evening, he sets a temp basal until 3am or he will be too low when the 3am increase occurs.

His bolus ratios vary by meal and the amount of carbs/fat normally in the meal:

13 breakfast (usually carbs & no meat- only protein from milk)
14 lunch (usually peanut butter)
12 afternoon (snacks)
11 dinner (usually higher fat meal - he has to remember to adjust down if he eats a lower fat meal)

My son snacks a lot but does not correct for snacks because we are usually in the 2 hour window of a meal. Correcting an already declining BS usually results in a Low, eating more without insulin and then a High.

I hope this helps.

thanks so much for all the details, i am curious to see how others are set. as i said i've lost some confidence in his endo and will be switching before his next visit. is your son off to college next year? another big mile stone! best of luck to him and you! amy

Yes. And, he wants to go away about 5 hours from us which is a little scary for Mom. His Endo has encouraged him to go away or at least not be afraid to go away due to his appointments. They have a "college" protocol where they see the students over Summer, Spring break and/or Christmas break.

Luckily, we have good friends in his proposed college town. It is the town that my husband grew up in so it helps to know that they are so close if my son should ever need anything or become ill enough to be hospitalized. If he will not stay in our town, it is the best I can hope for!

Yes, we have had to do large basal increases, and not just for puberty, but also if there is a big growth spurt. Just be careful to watch it, because once the growth spurt has ended, then you may need to decrease. Some times the period of growth lasts too long to just do corrections though. Also, keep in mind that the hormone HGH (which there is more of when they are in the midst of growth changes) does lower insulin sensitivity, and causes the insulin to be less effective.

My son is 12 and started waking up high. The endo suggested that if his blood sugar level is good at bedtime to leave the basal where it was until 3 am and then increase it. He is averaging about 22 u of humulog a day for basals. He also started 'forgetting" to put in some of his snacks after I went to bed. So I check his basal history on the pump if I find wrappers in bed. With growth and increased appetite the basals require close monitoring. Good luck.

Our endo told us you have to find out WHAT TIME the BS starts rising, and we found out Kennedys was stable from 9 to 5 am but THEN started rising, thus, her basal is .35 from midnight to four, then at 4 am it's almost double that till noon, due to adrenal output of puberty 9 (and other) hormones that make you more resistant to insulin. She is almost 12, no outward signs of puberty yet, but those adrenals kick in years before.

I guess puberty is a moving target, we are hoping to get a cgm soon so we're not so in the dark all the time. Best of luck, natalie

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