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2 questions

Discussion in 'Parents of Children with Type 1' started by vallecito93, Dec 27, 2007.

  1. vallecito93

    vallecito93 Approved members

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    Hi, my first question is since we have started giving DD her 3 units of Lantus in the p.m. She is waking up low. Her #'s have been around 51 - 67. I usually give her a GT and then we do a breakfast with a protien and about 2 servings of carbs. By lunch time the last couple of days she is running at about 430 to over 500 at lunch. Her snacks usual consist of a 1/2 apple and cheese stick or yogurt or something not over 15 g of carbs. I am not sure what is causing her to spike so much at lunch, is it the GT? Also on another thread from a lantus user I read that some of you all do the shots in the a.m. rather than in the night. We do not see an endo on a regular basis, but our dr. wanted her on this schedule. 9 units of nph in the a.m. 3 units of lantus in p.m. and humalog for her highs at lunch and dinner.
    I was just hoping for some feed back. This is all so confusing to me. Thanks!
     
  2. cindyrn6617

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    Hi,

    Everytime Ryan eats an apple, his bs sky rockets. Try it without the apple and see if it makes a difference.

    Good Luck,
    Cindy
     
  3. czardoust

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    Hi, valle. I was just wondering why if she is on lantus, does her endo still want her on NPH? Lantus is the better version of NPH from what I gather. I give Kat her full lantus dose (10 units) at 5 am every day and since we started that, her night time and early morning lows have decreased dramatically. when we gave it to her at night, we saw extremely high BS at lunch also. I wonder if asking that your daughters lantus time can be changed to am would help, and if changing from NPH to lantus would also help. Why the NPH? i would ask to see the endo, especially if she does not have a schedule of seeing him/her like regularly. Does your insurance allow for a referal to see the endo every 3 months?
     
  4. twodoor2

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    I think some people use a combination of NPH (in the morning) and Lantus (in the evening) to avoid a lunchtime dose of insulin. Correct me if I'm wrong. It's probably a good strategy if you cannot give insulin for the lunch meal (like at school).
     
  5. czardoust

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    ah....thats never been an issue for us, never would have thought of that..... thanks :)
     
  6. Big Hair Momma

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    Hi Audrey!

    How's the weather in Durango? We have over a foot of snow and more coming....yuck! Did you get to BDC over Christmas? It's a great facility. But I digress... ;)

    I know you don't see Dr Walravens regularly, but do you check any of your dosing with him or one of the nurses at BDC? If not, I would give one of them a call and see what they think.

    I agree with Cindy, It used to be every time Caleb would eat an apple we'd see a huge spike. I've learned (kind of) how to dose it now, but it was a struggle.

    I also think that switching the Lantus to the morning would help. While there is no discernible peak, for most people, it does have to begin working. So while it's not a peak really, it's more like a plateau. I think that would help with the some coverage in the morning when you're seeing the big spike for the snack.

    Lastly, are you doing a sliding scale for the Humalog? Or are you actually counting the carbs that are in the food eaten? If you're not counting carbs, that might help with a more accurate dose for the apple and the insulin required to cover it.
     
  7. mph

    mph Approved members

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    For morning lows:
    1. What is her avg bg at bedtime? Is it high enough to allow for the Lantus to kick in?
    2. Have you done night time checks to see WHEN she starts going low?

    They can help tell you if it is the:
    a. bedtime Humalog (if any given)
    b. morning NPH (Nick's 14am units last up to 20 hours!!!!! but YDMV)
    c. Lantus (if it is peaking a bit or if the dose is just too high)

    3. Is she still honeymooning? Because that throws a monkey wrench into it!!!!

    For lunch high:
    1. Is she getting Humalog at breakfast?
    2. The 400-500s at lunch may also be rebounds from the low mornings. The 51-67s may be when she is already on the rebounding rise.
    3. Do her snacks (15gr and up) need to be covered with Humalog? Maybe.

    Just my thoughts. Clear as mud, eh????:D So many things to consider (and I didn't even mention them ALL). You'll figure it out!

    I'd ask the doctor about lowering the Lantus a tiny bit and see if that helps. Or get rid of the NPH! Just one more stick stirring up the muddy water!;) Seems like the Lantus is good enough WITHOUT the NPH, JMO

    Best wishes! Sorry so long!!!!!!!!!!:)
     
  8. Heather(CA)

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    I agree, it worked for us until Seth learned to give himself a shot, then we stopped the NPH. It worked when we needed it, but I don't miss it;)
     
  9. Heather(CA)

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    Welcome to the forums...

