How much should basals on the pump account for?

Type 1 & LADA Flatliners
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I recently heard they should account for 50%! We are not very close to that at all but have been working on basals for a couple months, making smaller adjustments. My daughter seems to vary between crashing all night to having stubborn highs so we have been going back and fourth for nighttime basals. Her afternoons however has always been a rollercoaster and that’s where I want to make it more flat. We don’t have a good schedule around here, which I recently have heard helps keep a flat line too.

Also, do you decrease carb coverage for meals when increasing basals around the same time?

Thanks!

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I’ve seen various guidelines over the years, but I think it’s a totally individual thing, and of course the percentage of basal is going to change day by day depending on the total amount of your boluses. (My own varies from about 30% to 55% in a week.) So personally I don’t pay much attention to the percentage balance, especially if my overall BG results are in good shape. And my CDE doesn’t give it much weight, either, when we’re tweaking other ratios and numbers.

How often are you changing basals to try to rein in the overnight extremes? Because there are so many other variables in the equation, a sustained low or high one night may have nothing at all to do with the basal rate. I often let a new basal run for about a week before looking back at the numbers and assessing whether another change is needed.

It can be useful to focus on the lows first, rather than trying out different basals to correct lows and highs at the same time. Get rid of the lows, and then look at basal and bolus to correct the highs. If your daughter’s nighttime lows and highs are occurring within roughly four hours of the last meal, you might look at adjusting boluses rather than basals.

When I change a basal, I don’t change carb intake or boluses (insulin:carb ratio). The basal should operate independently of food/bolus side of things. A good test is to skip a meal and see what happens with the BG – but that’s probably impossible with a toddler.

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Hi - I can’t provide experience specific to a T1 toddler (I’ll defer that to the many active parents of toddlers here).

Here is what I’ve experienced/ learned as an adult T1 (diagnosed 2.5 yrs ago):

  • Basal/ Bolus ratios - reference points, not targets you need to achieve.
  • The basal rates required to stay in range are what they are (I personally don’t stress out at all about the % ratio if all else is going well)
  • I’ve been averaging 70% basal (I typically eat lower carb but not low or very low carb)
  • When my basal amounts fluctuate, I use temp basal settings as needed (and am very glad to have that option)
  • Experiment, try different solutions to find what works best.

Keep up the hard work!

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Some endos and CDEs believe you should have 50% basal, others 40% and I don’t understand why. We’ve had discussions about this idea before:

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I usually change it for a few days and send the info back to the clinic. They then will change it again depdning in what’s going on. Mostly they want me to be in range and hadn’t focused on the % of what basals are until our last visit. Maybe I will wait this change that I am making for a week or so. Her daily meals vary so much and what time she eats so it’s hard to keep an idea of what the basals may do to her, and she takes forever to eat!

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Yep, my daughter’s diet varies so much day to day and meal time can be a stress if I give her something she has loved and then happens to not want it the next day! Her carb intake is generally higher I think, but it’s foods she’ll eat, otherwise she will go a long time not eating and getting cranky and then crashing anyway.

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Thank you! I’m hoping as she gets older she will eat lower carb, she hates meat, eggs, and mostly all veggie. She’ll eat cheese till the cows come home though! I feel so focused on the basals because that’s how it seems to get the flare line but she’s in range quite often as long as I’m continually managing it by extra basal increase or giving carbs here and there. It would just be nice to have a way to make it a little more hands off if that makes sense…

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@type1_toddler, first, Welcome to FUD! Please feel free to introduce yourself and your daughter to us in the Welcome, introduce yourself here! thread! Also, if you set your “connection to diabetes” to “Parent of T1”, you’ll be able to set that distinction as your “title”, which will be visible to all members of this fine community!

