Is this stacking?

[Jordansmom]

Originally Posted by Knittingfor4

So if we increase Lantus, we should lower the carb ratio? And we should give Novolog for everyting over 5 carbs?

To be clear, people were suggesting you lower the insulin dose, not lower the carb ratio. The lower the carb ratio the more insulin. The higher the ratio the lower the insulin. That can easily get confusing.

I dont think there is a single member here who would suggest a ratio of 1:5 for a 4 year old (I doubt any would suggest 1:10 even). That is a ton of insulin for such a small child. Teenagers at their peak insulin usage get to 1:5-10. My DD uses 1:7. Actually so does my BIL and he is a grown man.

I think you would more easily expect a 4 year old to be 1:20 or higher. But your diabetes may vary, and really you should be getting dosing advice from your medical team (as inept as they seem to be).

[mmgirls]

Originally Posted by Knittingfor4

Hmm, so we are being too aggressive? That's odd. So if we increase Lantus, we should lower the carb ratio? And we should give Novolog for everyting over 5 carbs?

This actually makes sense now. I mean why she's so high all the time. She's having 10-15 carb snacks with no insulin 2-3 times per day. So if we only correct at 3 meals, and dose for everything that goes into her mouth, that should work out better?

Ok, this is really dumb MDI means Lantus plus Novlog, vs pumping which is just the Novolog? Does it stand for manual somthing injections? Trying to learn here

The carb ratio of 1:10 is aggressive, for her age
the lantus dose of 5 units seems "ok", not extremely high or low
The correction factor of 1unit over 250 is "weak", not aggressive compared to your ratio.

You can not just raise the lantus, you need to figure out if it needs to be raised. You need to figure out how long fast acting insulin works in her body (Novolog).

Lantus dose is based on keeping her level at night, because during the day you can use different carb ratios to adjust for too much lantus or too little lantus.

Where are you located Right now? I wonder if there is anyone that you could meet up with you fro lunch or dinner and help.

[steph]

It is so important to educate yourself and be an advocate for your child. when the medical team is not doing their job, you need to be able to catch it. i love the diabetes educators where we go, but the last endo we saw was just aweful, and if i had followed her advice, my child may not be alive today. thankfully i had spent hours and days soaking in everything i could from books and websites, and i knew enough to question her. you have to understand the disease and the treatment in order to help your daughter be safe and healthy.

you should be testing before every meal and snack and at night. and log everything. one thing i found out early on was that my daughter's correction factor was way to high. 1u for every 100 pts over 150 (which is what you are doing) sent her crashing. through trial and error we found that 1/2u for every 100 pts over 200 works much better. you have to look for patterns and tweak the dose little by little. i mention it bc it looks like your daughter's may be a little high as well. you need to see the log to know exactly why the BS is doing what it's doing. It's not very helpful just to look at the meter download. you need to see exactly what happened before the high or the low to know what is causing them. it's like solving a mystery.

you also need to know how many carbs go in, so please start counting. we started with measuring cups and just put a small serving (1/4 cup) at a time on her plate. that way it was easier to see what wasn't eaten. and then we could add more if she ate all of it. the food that doesn't have much carbs like meat and greens we don't really measure. sweets i measure by the teaspoon (jelly, maple syrup). i prefer the scale method bc i am not always cleaning out measuring cups. best wishes as you work on figuring all this out.

[steph]

ps. i know how incredibly lost and hopeless i felt when i realized i couldn't put my total faith in my endo team. and this forum really helped me to have the confidence to push them and ask the right questions to make sure my daughter's needs were met. i just want to say i feel your pain, and it infuriates, sickens and saddens me to no end knowing that there are medical teams that are supposed to be diabetes specialists that will just just leave a family in the dark while their child is suffering major life threatening consequences of this illness. shame on them!

[Knittingfor4]

Originally Posted by caspi

I know you've been given a lot of information already, but I have one more question. Are you only testing your daughter before meals and before bed? If so, you need to start testing 2 hours after she eats so that you can get an idea of how the novolog is doing.

Yes, only testing before meals and at bedtime. They said we could stop the 2am tests about 2 years ago.

Originally Posted by MomofSweetOne

...The first thing you need to do is test basal insulin. Watch how her BGs track at night, checking every 2-3 hours throughout the night. If her BG is increasing or decreasing by more than 30 points in a 4-5 hour period, her basal needs adjusted...

