Our Process of Tweaking

I'm often asked how we fine tune and make adjustments. Sometimes it hard for me to answer...there are so many variables and I honestly know ours.  But there are practices that I feel all T1's can employ. 

One of those is to log your results.  You can't fix what you can't see.

Next, change only one variable at a time. If you increase your bolus amount and increase your pre-bolus time and you go low, which change caused it?  It takes longer to fine tune this way, but I feel you have the best ability to learn how all variables work together.

When Samuel goes through a hard growth spurt (as he is now) often both his basal and bolus needs change - definitely during the spurt, but often permanently changes after it settles down.

His boluses have changed quite a bit -  the amount and prebolus time.  We've been working on each meal and look at them individually.

Here are some general rules of thumb for how we adjust insulin:

*Fast spike, stays high: more fast-acting insulin
*Slow spike, stays high: more Regular insulin
*Spike, but drifts down: longer pre-bolus
*Drops fast, stays low: reduce insulin
*Drops, comes back up: decrease pre-bolus time

Sometimes adjustments are a combination of these tweaks, but one at a time.

Below is our past 12 hours.

Overall, good but we're still getting a spike after lunch.  We've adjusted his Novolog and Regular (independently) and feel like we have the dose right.  I've been increasing his pre-bolus time 2 minutes at a time.  Each day the spike gets less severe and smooths out on its own.  Today was a 24 minute pre-bolus. Tomorrow I'll increase it to 26 minutes and we'll see what that does.

This is a pretty casual process for us. We don't like highs or lows, but they happen. We log the result, try to keep our foods consistent, and try better the next day.  This process is what we're trying to teach Samuel as he grows up with this disease.