How would you have "diagnosed" this

[Nancy in VA]

Emma had an unusual night last night - I'm curious how others would have interpreted this:

She was a little high at dinner (207). So I gave her the dinner dose and correction

At 2 hours, she was at 221 (almost where she started)

At 3 1/2 hours, she was at 201. She should have been lower by then, so I did a little correction. IOB said not to but I overrode it

At 4 1/2 hours, she was 250. I did another correction, overriding IOB again

At 5 1/2 hours, she was 290. I did a site change and overrode the IOB and gave almost a full correction.

2 1/2 hours after site change, she was at 214, so she's coming back down. (This was 2:30am)

This morning, she woke up at 52!

Did the insulin just stack and finally work 8-10 hours later!? Is that even possible? Or was the new site just so much more effective? That low was just really unexpected because that basal rate is actually pretty good (well, actually, she's been going up between 4am and 7am and we were considering increasing that basal rate)

Thoughts?

[Amy C.]

This happens to Philip sometimes. He has a high that is resistant and then when the site is changed -- whammo, he comes down.

I don't think it is insulin stacking, but the site wasn't working very well. When you changed it, it started working as expected.

[BrendaK]

We had this happen last week, even without a site change. Carson had a cold and we couldn't get his number under 300 all day (no ketones, just a slight fever and cough.) I kept giving tons and tons of insulin all day long and nothing would work. (I had just done a site change so I didn't think I needed to do another one -- he was just high.)

Then he finally started coming down aroudn 9pm, after he had gone to sleep. We ended up having to treat lows 4 TIMES that night. (Around 60 carbs). And he still only woke up at 70 or something.

I don't know if his fever broke and then the insulin started working or if it was stacked or what. But I was giving super doses all day, so I'm sure stacking had something to do with it.

[Kaylee's Mommy]

I had almost this exact night with Kaylee.. she just would NOT come down.. this morning, 72, not low low.. but low enough..

its frustrating when the answers are clear cut.. I wouldn't say insulin was stacked because there is to much time between site change and waking up the in the am.. although you don't know how long she was on the low side..it could be with the site change the insulin absorbed better so it worked more efficiently.. i've heard people say that their kids do go low after a site change.. its probably something that you'll rack your brain over and never get an answer to:cwds:

[WestinsMom]

Maybe the site wasn't absorbing? There are just so many possibilities. I guess if it happens again tonight it means basal change.

[hrermgr]

We have soooo been there! It just happens sometimes. And it is very frustrating. Could be something she ate earlier (high fat), growth spurt, illness coming on, bad insulin, air bubble in the tubing, etc. No easy answers but I know how you feel!

[Abby-Dabby-Doo]

You already heard the little list that would have went off in my head from the other parents.
I usually tend to lean towards the pump and a bubble in the tubing Or if that pattern continues between meals today- when it's site change time look for a small kink in the cannula. Sometimes I think a fair amount of insulin needs to "go through" there to push it out. And larger corrections, or meal boluses seem to do that when there is a small kink.

We also just have stubborn highs at night sometimes.

[thebestnest5]

The exact thing happens to us sometimes. I never know exactly what caused it.:cwds:

[DustinsDad]

Site change would be my guess. With us, in some spots the site starts "giving up" before site change time, and his numbers will climb just like having bubbles or a pulled site or kinked cannula, etc. When we change sites we've sometimes hit areas that are more sensitive or effective, and then we spend the next three days with lower numbers than normal. This is all on the belly, even. He hasn't let us go any other places (yet).

It is not inconceivable that in the act of removing the old site, the disturbance (rubbing with solvent, alcohol, or whatever) could push some insulin beyond the saturated cells to some more vigorous ones and thereby deliver more insulin from the old site than expected (like the dentist rubbing your gums after novocaine to help it settle in faster). So many possible reasons that it's hard to pin down the real culprit.

[Momof4gr8kids]

Nancy, I am not sure how big the boluses were, but since it was an old site it could be possible that the insulin may have pooled up and was not absorbed until later. That would be my guess, anyhow.

[Gwyn]

This has happened to us a couple of times recently too--and we're on MDI. I thought it was odd, because ours happened in the evening too, when we usually have to be more careful about corrections.

I was thinking maybe it was because she was less active during those particular days and the lantus is not quite kicked in at that time. I blamed it on lantus, but after your note, I guess it might be something not related to the insulin.

[mollysmom]

This just happened to us last night and has happened before. usually I end up doing a site change but last night I didn't because we had recently changed it and had great numbers all day, so I decided to see what would happen.

9pm 292 - full correction

12 am 292 - full correction

3 am 276 - full correction

7:30 am 155

mid morn and lunch numbers good too

I think nighttime numbers can be very stubborn sometimes. I don't know why, because we have also had her be more sensitive to corrections at night also:confused:

[Nancy in VA]

Nancy, I am not sure how big the boluses were, but since it was an old site it could be possible that the insulin may have pooled up and was not absorbed until later. That would be my guess, anyhow.

They were pretty little = 0.1 - 0.3. A typical correction wouldn't be more than .5 or so. I was taking the correction suggested and doing about 1/2 to 2/3, regardless of the IOB (since I thought maybe the site was bad).

This just happened to us last night and has happened before. usually I end up doing a site change but last night I didn't because we had recently changed it and had great numbers all day, so I decided to see what would happen.

9pm 292 - full correction

12 am 292 - full correction

3 am 276 - full correction

7:30 am 155

mid morn and lunch numbers good too

I think nighttime numbers can be very stubborn sometimes. I don't know why, because we have also had her be more sensitive to corrections at night also:confused:


Yeah, see - that's what we were dealing with as well. I just would expect the number to go DOWN for a correction, at least. Maybe not all the way but at least some.

[jendean]

MY diagnosis???
Yoru daughter has Diabetes.
LOLOLOLOL.
OK now that i am done.

There are so many factors in diabetes that have NOTHING to do with insulin intake.

That is what maked Diabetes so hard... It is not cut and dry.

Your entire endocrine system affects BG levels. BG is like a vital sign.

When we get upset, blood glucose rises.

Sexually excited... BG rises

Adreneline from too much excercise... or fear. BG rises

A nightmare can cause this.

Illness.

Menses...


All the sugar in alcohol... can cause your bg to drop low low low and supress glucagon excretion from the liver.

Point is there are a LOT of factors other than how much insulin or the right time to bolus.

Perhaps the nicest feature about the pump is the correction bolus.

What we cant perfect the first time around, we can correct later.