    At first glance, I would say that her Lantus needs to be lowered, and she needs to stop the uncovered snacks. After that, you can figure out if she also needs more insulin at meal times...:cwds:
     
  10. twodoor2

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    Just remember if you do decide to eliminate the NPH, you have to give a shot of fast-acting insulin (novolog, humalog) with every meal. You need to decide if that's a viable option for you.
     
  11. Nelson

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    Just a couple of comments:
    1) While we were on Lantus, I actually went against our doctor's request that we not switch to AM Lantus because he wasn't comfortable with it. We were seeing patterns very similar to yours with night-time lows followed by unexplained PM highs the next day. More Lantus to counter the late afternoon highs lead to unacceptable drops at night. Well, switching from PM to AM Lantus was by far the most productive single decision we have ever made regarding Derek's blood sugar control.
    2) Moral of the story, use the doctor as a good sounding board but only keep following their advice when it works. I found it very helpful to visit a pediatric endo because their flexibility of thought regarding T1 in kids is much better than the limited knowledge and textbook guidelines that non-specialists follow.

    Good luck,
    Nelson
     
  12. vallecito93

    vallecito93 Approved members

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    Clear as mud

    :rolleyes:Hi, Unfortunately we did not get to BDC. We are still in CO Sprgs, but the weather between here and there has been iffy. We do not give humalog to Autumn in the p.m. unless she is over 300 (per DE) We do not dose her for carbs yet for her humalog. Dr. says she is still in her honeymoon and that might make her to low. We just use a sliding scale for the humalog. I have started keeping a book on what she eats. When we left the hospital in May the dietitian said she could have between 9 - 11 servings of carbs a day, so I try and keep her in that area. We are trying to not let her get a shot at school. I think that is why we do the lantus and nph. Everything that I have read though says the lantus is to last 24 hrs. So I have often wondered about the nph myself. I definitely think I will ask about the switching to the a.m. for lantus. We do not do a night time test other than the one at 10 pm when we give her her lantus shot.
    We do not see a endo except for every 3 months when he comes to our area. Her avg bs have been in the 200's. According to the meter avg.
    Thank you all so much for your responses.
     
  13. Boo

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    So she currently eats breakfast without any "bolus" (fast-acting) insulin coverage? It sounds to be like she needs to start covering her breakfast with a small amount of fast acting insulin. It also seems that her evening lantus dosage may need to be slightly decreased (to prevent lows). Though it'll make for a lovely sounding A1C, I think it is not healthy to run that low all night long (which is what needs to be assumed if she wakes at that number and you haven't done any tests in between). But her bod will stop feeling the lows the more time she spends hovering around those numbers.

    You also need to consider that the very high lunchtime reading could be her body's natural rebound response to a prolonged low.
     
  14. vallecito93

    vallecito93 Approved members

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    Could you explain that a little more to me, about the rebound. Thanks
     
  15. Big Hair Momma

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    I can. A rebound is caused when the BG goes low, the body gets nervous knowing that's not supposed to happen and the liver dumps the glucose it has stored for emergencies into the bloodstream, therefore causing a high BG later. This typically happens for Caleb in any number under 50, but as they say YDMV.
     
  16. wilf

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    I think someone needs to give your doctor a good shake. An insulin regimen that has your daughter low in the night and over 400 at lunch is clearly not appropriate.

    I'm with other posters on changes you should discuss with the doctor/endo:

    1) Start giving Lantus in the morning not pm. (I would do this right away if it were me).

    2) Start counting carbs, and covering them with Humalog at breakfast, lunch and supper (rather than just correcting highs). Also use Humalog to correct with every meal-time injection.

    3) You can use NPH to cover lunch (in which case you wouldn't cover lunch carbs with H). If you start using H to cover every meal, then you can drop the NPH.

    If the doctor won't go along with these sensible changes, insist that they need to come up with some other insulin regimen to stop the night lows and lunch highs. If they can't/won't, then time to find a new doctor.
     
  17. lulu

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    I am new to this board and to learn from other's experiences. My daughter has been really sick with this D and that is difficult. She has been doing pretty well since her diagnosis one year ago, but the hormones are frustrating. She had a 501 last night before bedtime and I did correct. I just woke her up often throughout the night to test, to ensure there was not a low to follow.

    This morning she woke with a 200, but in the middle of the night it was heading downward and I gave her a juice of 15 carbs. Here is what I give her.

    Lantus 18 in the evening
    Novalog 1 unit per 10 carbs, but today I changed it to every 8 carbs.

    This has been working all along, until menstruation and now who knows.
     

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