Calculating doses of insulin?

[abacobaby]

Since I'm new to all of this, I'm trying to figure out how you all know how much insulin to give to your children every day. Right now we are still calling our Endo every evening and reporting the sugar levels for the last 24 hours and she then tells us how much insulin to give our daughter for that evening and the next morning doses. She did mention that eventually we would only have to fax in the numbers twice a week. This brings me to my question...how will I know how much insulin to give her each day? Right now our daughter, Grace, is on Humalog and NPH, twice a day. She is on a strict meal plan of 30 carbs at breakfast, 15 carbs - mid morning snack, 30 carbs at lunch, two 15 carb snacks in the afternoon, 45 carbs at dinner, and 15 carbs before bedtime.

I'm really new to all of this so I have no clue

[coni]

Hi -
I saw your other thread introducing yourself, so I'll just welcome you here! This forum is incredible. The help I've received with managing my child's diabetes here has been priceless.

As for your question, I suggest you get the book "Using Insulin" by John Walsh. It explains insulin dosing in detail and provides worksheets. That way, you can have a reference, and using your child's logs, you can determine doses on your own (with an endo's oversight). Sounds like this will be especially important since you have to travel to see your endo.

That being said, I have never used NPH. Our endo thinks its use is outdated, i.e. it's an "old school" method. HOWEVER, people do use it with success, but it has some big draw backs, one of which is a big peak that doesn't necessarily occur at the same time every day.

I'm sure others who have practical experience with your regime will chime in.

[zell828]

Hi abacobaby. I am new here too. My stepdaughter was diagnosed last week so everything is new to me as well. My daughter is using the Novolog/Lantus. We count carbs before meals or snacks and then inject insulin according to her carb intake. She doesn't have any limit on what she eats or how many carbs she can have. Your way sounds a bit more complicated and tiresome if you have to be on the phone all the time. Maybe ask your Endo why you are doing it that way (maybe they have a reason), or ask if there are other ways that are easier for you to understand so you become more independent.

[hawkeyegirl]

Hi abacobaby! We were diagnosed in November, and we also started out on a NPH/Humalog routine. It was really hard for us, because my son is only 3, and often times I felt like we were forcing junk food into him just to get him to eat enough carbs to cover the insulin.

At our two week appointment, I talked to our endo about that, and he switched us to Lantus/Humalog. Now we give one shot of Lantus at bedtime, and then Humalog depending on how much he eats at meals. It's much less stressful, and if he wants to eat a meal late, or doesn't want a snack, I'm not tearing my hair out trying to figure out how to get enough carbs into him to cover the insulin I've already given him. He can eat zero carbs at a meal or 100. It doesn't matter, because we just give him enough Humalog to cover what he eats.

We do give one more shot a day on the Lantus/Humalog regimen than on NPH/Humalog, (4 instead of 3), but it's soooooooo worth it. It's something to think about, anyway.

Many hugs. I know how hard it is at the beginning. I used to come on here and get so overwhelmed - everyone seemed so confident and almost like they were talking in a foreign language. Keep reading and learning, and you'll be amazed at how far you'll come in a short time!

[Andy'sMom]

Hi and welcome! I'm relatively new to this site, but have been treating my son's diabetes for almost 3 years. He's 3 now and will be 4 in June. I know what you're going through as we started on (and are still on) NPH and Regular insulin. It's been a challenge getting through the toddler years on such a strict food/insulin regimin, but we're having a lot of success with control, so we are reluctant to change. Andy is also on a strict # of carbs for each meal throughout the day. This is "feeding to the insulin" meaning that we give Andy a shot in the AM mixing the R and NPH and then his food all day is in response to that insulin and how it's reacting in his body. We test before each meal/snack and adjust the # of carbs in the food, if needed. We learned by trial and error what amount of insulin covered our carb regimin for the day - I think we were on our own w/o the endo after about a week or two. We rarely call our endo now (only if Andy's sick - which thankfully has been few and far between). Good luck - I know it can be terribly frustrating!

