Our best week in a long time

@TiaG - Thank you for all your valuable input and advise over the past week and a half. We’ve implemented some of the changes you’ve recommended (including not being afraid to micro-bolus), and we’re seeing definite improvements. See below graphs:

We’ve made more tweaks and hope to see those numbers improve even more. Still had 4 lows this week, but they came AFTER being treated…we just need to treat sooner in some instances it appears. To have a week where we only rose above 250 a few times is GREAT! No 300’s or higher this week at all.

Again, thanks so much for your invaluable assistance!


Wow, glad some of those tips helped! The low thresholds are something you have to experiment with; every kid has a certain kind of momentum so I’m guessing what works for mine may be different for yours. You guys calibrate a ton!

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We always say we are going to do it only when the blood drop appears {3 times per day} AND when his arrow is level but we end up doing more because our unit just isn’t as accurate as it should be… sometimes its off as much as 80 points

I will say this… Over calibrating (even when level) can have nefarious outcomes. I’ve personally noticed worse accuracy with over-calibrating. I only calibrate if it is significantly off and when flat. It seems counter-intuitive–but that’s what my experience has shown.

BTW–great job! Graphs are looking much better. :slight_smile:


We calibrate about 1.5 times a day – pretty much only at night once he’s flat and asleep and in the morning when he wakes up. I missed the morning calibration every other day last week and I will say this: The last sensor was very accurate despite my lackadaisical calibration. Calibrating when it’s off at other times I think leads to worse accuracy, I agree with @Bradford
The only exception for us is the first 24-48 hours of a sensor, when it’s been off by 150 points sometimes! But it always settles down eventually.

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Blood drop should only be appearing twice per day…is yours a Dexcom G5?

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That is not to say that I don’t check BG…I just don’t always put the number in (especially during rapid rise/fall).


Harold, this is FANTASTIC! Way to go implementing the micro-bolus. Real time proof that doing life in community just works better.

Celebrating your progress!

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@ClaudnDaye, it is WONDERFUL to see your progress!

I should tell you that your track does not qualitatively look very different from ours :slight_smile:

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This looks great! Tell Liam he is making his dad look smart! :wink:

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She opened up the world to us for quite a few concepts so far! Super-bolus (which we are now using), Micro-bolus (which we are now using), Temp-Basal for 1 hour before meal, etc., We’ve implemented a lot of what she discussed with us because after reading and understanding it, it just made sense!

Question to everyone, though. Is there such a thing (for a toddler) as an exact bolus? What I mean is…assuming basal rates are correct and assuming you wait the adequate amount of time, assuming the child isn’t sick, etc., Is there an actual I:C that will prevent the necessity of micro-bolusing? Last week as well as this week we’re finding that we still have to give one (or worse…stacking them with 2 or more) to prevent the numbers from getting above 200…) And, in some instances, even multiple stacks still don’t stop it from rising. We’re continuing to refine (push down) the I:C ratios each week after analyzing the previous weeks data, but was just curious about this because, it seems to me that if the I:C is dialed in correctly, that the drastic rises in BG shouldn’t occur…at least to the point that necessitate one (or more) micro-boluses.

Is this just because our I:C isn’t right? And when it gets dialed in correctly those dreaded (double arrows) will stop (or at least be easier to stop once they appear.)

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I think you need to define the goal of your I:C ratio if you can say if it is dialed in or not.

My understanding of a correct I:C would be back at baseline 2 hours after eating a meal. If you goal is, in addition I don’t want him to go over 200, then I am not sure I:C would be the correct thing to adjust, rather you adjust the prebolus time and feed him food that digests in a similar way as the insulin action curve.

Also noting that illness, activity, and growth will all affect how quickly the food is digesting. So in my mind, having an I:C ratio dialed in doesn’t protect from going over 200, and that your micro-bolusing strategy would be more effective in dealing with the differences mentioned above. If you increase your I:C ratio, you may well end up administering too much insulin in a meal where digestion really matches the action curve of your insulin. Of course, it isn’t the end of the world to eat more candy.

If we want our son to stay below 200 we have to stay away from fried foods, feed him food that is lower on the glycemic index, prebolus and wait for a stong bg dip to occur before eating. All things that are doable, until the schedule overwhelms the desire to stay below 200…


I am with @Chris. Outside of spikes, schedule pressure is the #2 issue for us :slight_smile:

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From last weeks GREAT BG’s, we made some tweaks on Sunday night…specifically, we increased basal rates in the evening and morning and we decreased I:C ratios for 2 meals as well as increased it for 1 meal.

What I don’t understand, this week, is that…after MORE insulin (both basal and bolus) his numbers have been WORSE this week. :frowning:

Diabetes is SO freaking frustrating! The emotional Highs and Lows that come with this disease take a toll not unlike the rising BG Highs and Lows…

Oh well…time to keep on keeping on!

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Today’s Testing methods will include:


  1. Temp Basal of .95% extra for 2 hours (1 hour leading UP TOO the meal + 1 hour after meal)
  2. Super Bolus (over bolus for more than he’s going to eat, then “if” he’s not high; rather, heading to the low end, give the remainder of the food 45 min to 1 hour later)
  3. Micro-bolus AS SOON as we start to see the 45 degree arrow upward…not waiting for “double arrows” today.

