I’m not a fan of rules.
There are a lot of rules in diabetes, but most are relative.
Each rule has a set of sub rules, which have a set of conditions that have a set of half baked nuances.
But there is one rule I stand by. Rain or shine. High or low.
One rule that I hold fast to…no matter how hard the winds blow.
The Three Day Rule.
THREE. DAYS!
Not one day more…not one day less. Three days!
When we change basals, I will ALWAYS wait three full days before I change them again.
(Basal is the underlying insulin that acts as long acting. So if you or your child are on shots, this rule would pertain to your long acting insulin, such as the NPH or the Lantus.)
Is it easy?
No.
Do I usually want to bang my head against the wall?
Yes.
Is it worth it?
Always.
Case and point: B had a bout with some uber bad lows when he returned back to school after Christmas break. It stood to reason though…during Christmas he wasn’t running around the playground…he was eating more…he was SITTING more. So basals went up! But when school started again, all that movin’ and groovin’ led to nasty after school lows. Some in the 30’s. (This was during Lawton’s “vacation” by the way.) 30’s are not ok. I haven’t seen 30’s in YEARS. 30's scare the crap out of me. Heck, 40’s scare the crap out of me! 50’s scare me! 60’s tick me off…and anything above I’m happy to deal with.
Three days in a row…30’s after school. Even without bolusing for lunch? Yeah! We needed to dial the basals down! (FYI: This is another rule of mine. I always wait three days to establish a pattern. The 30-something could have been a random thing. On day two, it could have been his body adjusting to the new routine, but day 3...HELLO! A pattern has been established, and things needed to change, NOW.)
So I made my changes…and the next day, lo and behold! 30’s again. But did I waver? No, I did not.
I waited.
It is a RULE for a reason!
The next day…he was high. Boo! 274 and I wondered if I lowered it too much.
But did I waver? Did I dial the basals back up?
NO!
I waited.
And the next day he was perfect.
And his afterschool numbers have been beautiful ever since.
I used to have a basal trigger finger problem. I have been guilty of changing basals less than 24 hours after the previous change…and every time ended in disaster.
Fair warning:
Those three days will give you false alarms.
Those three days will make you want to pull your hair out.
But if you wait…good will come of it. As with anything else with diabetes, it isn’t easy…but totally worth it. I can’t explain the medical aspect of it all, but the bottom line is their bodies need time to settle into the change.
When I do make the new basal changes, I make them on day 4. Not day 3. Day three is a no fly zone day. I leave it alone!
That is my two cents…let’s make it 40 cents…’cause in my book, it is so worth more than two!
Yay!!! That is EXACTLY what my Endo and the Nurse Educator and the Dietician all said!!! Three days is a pattern, then you make changes!! I see the logic. You make a change, their bodies react, and sometimes the over react, but by day 3, they are reacting as they normally would..... Congrats to you!! Huge hugs, thanks for your posts, you are a great inspiration!!
ReplyDeletewe were told the same thing...I have to say it's incredibly difficult for me, but I do try my best and it's getting better :) The trouble for me is do I make multiple changes or just one at a time? What do you do?
ReplyDeleteYeah... I suck at that. These issues usually happen to us during hours that normal people SLEEP, so we (I) tend to jump the gun a bit to play things safe. It's hard waiting 3 days of a kid tanking every night into the 40's before switching something up. I just can't sleep waiting for it to happen.
ReplyDeleteSome day I'll have your patience. :)
You know Meri, when you wrote about this a while back, I took it to heart. And I started to wait three days and you are so totally right my dear! I ride out the basal change and boom! on the third day, things settle and it works. I don't know why either, but I love your advice, it has saved me worry and time. That's why I love you and the DOC -advice I can't get anywhere else!
ReplyDeleteThank, you..thank you for posting this. I commented to Reyna on her blood ketone post, "how is it that you d-mama's seem to always know what post I need??"
ReplyDeleteI am driving myself INSANE trying to figure out basals with Adam. And yes, we are new to pumping, but I am impatient. Not one of my finer qualities. :) I feel like if I get it wrong one day, that I need to change it again quickly. It has been 3 days now that Adam has woken up on the high side, so now I have the confidence to go ahead and change raise his basal for the early morning hours. And then I will wait 3 more days. I promise. :)
Uuuuuuuuuggggghhhhh! I HATE waiting three days! It's not so bad when it's highs we're dealing with, but now we've been dealing with chronic, freaky LOWS! We had our first 30's low yesterday, after I'd dropped his Lantus AGAIN. But, just can't get an overall pattern. Boo. Time to fax crappy numbers to the Endo again. Poop. I hate doing that. Thanks for keeping us all on track and laughing :) Mo
ReplyDeleteI am soooooo bad about this. I HATE waiting those three days and I really should get better about it.
