Coverage of Carbs when Low

[Tigerlilly's mom]

Just wondering how many of you cover the carbs of snacks that your children eat when they are low. (talking about the snack that they eat once there bg is back "in range") I am having a tough time wrapping my mind around the fact that carbs are suppose to be covered by insulin for this snack. I understand the whole concept of insulin being the key for food - blah blah blah. But it seems that whenever I cover these snacks (even at 50% coverage) he tends to go low again shortly after.

Any input on this would be greatly appreciated.

Thanks!

[Judy&Alli]

Once your child goes low there always seems to be a second low at least for Alli (ydmv). Once she goes hypo we are on high alert for the next.

As far as what to cover, how much does your child need carb wise to bring out of hypo? Alli needs 15 cho, unless of course she is in that downward trend. We treat and set the timer for 15 min. If she still wants a snack and she is in target then we treat with insulin.
I hope that helps
Judy:)

[twodoor2]

It also depends on how far along they are in their duration of insulin action (DIA). This is the time that it takes for insulin to be completely processed by the body, which averages around 4 hours. If you're 1 hour into your DIA and you're already low, then I wouldn't cover any of the carbs, and wait 15 minutes and recheck. If you're at the tail end of the DIA, with the same low, perhaps you may want to cover the carbs. It also depends on how low, some mild lows at the end of the DIA can be covered with insulin. If it's a low at the early part of the DIA, or a severe low even if there is no bolus left in the body, you need to use glucose and in extreme cases, a glucagon.

For example, if your child is 60 and there's 3 hours of the DIA left, just use the 15g rule, and in this case, I would use glucose. There's still too much active insulin left in the body to ensure the low will rise high enough to counter the active insulin remaining.

You don't even have to be considered "low" to have uncovered carbs. If I'm already in the low part of my target range and I'm only 1 hour into my DIA, then I would still give some uncovered carbs. The amount really depends on how many blood sugar points a gram of carb will raise you. Pumps can estimate how much active insulin from the last bolus is still in the body, and if you know about how much a gram of carb will raise your blood sugar (there is a chart based on body weight somewhere in this forum), you can estimate how much you can eat uncovered based on that.

[kirish]

My daughter (diagnosed 3/10/08 on novolog) and I just went to training on this. They said if 70 or less eat/drink 15grams of fast sugar. Wait 15 min and recheck. If above 70, eat a 15 gram snack with some protein too. Do not cover with insulin.

My son, on a pump does not eat a snack after a low.

[twodoor2]

My daughter (diagnosed 3/10/08 on novolog) and I just went to training on this. They said if 70 or less eat/drink 15grams of fast sugar. Wait 15 min and recheck. If above 70, eat a 15 gram snack with some protein too. Do not cover with insulin.

My son, on a pump does not eat a snack after a low.

On MDI, it's difficult to really give a good estimate of how much to eat, so the general 15 minute rule usually applies, but it can cause highs. The pumps can calculate the active insulin, and based on that, you can get a better idea if you need to eat uncovered carbs, and about how much.

[Ivan's Mum]

when we were on MDI we would throw food at the problem as Ivan takes SO LONG to come up again. Of course we would then be fighting highs at the other end. I'd either do the maths on the time of day as to how much he'd go up by with the chosen snack.

With pumping, if Van is low, I get him up with glucose and then give him a snack, then when he's up I bolus for the snack and the glucose and put in the low and let it do all the maths for me. Works a treat. I don't over treat now.

What they really need is a link to a page on this site where it can do all the maths like a pump for you and tell you either how many carbs you need or how much insulin depending on your I:C. It would make life much easier for moments like this!

Marsha, oh maths geek, maybe you could do a sum on how to work out how many carbs to give to get your child up. I know it mentally but can't figure it out on paper

If the I:C is 20 and the ISF is 8 then 20gm carbs will move BG 8 places. Is there a way that one can put that into an equasion? Even writing the above down I doubt myself.

man, and it's only Monday

[twodoor2]

What they really need is a link to a page on this site where it can do all the maths like a pump for you and tell you either how many carbs you need or how much insulin depending on your I:C. It would make life much easier for moments like this!

Marsha, oh maths geek, maybe you could do a sum on how to work out how many carbs to give to get your child up. I know it mentally but can't figure it out on paper

If the I:C is 20 and the ISF is 8 then 20gm carbs will move BG 8 places. Is there a way that one can put that into an equasion? Even writing the above down I doubt myself.

man, and it's only Monday

I wrote a whole spreadsheet that does all the food dose, IOB, and correction calcuations for me the way the MM Paradigm pump does it. There is no such thing, to my knowledge, of a personal MDI calculator. The pumps have their own patented calculations as well, so they vary from each other.

You also really have to take active insulin (IOB) into account, because the actual straight calculation doesn't work properly UNLESS there's no bolus on board. For example, if 1 gram of carb raises Elizabeth 7 blood sugar points, that's fine, but if there's still .6 units of active insulin in her body, and I give her 10 grams of carbs, her blood sugar will not rise up 70 points. It will only do so if all the active insulin is gone.

The .6 units is still working to bring her blood sugar down, and that amount is based on the ISF. If your ISF is say, 100, then the MOST it will bring down the blood sugar should be 60 points, but remember, that's the most it will bring down a fasting blood sugar number. If there's still food in the system, it may only bring it down 30 points. There's no way to be absolutely sure about these things, but to get an idea.

Consequently, based on the information I have. If her ISF is 100, and she has .6 units of IOB left, and 1 gram of carb will raise her about 7 points, and I give her ten grams of carbs, I can guestimate that she will rise about 30 points maybe.

[Ivan's Mum]

this is why I wish I had the new cozmo, I believe it has a function where you can put in a your low and it tells you how many grams of carbs you need to get back to target.

Of course, your correction factor has to be right.

[twodoor2]

this is why I wish I had the new cozmo, I believe it has a function where you can put in a your low and it tells you how many grams of carbs you need to get back to target.

Of course, your correction factor has to be right.

I've heard that cozmo hypomanager doesn't work well from some people. It's still an estimate, and it's not a precise science.

[czardoust]

i usually wait about 10 minutes after she eats the carbs to see how high it gets her, then about one hour after i start correcting for highs caused by the carbs.