If anyones has the time...

[lil'Man'sMom]

We had to change a few of lil'Man's ratios and increase the Lantus .5un last week due to highs. This week still seeing wacky #'s. Going to call Endo tomorrow, would like some feed back from CWD parents.

Lantus = 5 units @ 9:00 pm
Breakfast I:C = 35
Lunch I:C = 40
Dinner I:C =35
BG range = 80-150 day, 100-200 night
ISF = 100 (all day)

5/4 (rainy Sunday, no outside play)
86 @ 9:00
no snack
127 @ 1:53
76 @ 3:35
uncovered 15 cbs (slight low)
175 @ 4:15
282 @ 6:40 (dinner @ Olive Garden)
no snack
172 @ 10:25
326 @ 2:15 (20oz water)
233 @ 4:20

5/5 (School)
172 @ 7:30
protein snack under 10 cbs @ 10:00
225 @ 11:55
83 @ 1:10
protein snack under 10 cbs @ 2:00
139 @ 3:00
142 @ 5:00
133 @ 7:40 (after Bball)
162 @ 8:40
covered snack @ 8:45
126 @ 2:00

5/6 (School)
89 @ 7:40
free snack @ 10:00
143 @ 11:55
139 @ 1:55
protein snack 10 cbs @ 2:00
111 @ 2:50 (after Gym)
97 @ 5:25
141 @ 7:40 (after Lacrosse)
139 @ 8:30
snack (SF cookies) 8 cbs @ 8:40
225 @ 12:30 (water)

5/7
99 @ 7:40
12 cbs snack @ 10:00
241 @ 11:55
42 @ 1:30 (2 glucose tabs)
100 @ 1:45
protein snack under 10 cbs
74 @ 2:30 (nurse did not correct)
128 @ 2:45
136 @ 3:15
free snack @ 3:25
90 @ 5:25
played outside
140 @ 8:15
snack (SF cookies) 8 cbs @ 8:30
we will see!!!!

My concerns: over 200 during sleep if we don't cover bed snack, spike at lunch if snack is not free (even protein), lows after lunch.

Any thoughts????

[Judy&Alli]

Have you done any basal testing? It's so hard to do daytime basal testing. If you haven't I would start with the night time testing to see how steady that is. If it were me I would change the lunchtime carb ratio by 2 until I heard from the endo just to give you a little more breathing room.
Judy:)

[taximom]

When my DS was on MDI we were trying to give small uncovered snacks, but it never worked. Our endo told us to cover every snack. It's seems like whenever you do cover his snacks your numbers are fine. Id just keep covering those snacks.

I only see 1 real low after lunch (42). Maybe your lunch carb count was a bit off or the nurse over-corrected?

Do you correct those highs during the night?

[lil'Man'sMom]

When my DS was on MDI we were trying to give small uncovered snacks, but it never worked. Our endo told us to cover every snack. It's seems like whenever you do cover his snacks your numbers are fine. Id just keep covering those snacks.

I only see 1 real low after lunch (42). Maybe your lunch carb count was a bit off or the nurse over-corrected?

Do you correct those highs during the night?

At dx Endo said 15 carb snacks uncovered were fine...that was 9 months ago...probably need to change that.

Do you cover all snacks even protein/low carbs?

The nurse did say that the regular lunch lady was out and he had hot lunch today.

I don't like to correct at night but I have and will if I don't see him going down or if Ketone's were present (have not had any since dx). We usually give water, recheck, correct if he has not gone down by at least 50 points. If he were over 350, yes definitively a correction

[taximom]

At dx Endo said 15 carb snacks uncovered were fine...that was 9 months ago...probably need to change that.
Same here. At dx'd they said under 15 carbs was okay, but that ended when we went from NPH to Lantus.

Do you cover all snacks even protein/low carbs?
It depends. But for the most part, yes we have to cover everything. He could have a very small bag of peanuts for a morning snack at school and not spike at all.