[liasmommy2000]

Most here use Lantus with a fast acting insulin such as Novolog OR just a fast acting insulin in a pump.

On these regimines a person has an I:C ratio. AKA insulin to carb ratio. If your child's ratio is 1:30 that means they get one unit of insulin for every 30 grams of carbohydrates eaten. Most will also have different I:C ratios for different times of days/meals. So they may have a ratio of 1:30 for say dinner and 1:35 at breakfast etc.

They also have correction factors for when they are high. Say 1:100. One unit of insulin brings that child's blood sugar down 100 points.

In the beginning you figure these out with the help of the endo and CDE. After time though many adjust on their own with guidance from the endo's office as needed.

Lia's endo started her out on NPH also. So she had strict carb limits at meals and we only adjusted her fast acting (well, it was Regular in the very early months and that's not that fast acting lol) based on if she was high/low before a meal, not how much she ate. Then we switched to NPH/Novolog, then Lantus/Novolog and now just Novolog in the pump. They all have their advantages even if some of us don't like a particular insulin, others have found a way to make them work for their child. For us NPH and Regular just did NOT work. But I know of a few that like NPH and one even uses Regular too. I think a lot of it comes down to how good you are at math, how organized you are, the guidance you are given from the endo's office etc. The better you are at those things the easier it is to play around to find what works with the least amount of stress. But even if you're not (I'm not unfortunately), you can still do this. It just may take a little longer to adjust to new things and to get the numbers improved etc.

Good luck!

[wilf]

Welcome! You need to learn a lot if you want to give the insulin yourself. Ask your endo if anything is offered, otherwise get yourself the book Using Insulin by John Walsh..

[hold48398]

Hi and welcome. We too started on NPH and on a strict meal plan when we were first diagnosed. Now looking back I would have preferred to start off with a more flexible routine, something like carb counting and flexibility in the number of carbs for snacks and meals. Mia was 3 at time of diagnosis. We only stayed on NPH for 3 months due to many lows, especially at night. I would highly recommend that you discuss switching your insulin routine to Lantus/Levemir instead of NPH. I just think that would make things so much easier, especially in consideration of your daughter's age (and the inconsistent eating habits of a toddler). With Lantus, your daugher's blood sugar levels should remain stable day and night, if the doses are set correctly, and there is no need to "feed" the insulin. Then when she eats, you would count the carbs in the snack or meal and give her insulin according to a carb to insulin ratio, which your endo will help you establish. So if your daugher doesn't want to eat much for a snack, she doesn't have to! This method mimics normal eating habits much more than NPH where you HAVE to feed the child in order to prevent her from going low. Just a thought! Also, ask for a chart from your endo that outlines how much insulin to give depending on the meal and blood sugar levels. This way you don't have to call them at every meal and you have a back-up because the time will come when you can't get a hold of them and you need to know what to do. I think these are all reasonable requests!
Good luck, and we are here for you!

[hold48398]

I just wanted to add that Lantus is taken in addition to Humalog/Novolog. It is the "background" insulin where as Humalog/Novolog is the "meal-time" insulin. So it is always used together.

[twodoor2]

We were on NPH for three weeks, and that was all I could bear. It does work well for some people, and the beauty of NPH is that you don't have to give a bolus shot with every meal. However, I didn't have the patience, and from what I've heard, endos in the U.S. don't know how to make the best use of it. I guess they use it differently in Europe so that it works more effectively without all the lows. (Wilf, correct me if I'm wrong).

In any case, make sure you mix it really well. It can affect absorption variability greatly. Gently roll it between your hands 20 times. That's about all the NPH advice I can give!!!

Most of the people that belong to this board that do multiple daily injections are on a Lantus/Fast-acting regimen. But, the caveat with that is more shots, albeit tighter control.

The one good thing about NPH is that it has been around since the 1950's, so it's long term effects are known.