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440, No Ketones..what to do?

Discussion in 'Parents of Children with Type 1' started by danielsmom, Nov 28, 2011.

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  1. Christopher

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    I think you will find that the majority of parents here are very grateful to have found this site early on. I know I was.
     
  2. Butterfly Betty

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    I wasn't. When I first started posting her, I often left feeling like an idiot for not just knowing what to do. Am I thankful for if now? Yes, it's taken me months to get to the point where I feel somewhat comfortable at all giving advice.
     
  3. Christopher

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    Sorry you felt that way. I think it is important for newly dx parents to manage their internal expectations (I know, easier said than done). This is a very complicated disease and one of the only chronic diseases where the patient (or caregiver) is responsible for the majority of the day to day management and medical decision making. That can feel like a lot of pressure at first.

    It takes time to learn all the ways to manage this illness and if you expect yourself to know how to do it right after dx, that is not only unreasonable but you are setting yourself up for disappointment and "feeling like an idiot".

    I still believe that the majority of the people here were glad to find a place where they could come for answers, communication, or just to vent to people who know what it is like to live this alternate life.
     
  4. Becky Stevens mom

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    I did go back and look at all of Shirley's posts. First of all, my apologies to Shirley for talking about her in the 3rd person here. I know that youre probably still looking this thread over Shirley and hope that you can get some useful info off of it. This group of people that have given you advice would put any endo group to shame. They would probably even put Ragnar Hanas to shame. What I have found over the years is that endos honestly dont always know whats best for each individual child. Our kids arent test subjects out of textbooks that they looked at in med school. They are living, breathing human beings and they are all different. Different needs, different ways of reacting to insulin, different likes and dislikes, different personalities, different family dynamics, different. Therefore I have learned over they years to take everything that the endo and CDE and dietician tell me and work it into our own game plan our own way of managing our son's diabetes.

    I am not in any way expecting you Shirley, or anyone else to do this especially being so new to the life of diabetes. During those first months I nearly felt that I couldnt use the bathroom without asking the endos permission:) It was a process of learning and making adjustments and reading Dr Hanas' book and the stack of other books that I had and talking to others who had CWD and seeing if what they did may work for us better.

    Now, to get to the quotes above. I have spent the better part of an hour going over each and every thread that Shirley has started herself and can only find a few comments and concerns about pizza/fat spikes. I did see that she said she hated him having to have more shots as he has alot to deal with already. I know how that feels. I hate having to give my kid shots but he's used to it, he's ok with it and it is what it is. Steven often gets 6-8 shots a day. For us we often have to give corrections for pizza. In Gary Sheiners book "Think like a pancreas" Gary talks about different types of foods and when one should be bolusing for them. Its been very useful for me in the past. If you can get a hold of it Shirley, I would recommend it highly. So I didnt see many posts about pizza nor have I seen many posts that said that the OP was unwilling to try anyones suggestions in this thread or other threads. And I have yet to see even one post where she says "Oh well, thats diabetes" She does say that shes trying to get used to things and trying to get things figured out but so was I at 4 months in. And I still need someone to show me the thread or post where she says that she will keep doing exactly as she is doing even if the results are no better. I did read the post that says that she is mixing the Levemir with humolog as the endo and nurse manager said that is ok. She is only doing that at night before her son's snack and not before a meal so Im not sure if it would really do any harm if its slowing down the effects of the humolog for that one snack. Maybe it is, maybe its something she'll have to ask the endo about and make changes where needed.
     
  5. 5kids4me

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    http://www.diabetes24-7.com/?p=871

    This link is to an article about T1U, Gary Scheiner and has a pizza tutorial video.
     