The nurse did say that the regular lunch lady was out and he had hot lunch today.
School lunches are tough. We have problems with this too. You never know if the serving size they are getting is exactly what it is supposed to be.
I don't like to correct at night but I have and will if I don't see him going down or if Ketone's were present (have not had any since dx). We usually give water, recheck, correct if he has not gone down by at least 50 points. If he were over 350, yes definitively a correction
We correct more conservatively at night. I correct anything over 200, but only 1/2 the usual correction.
Like someone else mentioned, you might want to do a basal test over night to see how his Lantus dose is working.

[Gwyn]

Like the others have said, it looks like the snacks are going to require some insulin.

About the after lunch lows, does he have recess after lunch? Extra activity now that the weather is getting nicer could be the culprit.

[twodoor2]

We had to change a few of lil'Man's ratios and increase the Lantus .5un last week due to highs. This week still seeing wacky #'s. Going to call Endo tomorrow, would like some feed back from CWD parents.

Lantus = 5 units @ 9:00 pm
Breakfast I:C = 35
Lunch I:C = 40
Dinner I:C =35
BG range = 80-150 day, 100-200 night
ISF = 100 (all day)

5/4 (rainy Sunday, no outside play)
86 @ 9:00
no snack
127 @ 1:53
76 @ 3:35
uncovered 15 cbs (slight low)
175 @ 4:15
282 @ 6:40 (dinner @ Olive Garden)
no snack
172 @ 10:25
326 @ 2:15 (20oz water)
233 @ 4:20

5/5 (School)
172 @ 7:30
protein snack under 10 cbs @ 10:00
225 @ 11:55
83 @ 1:10
protein snack under 10 cbs @ 2:00
139 @ 3:00
142 @ 5:00
133 @ 7:40 (after Bball)
162 @ 8:40
covered snack @ 8:45
126 @ 2:00

5/6 (School)
89 @ 7:40
free snack @ 10:00
143 @ 11:55
139 @ 1:55
protein snack 10 cbs @ 2:00
111 @ 2:50 (after Gym)
97 @ 5:25
141 @ 7:40 (after Lacrosse)
139 @ 8:30
snack (SF cookies) 8 cbs @ 8:40
225 @ 12:30 (water)

5/7
99 @ 7:40
12 cbs snack @ 10:00
241 @ 11:55
42 @ 1:30 (2 glucose tabs)
100 @ 1:45
protein snack under 10 cbs
74 @ 2:30 (nurse did not correct)
128 @ 2:45
136 @ 3:15
free snack @ 3:25
90 @ 5:25
played outside
140 @ 8:15
snack (SF cookies) 8 cbs @ 8:30
we will see!!!!

My concerns: over 200 during sleep if we don't cover bed snack, spike at lunch if snack is not free (even protein), lows after lunch.

Any thoughts????

The one thing that really sticks out like a sore thumb is that he has an ISF of only 100 (mid range insulin sensitivity), but his I:C's are so high. I would expect an ISF of at least 200 for those particular carb ratios and for his age. Do your corrections usually work when you give them??

That drop of 225 to 99 the next morning, did you dose for that 225?

I also think your basal is very high in relation to your carb ratios as well. Why did you raise the Lantus, were you seeing the numbers increase substantially during the night?

These are just some high level observations. To give more detailed analysis, you would have to post every dosage amount with the breakdown of correction and food, and all carbs for all meals.

[lil'Man'sMom]

The one thing that really sticks out like a sore thumb is that he has an ISF of only 100 (mid range insulin sensitivity), but his I:C's are so high. I would expect an ISF of at least 200 for those particular carb ratios and for his age. Do your corrections usually work when you give them??
Yes they seem to work, sometimes to well, this is when tends to go a little low. There are times when I do correct at night that it will take a longer time to come down.

That drop of 225 to 99 the next morning, did you dose for that 225?
I did not dose for this, this is why I take caution with corrections at night because it so erratic.

I also think your basal is very high in relation to your carb ratios as well. Why did you raise the Lantus, were you seeing the numbers increase substantially during the night?
Yes, for three days the previous week we had a really hard time with highs at night. The Endo wanted to increase by .5.