Ok, too late tonight, but I can do that tomarrow. Hopefully. I sleep through fire alarms, so we'll see how it goes with an alarm clock!

Originally Posted by mmgirls

You can not just raise the lantus, you need to figure out if it needs to be raised. You need to figure out how long fast acting insulin works in her body (Novolog).

Lantus dose is based on keeping her level at night, because during the day you can use different carb ratios to adjust for too much lantus or too little lantus.

Where are you located Right now? I wonder if there is anyone that you could meet up with you fro lunch or dinner and help.

They never said anything like this! They just see that her A1C is high and say maybe we should try an extra unit of Lantus! I've never heard of any kind of formula for figuring it out

I am near Portland, OR. I was thinking of calling JDRF to see if they have any local resources. Maybe even my stupid team knows of some groups around here

[mmgirls]

Originally Posted by Knittingfor4

Yes, only testing before meals and at bedtime. They said we could stop the 2am tests about 2 years ago.


Ok, too late tonight, but I can do that tomarrow. Hopefully. I sleep through fire alarms, so we'll see how it goes with an alarm clock!


They never said anything like this! They just see that her A1C is high and say maybe we should try an extra unit of Lantus! I've never heard of any kind of formula for figuring it out

I am near Portland, OR. I was thinking of calling JDRF to see if they have any local resources. Maybe even my stupid team knows of some groups around here

OK, you need to be testing at night. TONIGHT.

IF your daughter is going low at night you might be fighting a lossing battle.

IF your daughter is staying way high at night, again, you might be fighting a lossing battle.

WHY, because both can cause extreme insulin resistance. Resistance that can last for hours and you are just behind the 8 ball all of the time, and can never catch up.

I would not say that the basing the "Lantus" on the night numbers is a "formula' persay, but it is what most need to do in order to have numbers that they are comfortable with in a growing child.

No one wants to be wakeing their child at nght to feed the Lantus dose that is too high. and noone wants to be drawing up a correction dose of insulin and either hoping that their child does not wake up or waking their child and explaining that their number is too high and they need a shot.

SO, the only logicall thing to do is try to get the Lantus dose dialed in close enough that you do not have to give carbs, nor, correction. We are talking about nearly half of a day for a younge child, 8+ hours.

I hope that someone in the portland area can point you in the right direction to resources that can help you soon.

[Knittingfor4]

Thanks, I may have prevented a low last night. She was 178 after you told me to test. So I gave her a few sips of milk. She was 300 later. That was a close call.

I was going to do the carb test this morning, but when I got up they were already eating I told her not to eat anymore until I say it's okay, but I don't know how that'll go. I'll tell the boys not to feed her, they're pretty good about being little food spies for me when it comes to her sneaking food. Guess I'll try again tomorrow.

[caspi]

Originally Posted by Knittingfor4

Thanks, I may have prevented a low last night. She was 178 after you told me to test. So I gave her a few sips of milk. She was 300 later. That was a close call.

I was going to do the carb test this morning, but when I got up they were already eating I told her not to eat anymore until I say it's okay, but I don't know how that'll go. I'll tell the boys not to feed her, they're pretty good about being little food spies for me when it comes to her sneaking food. Guess I'll try again tomorrow.

I wouldn't have treated the 178. Also a few sips of milk shouldn't spike her to 300. As for this morning, did she get any insulin for the food she was eating before you awoke? What was her pre-breakfast #?

[MomofSweetOne]

You really need to check the basal before bothering with carb ratios. If the basal is too much or too little, it will affect the carb ratio testing.

What guidelines were you given for night times? We are told to have her BG above 100 at bedtime but my child is older. I personally would never give carbs at 178. If your daughter is dropping to a below 70 low, then she has WAY too much basal working. Again, we can do tiny, tiny doses because of the pump, but I tweak down BGs that are above 140 to get my daughter in range. How my daughter's BGs are during the night affect the next day. If she wakes in the 160-170s or above, she's sluggish and slow with her schoolwork. If she's in the 90-120, she's bubbly, ready to work and finishes quickly. For me, it has far less to do about the A1C and more how she feels. The A1C and less complication risks then come as a result of keeping her feeling as optimal as possible.

[Sarah Maddie's Mom]

Originally Posted by Knittingfor4

Thanks, I may have prevented a low last night. She was 178 after you told me to test. So I gave her a few sips of milk. She was 300 later. That was a close call.

If you have been treating 178 as a precursor to lows then something in your education was amiss.

Can you explain the thinking behind the above?