  6. Mommy For Life

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    I wasn't sure if I should reply to this thread..over 3000+ views and 80+ replies this is a HOT TOPIC for sure! I just wanted to say Shirley out of all the responses, Ms. Becky's reply said it best...at the newbie stage asking the Endo for permission before you use the bathroom does seem logical! Also, getting a copy of "Thinking Like a Pancreas" is another great suggestion! I just started reading it and it does have a lot of useful advice...just like what you will find on the CWD forum! Hang in there Shirley your DS is counting YOU to be a good pancreas! :cwds:
     
  7. Becky Stevens mom

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    And I honestly dont think that Ive done that nor given her rainbows and unicorns. I think that Gary's book is awesome! Thats why I suggested it to her and someone posted a link to Gary's way of handling high fat foods. Im still not seeing where she constantly complains about this happening unless people think that once a month is constant. From reviewing all of her posts thats what it averages about once per month. Maybe she will try something different this time. I for one will continue to give her the benefit of the doubt unless she tells me to shove off thats shes gonna keep going this route
     
  8. Jeff

    Jeff Founder, CWD

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    Two quick thoughts:

    1. Pizza requires that insulin delivery be extended over several hours. A couple of studies have shown this conclusively. If you're on a pump, that means an extended bolus. If you use MDI, that means more than one injection of a rapid acting analog or adding regular insulin to your pre-meal dose. There simply are no other ways to do pizza. And even following these strategies is likely to require multiple tries to get it right. A good friend of mine worked on Pizza Hut Personal Pan Pizza for a year before he got it perfect. (For him, it was a personal challenge to be able to "own that pizza!")

    2. Studies that explored the impact of mixing rapid acting analogs with Lantus and then Levemir were done after a couple of peds endos discovered that some of their teens were mixing the insulins on their own as a way to reduce the number of injections per day. The goal was to understand what impact, if any, this mixing would have on HbA1c. The first report on this was a poster at an ADA Scientific Sessions many years ago. It was followed by Dr. Chase's study. Both of these showed no adverse effect on HbA1c if the mixed insulin was injected immediately. Since mixing does change the performance of both insulins, if you decide to do this, you have to understand what's happening and be sure it's what you want to happen. It might be, it might not be.
     
  9. Christopher

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    And in addition to the poster and the study you mentioned there was also the other study that found that there was a change, a "flattening" effect.

    CONCLUSIONS These data demonstrate that mixing lispro with glargine markedly flattens the early pharmacodynamic peak of lispro and causes a shift to the right in the GIR curve changes that might lead to difficulties in controlling meal-related glucose excursions.
     
  10. danielsmom

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    I'm going to clarify. I mix levimir and novolog at bedtime when he gets his nightly snack. 7 units of levimir, 1/2 of novolog. Thats it. Been doing it for months. (well first it was lantus, but now we're on levimir). His food bolus is just novolog, no mixing. You don't have to like it but thats how my team wants it and it hasn't caused any adverse affects and does it keep his blood sugars steady through the night with the nightly protein snack. Yes.

    And Yes I may still ask my endo permission to use the bathroom, but I"m barely 5 months into this and still working on feeling secure with my own decisions on changes. I'm still getting to know my son's body and how it works. He is still honeymooning...I don't want to make drastic changes without their knowledge and reassurance right now.

    As for the pizza "complaints" i make over and over....this thread started because of a 400 bg..it really wasn't about the pizza spike..I know I under bolused and I just wasn't sure how to "fix" it sooner rather than later when that number hit.
    I have discussed endlessly over and over about splitting the dose with my educator... I've told her what this forum has suggested. Her response was this: "Don't split right now" Daniel is honeymooning, he is still sensitive to insulin, fix the high at the following meal"...even if that means he spikes at 2am, they absolutely don't want me correcting. If he is ill that is another story."

    And those getting offended by my " oh well, thats diabetes" statement...don't think I don't take this disease seriously!...its just in that moment I am trying to just release the tension and loosen up and not let it bring me down. Maybe many of you have forgotten what is like to be newly diagnosed, we all react differently. I do want to hear what you have to say and it does give me something to think about and to discuss with my endo, or do my own research. So I apologize if I seem to repeat myself over and over. Maybe I don't always get it. But if you are tired of answering my same questions, then please don't.
     
