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My 10 year old son has had diabetes for 3 years and has been on a pump for 9 months. Two times while on the pump he has had what I call a growth spurt that has dramatically affected the amount of his basal insulin. It seems to take me a week to 10 days to increase his basal insulin appropriately. I have been told by the Ping representative that I need to have him fast for three mornings; fast for three lunches; and fast for three dinners and evenings to evaluate his basal. I see the logic behind this. I can't imagine implementing this because: 1. His days aren't the same (school days, sport days,less active at home days). 2. He seems to have these growth spurts 2-3 times per year. Once I evaluate his basal he'll grow (or change his sport choice of the season) and we'll start all over again. 3. The number of days involved three breakfasts x three lunches x dinners x three evenings = 12 days. 4. Very busy schedule (Piano, Church, Tae Kwon Do, etc.) How beneficial is this whole process for a child? Is it worth the disruptions to his life? What can I glean that will give me the best information with the least amount of effort and upheaval?
Responses
Ginger Vieira says
This is exactly what my book is on!I suggest: If fasting is too difficult, then your next bet is to make changes in his insulin needs and closely observe while he goes through his day-to-day life.
Don't be afraid to make your own insulin adjustments. You don't have to find all the answers tomorrow. It's a process, sometimes a gradual one, and it's a process he will need to learn how to do for his entire life. Your insulin needs change throughout your entire life.
I recommend never increasing an insulin dose by more then 1-2 units for a child. If you're adjusting his basal rates, that means that the total
increased amount changed in his basal will amount to 1 or 2 units for that day. Observe the next day, and adjust the insulin doses further as needed.
Focus on one particular time of day if you need to, or it sounds like he
really just needs more insulin overall as well. Remember, this is a process and you don't have to have it all figured out in one day.
Gary Scheiner says
Dear Susan -As is often the case, the best option is a compromise between what is "ideal" and what is "practical". I do agree that basal testing is important for establishing appropriate basal patterns -- when peaks/valleys take place, and how long they last. This can usually be accomplished by fasting just once at each phase of the day, adjusting accordingly, and repeating the test during those phases that were adjusted.
After the initial pattern is set (properly), as your child goes through growth phases and needs increases, the entire basal program is simply shifted upward. The peaks/valleys stay the same, but the magnitude of all the settings increases.
If this doesn't make sense or you would like some assistance with the basal fine-tuning process, please feel free to get in touch with my office. This is something we work on with our clients all the time via phone and the internet: (877) 735-3648.
