Five hypoglycemic treatments??

[Nelson]

Any thoughts?

Derek started getting the sniffles a few days ago and missed school on Thur. He was basically whiny and clearly not feeling well. Unlike what is suggesting in most of our reading, Derek typically goes low with colds, not high. But, this one seems to be taking the cake for lows . . .

Day before yesterday in the early afternoon, while I was at work, I got a phone call. My wife was concerned because Derek had been low, had been treated four times and, although he was not continuing to go lower, and was feeling pretty good, he was not going any higher either. I suggested that she was doing the right thing and keep it up until things improved as long as he wasn't going any lower than he was (55-70). It had been about 2.5 - 3.5 h after his last Novolog injection so not much insulin should still be active. The fifth treatment treatment finally did the trick. Then, the rest of the day and night were fine with no unusual drops overnight. Yesterday was a good day with good control.

Then came today. About 2.5 h after lunch we were at Derek's Christmas music concert and after playing his ukulele, he went low and again, it took 3 treatments to get him back above 80. Now it is several hours after dinner and we are at it again. We are again on treatment number 4, and will see how things go.

I have been assuming that he is coming out of his honeymoon since his carb to insulin ratios and basal doses have had to increase a lot in the last couple of months. His carb to insulin ratio has deffinitly gone up in the last few days from about 20 to about 27 (higher than it's been for over a month).

What the heck is going on? Why isn't his body responding more to any of the various sugars (milk, juice, glucoburst, glucose tablets, etc.). He's only ever needed more than a single treatment once or twice before, and then he always responded to the second treatment.

If his bolus was the reason, why is this happening at the 2.5 to 4 h mark?
If his basal insulin dose were too high, he should be going low at night, which he's not.
Rumor has it that with diareah his body may not be processing sugars efficiently, but he doesn't obviously have diareah and he is not going down during peak insulin activity which he does when we over-bolus him as would be the case with poor sugar processing, I would think.

Thanks in advance for any insights you folks might have.

Sincerely,
Nelson

[EmmasMom]

If he's not eating well that could be a huge factor. When Emma is sick and doesn't eat well for a few days the effect seems to be cumulative. After a couple of days she's running lower and dropping much faster than normal, even though her insulin is decreased. I think the reduced amount of food in the digestive system makes it much harder to keep blood sugar stable and treat lows.
It also contributes to ketones, so I always watch them closely when she's having a lot of lows due to illness.

It could be a honeymoon issue, but I think it can happen anytime food intake is decreased for a few days.

I hope he's feeling better soon!

[Momof4gr8kids]

If he is constipated he also wont absorb the carbs quickly. Maybe his digestive system has slowed down because he is ill.

Julia hit lows the first time she had a cold post dx. She was honeymooning very strongly at the time.

Maybe decreasing carb ratio for now would be a good thing despite not knowing the cause. Sometimes we can't figure out why, and just have to treat the best we can. Good luck. I hope you can prevent some of these lows.

[georgia]

a similar thing happend to us over Thanksgiving, not exactly but similar. we fought a few days of just trying to keep her up. We cut our lantus In half, (mdi) and upped all our ratios. Now we are creeping up again. The only explanations we know of are her bodying kicking out some serious insulin or maybe a virus (although no diaherea or vomit) but she was gasy! I was told if she has virus her food may not absorb well and so she is not getting the carbs! It did end though, it was very scarey! Are you on the pump?? I was told if we were it would be easier to deal with, instead we had to feed the lantus until it was gone!
GOODLUCK~ it sounds like you are on top of it!

[Amy C.]

My son has not been feeling 100% lately -- he is achy and has a headache sometimes and occasionally a stuffy nose.

All this has lowered his insulin requirements. He too needed multiple treatments to get his sugar up and finally I lowered his basal 20%.

Some sicknesses raise the need for insulin, while others lower it. You have to go with the flow.

[Nelson]

So, the 5th treatment (maybe 10:30 or so) last night brought him up to 82, after which he had some cheese and two squares of graham crackers to hold him for the night . . . maybe. At midnight he was at 161, so I went to sleep with an alarm set for 3:00 AM. At three AM he was 311. We gave him one unit of novolog. At 5:00 AM he was 315, so we gave him another unit of Novolog. At 7:00AM he was 324, so we gave him another unit of Novolog, and his morning Lantus. Buy 9:00 when I woke up again, he was 151, running around the house, and eating a very small snack so he wouldn't go high again and wouldn't have to have another shot.

Every time I'm struggling with the misery of this darn disease, I keep reminding myself that Derek is really doing very well, is fundamentally healthy in all other ways, he will probably live a long, healthy and happy life (albeit with lots of pokes), and without these struggles which we all seem to keep overcoming, our kids would be dead. So heck, this hell is a small price to pay. It is just another little drop in the very big bucket of life.

Hopefully today will be a much better day than the last. Thanks everyone for you insightful thoughts.