These are just some high level observations. To give more detailed analysis, you would have to post every dosage amount with the breakdown of correction and food, and all carbs for all meals.
I could do this but I don't want to bog anyone down. I know how little time is left at the end of the day...thats why it's almost 12 midnight my EST and I am still up with D. :cwds:


I am off to do a quick check.

[twodoor2]

One more thing, when you were having problems with highs at night, were the BG values increasing steadily throughout the night, or did they just sit in the 200's all night long without much movement up or down? When I say not much movement up or down, was it increasing/decreasing more than 40mg/dL either way throughout the night?

[lil'Man'sMom]

One more thing, when you were having problems with highs at night, were the BG values increasing steadily throughout the night, or did they just sit in the 200's all night long without much movement up or down? When I say not much movement up or down, was it increasing/decreasing more than 40mg/dL either way throughout the night?

Night 1
Bed BS = 69 @ 8:25 (Turkey hotdogs for dinner)
16 Carbs (ice Cream)
229 @ 9:30
249 @ 12:00
149 @ 3:20
77 @ 9:20 (wake-up)

Night 2
Bed BS= 151 @ 8:31
11 carb snack
312 @ 12:55
1.25 units
151 @ 3:50
148 @ 7:48 (wake-up)

Night 3
Bed BS = 259 @ 9:00 (no correction , dinner was 2 hours earlier w/fat)
20 oz water
217 @ 10:20
219 @ 11:50
no Ketones
.75 units @ 12:00
151 @ 1:15
152 @ 7:30 (wake-up)

Night 4
Bed BS = 207
increased Lantus .5
268 @ 10:41
284 @ 12:20
1.5 units
(slept through...BAD Mom)
96 @ 7:15 (wake-up)



Just checked tonight/this morning ...138 :)

[twodoor2]

Night 1
Bed BS = 69 @ 8:25 (Turkey hotdogs for dinner)
16 Carbs (ice Cream)
229 @ 9:30
249 @ 12:00
149 @ 3:20
77 @ 9:20 (wake-up)

Night 2
Bed BS= 151 @ 8:31
11 carb snack
312 @ 12:55
1.25 units
151 @ 3:50
148 @ 7:48 (wake-up)

Night 3
Bed BS = 259 @ 9:00 (no correction , dinner was 2 hours earlier w/fat)
20 oz water
217 @ 10:20
219 @ 11:50
no Ketones
.75 units @ 12:00
151 @ 1:15
152 @ 7:30 (wake-up)

Night 4
Bed BS = 207
increased Lantus .5
268 @ 10:41
284 @ 12:20
1.5 units
(slept through...BAD Mom)
96 @ 7:15 (wake-up)



Just checked tonight/this morning ...138 :)

Based on the numbers he had before you increased the Lantus, I think the Lantus was fine at 4.5 units, and this is my reason why. He was pretty level, even when he was in the 200's, and the corrections you gave kept him pretty level after that. Take this example of Night 3.

Night 3
Bed BS = 259 @ 9:00 (no correction , dinner was 2 hours earlier w/fat)
20 oz water
217 @ 10:20
219 @ 11:50
no Ketones
.75 units @ 12:00
151 @ 1:15
152 @ 7:30 (wake-up)

I think the problem you had was that the I:C ratio for dinner was not low enough, and that was keeping him high, and an uncovered snack on Night 2. In the above example, you probably had too much fat as well. Your endo saw high numbers at night and automatically assumed it was Lantus. If you put him to bed at 150 for example, I think he would have stayed close to that number all night long.

Now, if you were to lower your Lantus, and start working on the I:C ratios a bit, I think you would have a better bolus/basal ratio, and the Lantus would not be pulling him down as I saw on recent nights in your first post. The Lantus could also be attributing to some of the lows during the day.

JMO. My endo sees high numbers at night, and she automatically assumes it's the Lantus:rolleyes:. I only know it's the Lantus if that bedtime number, 4 hours from the last dose, keeps rising all night long. If it stays steady, regardless if it's 50 or 350, the Lantus dose is fine. It's not the Lantus' job to bring you down, that's what the bolus is for.

I hope that explains things. Please correct me if I'm wrong.