Will see how this goes. :smiley:

I have to say though…I do love the challenge.

The hardest thing to account for isn’t I:C. It is timing. So many times I “get behind” the meal curve (sending him high)–then giving more to account for that high–just to bring him too low later. All while the actual ratio was correct. Trying to match the meal curve via food absorption to insulin bolus(es) is truly an art.


Easter and other holidays are especially hard. There is simply no way to plan that far ahead to exactly what is needed.

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@ClaudnDaye, in response to your question:

Is there such a thing (for a toddler) as an exact bolus?

Well, I would say in theory, yes? Maybe?

But in practice, for us, there is maybe one day out of seven where we don’t need to give any follow-up microbolus and he just winds up magically at 110 at the 3- or 4-hour mark. It’s frustrating because that’s how it’s supposed to work…right? And I keep thinking I’m doing something wrong when I have to microbolus. Plus, once he’s in kindergarten we’d like him to be less of a hassle for the school nurse – just a lunch bolus, not middle-of-the-day boluses. But we just can’t get it to work with the same results.

But the way I think of it is that the insulin has a certain duration of action, a time when it’s most and least active. This is based on the insulin’s chemistry and the site where it’s in your son’s body, how well it’s working, etc. In order for you to achieve a meal where your son doesn’t spike too much 1 hour to 90 minutes after the meal, then slowly drifts down to his target four hours later, you’d need that insulin curve of action to perfectly match your son’s digestion and production of glucose from a meal. First off that’s going to vary based on mysterious inner workings in his body. And second off, for us, we’ve found our son seems to digest foods really slowly. So we always need to give him a little bit of a bump two hours after breakfast. If we don’t he’ll slowly rise up before his next meal. We’ve tested and his basals are right, so raising basal isn’t the “technically correct” solution because a higher basal means he is locked into eating at set times. Those little bumps are basically the best option for us. And if we raise the I:C too much, he goes low after the meal, we have to give him some fast-acting carbs, and then he goes high anyways… So to me that’s a sign we can’t really get much closer without those extra little bumps.

For those who have very spiky responses to food, the way most people try to “match up” the insulin duration of action with the body’s glucose production is to do the prebolus… sometimes 30 or 45 minutes in advance. If you’re willing to risk it, you can try one time when your son is, say, running high (like 180-200), prebolus 45 minutes in advance and only feed him when he’s dropping really quickly (like 140 double arrows down or something) and see if he still spikes or if he goes low from the I:C. If, after the prebolus he is still spiking up a decent amount, It may be that your I:C is too weak. If, on the other hand, his I:C is causing him to go very low when insulin is at its peak action (insulin has it’s most potent blood-sugar lowering power about 1-hour after administration) , that’s an indication that really you may just have a kiddo who needs a little bit more of a prebolus than ours does. Then you have to make the mental tradeoff-- do you want the increased risk of lows in exchange for fewer spikes that a prebolus entails? 4 times out of 5, for us the answer is no, but for others that may be different. If he’s like our son, in this experiment he may go low, then go high, meaning that his food is outlasting his insulin and that the ideal matchup between the insulin duration of action and our son’s blood sugar production is with less of a prebolus.

Also keep in mind that he will spike sometimes. At least, I have found no way with a toddler to prevent all spikes. Our son spikes to nearly 200 about once a day. I could prevent some of those spikes if I stopped all my work and followed him around all day ready to pounce on the slightest rise, but sometimes I have other things to do and have to let those rises occur. Honestly, if my son spikes up to 200 briefly, even though it’s way out of our current target range, I’m not too concerned if he starts immediately dropping down. If he’s spent less than 20 minutes above 150, it’s not going to affect his A1C too much.


And THAT is the frustrating thing with toddlers. Check out his TDD. Is it much higher than last week? if so he may either be coming down with something, growing, or something else that simply requires more insulin. Or his site could be crummier.

Honestly for us the most useful, quick sanity check on our numbers is the TDD. When it’s higher, it all of a sudden clicks why he needs more insulin and the crazy increases he seems to need just don’t seem that drastic; it’s easier for me to roll with the punches and adjust up as needed.

I would say to get good BG control his numbers should be reviewed and potentially revised up to twice a week. That’s what we’ve found with ours. Some numbers need little tweaks here and there all the time.


I was wondering about the numbers.

From your earlier post (How to NOT spike so much after a meal) I remember having the thought that the minimum you can give with the omnipod (0.05 units) might be a lot for a little guy.

After-all, for me a micro-bolus is 0.10 units! I setup a pen for 0.10 unit doses.

When you speak of a micro-bolus, what size is that?

I guess in general, I don’t have a clear definition of micro-bolus. For one person, a micro-bolus might be 0.50 units. For others it might be a tenth of that, 0.05 units. What do you call a micro-bolus for Liam?

Is there an actual mathematical definition of micro-bolus somewhere? I looked and can’t find one. I would guess it would be a factor of your TDD.