Also, if you have time and have the desire, please feel free to Share your families story in the Share --> My Story category! Here is Liam’s (my 3 year old…diagnosed at 2 years, 2 months of age) story. Liam’s Story

Okay, so to give you my answer with regards to basal / bolus percentages. When we first started pumping (Liam uses the Omnipod), we tried our best to get as close as possible to 50/50, but that didn’t last long. Why? Because Liam’s Bolus requirements each day FAR exceed his basal requirements. We have him on .05 and .10 per hour staggered as best fits his body. And, for us, that only works out to around 30 to 40% of his TDD (Total Daily Dose). Because we DON’T do low-carb, his meals usually work out to between 25 - 50 carbs PER meal. His I:C is set to 1:18 and 1:20 for different times of the day…1:20 for breakfast because that’s when his BG’s spike the most during the day. For the rest of the day, we do 1:18.

What is right for your and your daughter is really something that no one here can delineate for you - it only comes as a result of many weeks / months of testing. Only after “failing” to find the right dosing do you eventually land on the right dosing. We are currently on a regiment that is working for Liam but we know that this is only temporary. Our toddlers have a lot of stuff going on, growth hormones, brain and body development, extreme sensitivity to insulin, etc., that makes it very hard to find the right mix, but it is possible.

What I learned when I first started him on insulin was first and foremost…find the right basal dose. The right basal dose should keep your daughter flat when fasting (within reason on the number of hours between meals). Once that dose is determined…WHATEVER it amounts too toward your TDD, that’s just what it is. If it’s 10% of TDD, then that’s what works for you. If it’s 90%, that’s what works for you. Each child and person are different so each one of us is going to be different.

I am giving info here that you may already know, but I’m not sure when your daughter was diagnosed or how much knowledge you have right now. If you’re a vet already, then my apologies for giving answers that you may already have known. Please tell us a bit more about your daughter and your family! We consider ourselves family here and we support one another through the good times and the bad. As such, we like to get to know you!

Again, very nice to meet you!

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For us…using the Omnipod, we have “Temp Basal” rates set up to add “a little more” insulin during specific meals. So, for breakfast, in addition to his regular basal rate of .10, we do 95% more “basal” insulin for 2 hours after his breakfast meal. We have also found that “Extended boluses” work best for us for just about every meal. If you don’t know what an extended bolus is and you’re interested, I can tell you what we do. Liam’s A1C is currently 6.4% and at last check, he has .7 severe lows and 3.1% lows. We are working on getting that severe low percentage down to the recommended .4% (or lower), but it’s tough, especially for toddlers, and especially during a bout of sickness (which can throw two months worth of good work out the window.)

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@type1_toddler, welcome to the forum!

We have a lot of members with toddlers, so I am sure you will get a lot of info. Some thoughts from a parent with a 12 year-old:

  • Typical range I have seen for kids ranging through broads sets of ages is 33% to 60%. The 50% ratio (or 33% ratio for mamny pediatric endos) is only a ranging number, in the opinion of many of this forum. For us, we do use the TDD (Total Daily Dose) to help us adjust basal as the week goes when we get into sickness, sports etc., but it never dictates our basal. As @ClaudnDaye writes, you have to try a lot of numbers to find what works for you at a given time (and it drifts away from that quickly). But I would say that, for us, with a 12 year old eating moderate carbs, 60% is in range for many good days, 50% is in range when we have some correction issues or larger carbs, and when it gets to 35% we typically must make adjustments because it is too low. That’s for us!

  • the percentage of basal to TDD varies also according to how much sports activity our kid does, and how many carbs he/she will eat. If we ate a high-carb diet (we are not low-carb but we are definitely not high-carb) my son’s basal to TDD ratio would be a lot lower.

  • I notice your endo does all the adjustments for you. That’s great. You will probably get to do your own adjustments sometime soon. That will make a lot of things easier (much faster to find the right ratios), but there also will be more head-scratching and doubt! We have found on this forum and others that, when dealing with kids, at least for us for ratios and dosing, a good patient community can be much more helpful than a diabetes clinic (in particular when you are trying to go for good A1cs).

Again welcome! It is great to have you! If you wish you may want to introduce your family in the Introduce yourself thread.

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Just wondering if you guys are using a CGM? If not, it might be a worthwhile addition, even if you only use it for a few months to learn more about how your daughter reacts to everyday situations. We did great before our CGM, but after, my son became a diabetic rock-star (at least in my eyes).

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