  11. L101418

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    Shirley,
    All of your points above were very clear to me. I took your post for this thread to be a question mostly about timing corrrections. You are 4 months into this and are nice, courteous, curious and working hard for your son so post away. I like reading your posts (but I do miss the cutest picture of your kiddos with their rock star hair). I don't know why, if some don't like repeating themselves, why they are repeating themselves. I find it completely appropriate for a 4 monther of a honeymooning child to be treating the highs like you are and following the instructions of your endo team. I still have a honeymooning daughter that we barely correct. I think I paced around the house for 20 minutes in a nervous fit the first time I gave a nighttime correction and then I think I only gave 1/2 and checked like a maniac. You'll find your way!
     
  12. Mom2Kathy

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    Yes. This.

    Shirley - you are early into this and honeymooning is tough. Hang in there and learn as much as you can from your team, those that know you and your child the best. :)
     
  13. L101418

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    So can't you look at it as, if you know how it works for "you", you can make it work for you?
     
  14. Becky Stevens mom

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    Thank you for responding Shirley:) That does make sense to me that you might not want to start splitting the dose if Daniel is honeymooning. To be perfectly honest, we never split the dose for pizza, not ever. I didnt when he was on NPH because that is a completely different regimen and I dont split the dose now. I dont give him a full bolus for pizza meals and I do have to give a correction at times later in the night but I dont purposely split the dose. More often than not this has worked for us. It depends a great deal on Steven's activity during the day. You may find that if Daniel is real active during the day that he wont see a spike or not enough to be concerned with splitting the dose or correcting a high after.
     
  15. Flutterby

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    But, Becky, you ARE splitting the dose. ;)
     
  16. Flutterby

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    A lot of this information would have been helpful in the beginning. Knowing that you've spoken to your diabetes team and they don't want you splitting right now for various reasons is extremely useful information. Asking 'what to do' opens the thread up for a variety of suggestions. Knowing one of the options (really the only good option right now) was off the table may have help others come up with some other creative ways to work around not splitting the dose. But honestly at this point if you don't want to do things without the premission of your diabetes team (which is normal in the beginning), they don't want you to split the dose or correct between meals then you have two options, 1, keep eating the same foods and deal with that spike until you (and your diabetes team) are ready to try something else. Or take those foods out of his diet for now, until you and your diabetes team are comfortable doing the split dosing and corrections between meals.

    Good luck!:cwds:
     
    Last edited: Dec 1, 2011
  17. danielsmom

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    I spoke to d manager yesterday. I was trying since Monday, after what happened on the weekend. I had already brought up the problem with the foods. It's not just pizza, i would have to omit pasta, rice and potatoes in addition if I want to avoid spikes. That's not happening. So she finally got back to me yesterday and I was told no splitting. The only thing I can do is feed him these foods at lunch and deal with spikes at dinner. My boy is not a pick protein eater. And I can't force him to like foods he just doesn't. I am trying and introducing to get better foods in him. The thread was about the number not the food. I wanted help in dealing with the number at that moment. But my team told me I handled it well. And it was a good thing I didn't over correct.
     
  18. 3kidlets

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    Wish there was a "Like Button".
     
  19. Butterfly Betty

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    You're right, you can't force him to eat foods that he doesn't like. REally, none of us can, but you can do something to help manage how his body reacts to the food he is eating. IMO, based on the infomation you are giving, it seems like on nights when he eats pizza, chicken, fries, rice, that mixing his levimer and novalog doesn't work. So why not try two shots? At least on those nights? I have a hard time understanding why your endo is saying feed him this and let him spike, just deal with it later when there are ways to prevent the spike from happening in the first place.

    I don't mean to come off as judging, and I certainly don't have all the answers, but you've come on here more than once and asked the same question, yet you don't want to make the choice to try something new.
     
  20. Christopher

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    I would like to understand, from your Endo's point of view, what is the relationship between the child being sensitive to insulin and not wanting to split the dose? I really do not understand that logic.
    By splitting, you are actually giving LESS insulin per dose.

    Thank you.
     
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