Emma's Sensor Analysis

[Emma'sDad]

Hey guys,

Sensor data is done and I would like your opinions on what we got. Good news, we didn't lose the data that we thought we did, quite excited about that. I really don't know what to think about the data that we got. Look at those spikes, it's unreal! 22 one minute and 3 the next. I can't begin to wonder what Emma feels like during these periods. So any opinions would help.

Emma:
4.5 years old.
Levemir: 4.0 night, 2.0 morning
NovoRapid:
1.25U/10g morning,
0.5U/10g lunch,
0.75U/10g supper.
Snacks: 10:30am, 3pm, 8pm

Links to data:
Emma-Sensor-daily.jpg (http://trobichaud.dyndns.org/Emma/Emma-Sensor-daily.jpg)
Emma-Sensor-composite.jpg (http://trobichaud.dyndns.org/Emma/Emma-Sensor-composite.jpg)

[Kirsten]

Looks like you've got big after meal spikes. This is a lot easier to manage with a pump. What did your endo say?

Kirsten

[selketine]

We've been pumping so long I don't pay attention to what insulins are out there now - but levemir is like lanuts right? A 24 hour flat line insulin - and then you use a rapid acting insulin for meals and snacks?

I was wondering with those big spikes at meals if you are bolusing *after* the meals or before? Does she generally come into the meal at a good number?

William is the same age (pumping) and he generally has a difficult morning spike but I don't think he does after so much. He is an extremely consistent eater so we can give insulin before the meal if needed without fear that he won't eat.

I agree that pumping might help but hopefully someone with more experience with a child that age on MDI has better advice. My only thought was making sure she is on target coming into meals as much as possible and giving insulin at the beginning of the meal rather than waiting until afterward if she is a consistent eater.

[Carrie]

That is crazy how BG can flucuate. :eek: Might explain some of our melt-down moments throughout the day?!? :o

[cydnimom]

I agree with Carol. If you are giving her insulin after she is done eating that would explain the high spikes. If she tends to eat everything I would give her her insulin before she eats or half way through. This would be more so important if her premeal blood sugar was in a higher range - lets say 8.0 (144). If she was in a more normal range 5.0 (90) then waiting to give her insulin wouldn't be so worrisome. I guess it would also depend on the meal being eaten like high fat food. I know even for myself if I take all my insulin before eating and we have pizza my blood sugar can drop before all the carbs hit my system.

Its pretty interesting seeing whats going on though...

Just some thougths,

[kiwikid]

Even though it looks like 'scribble' - you can see on the composite graph that you have definite 'trends" - are you getting help to sort them out? Does your team have any ideas?

[EmmasMom]

This looks very similar to our first upload from the Guardian... I was horrified!!
Unfortunately I think most kids have pretty big post meal spikes, you just don't know it unless you test every 20 minutes after they eat.:rolleyes: By the next testing time they're back in range, so everything seems OK. And to see what the insulin does when it's peaking... yikes! They can easily drop 200 (11+) points in 30 minutes during the insulin peak, and they may still be dropping when you give insulin for the next meal or snack. Scary!
Looking at the graphs and seeing how much I didn't know about (my)Emma's numbers made me want my own CGMS asap!

I've been trying to give some pre-meal insulin, especially at breakfast, to help prevent the huge spikes. I have also made numerous basal adjustments to help in the a.m., and to make sure she wakes with a good number, but it's hard!
Will they let you use it again after you make some changes? That way you can see if it's helping. I sat with my rep and she gave me some advice, then Emma wore it for several more days so I could see how we were doing. The changes made a huge difference! Of course we were pumping, so there were a lot of things we could adjust, but I'm sure you can make things a little better with MDI as well.

Good Luck!

[selketine]

I think Amy is right on that (not that I have personal experience) - it makes sense to me that our kids would tend to spike after a meal and we don't see it.

I didn't get from the graph exactly how long she stayed in the "spike." I know that for breakfast if we didn't give William his insulin 15 mins AT LEAST before he eats then his spike can stay up there 2+ hours before he has a big drop.

[Emma'sDad]

Thanks for the response guys. Everybody is pushing us to go on the pump. I wish it was that easy. I wish somebody would come up to me and say, there, here's the pump, here's magically the knowledge on how to use it, go, go.

DW is meeting with the nurse that gave her the Guardian today. Hopefully they will be able to capture that trend and possibly see what dose could be changed to help those spikes and the fact that it seems that she's running at an average 11.1. We will also be showing the results to our doctor in the next week or so.

I know that giving her the needle before a meal would help alot, but she too often stops in the middle of eating and says, Ok, I'm done. I'd hate to have to be put in the position where I have to shove her food down her throat after she is full just to properly chase the insulin we gave her before the meal. A few times if she is high before the meal, we'll give her the correction and add what we know she will eat, and then give the balance after the meal. Imagine having to do that for every meal we'd be up to 8 needles a day...5 is bad enough.

Thanks again for your help, if somebody else sees anything that we could be missing, please let me know.

[selketine]

but she too often stops in the middle of eating and says, Ok, I'm done. I'd hate to have to be put in the position where I have to shove her food down her throat after she is full just to properly chase the insulin we gave her before the meal.

I think then you definitely cannot predose the insulin - very understandable. I think having to force her to eat is a worse thing than the spikes.

We were only on shots for 6 months so I do not have much experience dealing with shots and spikes. This is an excellent article by a guy who often presents a talk on spikes at the CWD conferences. This is called "Strike the Spike" and perhaps it will have something useful in it for your needs - I don't have a chance to re-read it to see at the moment: http://www.diabetesselfmanagement.com/article.cfm?aid=2102

[Emma'sDad]

Carol, thank you so much for that article. It is a really good article with really good suggestions. DW had to call in sick today and wasn't able to make it to the meeting, so it'll be next week instead. But we're printing it and bringing it with us as a reference.