ReplyDeleteYoure talking directly to me aint cha? Lol great point and post!
ReplyDeleteGood advice. I should heed I more. I fall into the category of sucking at waiting.
ReplyDeleteCute signature. :)
It*
ReplyDeleteI am SO with you on this Meri AND...surprise, surprise, surprise ...I had a massive pump rate adjusting trigger finger problem. I could change rates faste than you could say "insulin"! WOOT. I was outta control the first year or so on the pump. Now I am more patient and wait.
ReplyDeleteGreat post...and you are the Queen in this department dear friend. I cannot even imagine. Wait! I cannot even BEGIN to imagine tweaking three pumps. I think my head would do 360s and pop off.
xoxo
Wow thanks for posting this! I just needed to see this even though I've heard it before, this was a good refresher. Although sometimes I tend to go the other way, not really noticing patterns until they've been happening for a week or more. I'll then start thinking 'Gosh my level has been low at about 4:00 for the past week.'
ReplyDeleteExactly like you said though, right now I'm still on vacation but I go back to school Monday and I'll definitely have some adjusting to do. I'm more active now at home than I am when I have to go to three college classes in a row. I'll keep the three day rule in mind.
I love this rule. You mentioned it a while back and I too took it to heart and you saved my arse! Great post friend, you ALWAYS have the best advice! Oh and thanks for the heads up about the growing time. I think it's illness this time, I ended up doing a 50% basal increase most of the day and still got a few numbers in the 200s.
ReplyDeleteI just love you!
I'm totally showing this to my husband. I love that he is so hands on, but that trigger finger issue - whew! Not that I wasn't guilty at times! :) 3 day rule - genius!!!!
ReplyDeleteIve always been a 3 day'er too. But, ya know sometimes you feel magical like you have the answer! Like I did this week. Changed a ratio (by 2pts) after 2 days of lunch highs and what did we get the next day? LOW LOW LOW. Flipped it back again and what-do-ya-know- GOOD AGAIN.
ReplyDeleteNote to self...Meri also says so! BE A 3 DAY'ER ALWAYS!! LISTEN TO MERI!!! :) Meri knows best!
I am so, so terrible about this. I have no patience when waiting for results and I always want to jump the gun and do something else. Doesn't help that the endo's office had never told me the 3 day rule until it came up in conversation during a visit because I'd been tweaking the week before. So...a year of not waiting and then having to wait...so hard. I am trying, though.
ReplyDeleteI am all about the 3 days for a pattern, though!
Absolutely, just wanted to chime in that my son's Endo (the lead Endo and manager of all Endo's at Phoenix Childrens Hospital) has pounded this into my head.
ReplyDeleteI get so anxious and impatient sometimes it just screws up everything, I'm really going to try this 3 day rule. You're a smart lady! Thanks for posting this!!!!
ReplyDeleteNews to me! As in I have just bookmarked this post for future reference. Yeat another educational and entertaining post from our dear Meri!!!
ReplyDeleteI totally agree - it's not easy but SO worth. I need to see a real pattern before I make changes. I have wavered from the rule and it came back to bite me in the bum so now I play by this rule too!! Just like the doc taught me --- I'm so hard headed I had to learn for myself.
ReplyDeleteThanks for always sharing your fantabulous tips!! :)
I'm so impatient! I hate waiting. And I'm in such a fog I can't remember when 3 days was! Lord helP me! Good advice, Meri! Thanks!
ReplyDeleteOh yea baby! I remember reading this rule in a previous post or comment of yours when I first found you. I told my mother back then...If Meri says wait 3 days, we will, she has 3 Type 1's and I bet not a one of them is the same! So three examples of what can or will happen...I have had it pretty lucky on the basals so far, just 2 and I only have to adjust the time every once and awhile or bump one up or down every once and awhile. Now I think I'm probably pretty tolerant of the numbers, but I did learn in the hospital last week that I am actually VERY patient when it comes to "reacting" to numbers, it takes quite a few hours of issues before I begin to get a bit pissy and tense. Loves to you and yours!
ReplyDeleteFinally catching up on blogging around here. Actually, I read this post days ago, but I never responded.
ReplyDeleteAnyway, THANK YOU for this post!!!
Our CDE told us about the 3 day rule, but I don't think I really "got it" until your post.
I'm going to stick to it. : )
Are there other important rules you've discovered? If so, please share in a post one day!
Hello! New to your blog. Great post. I can get a case of trigger finger at times. Thanks for the encouragement to stick it out.
ReplyDeleteWe're on day 2 of a decrease in lantus. Still seeing lows, but you've been quoted to my husband. :) Thanks for the information you've gleaned and thanks for being real. It means alot to a mom of a newly dx 7yo who's really tired! Carol
ReplyDelete