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Basal production with too little insulin

Discussion in 'Parents of Children with Type 1' started by Lisa P., Jul 17, 2010.

  1. Lisa P.

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    Looking at some dog diabetes stuff, so this might not apply :eek:, but I saw something interesting.

    A doc wrote that when there is insufficient insulin production, the liver doesn't get the message to stop pumping out glucose. I read that as basal sugar will increase with too little insulin.

    Does it make sense that our kids might do that? So if I am already giving too little basal insulin, or there's a pump or site problem, a shot that is missed, etc., I know the glucose from a meal and the basal glucose will raise her blood sugar because there isn't enough insulin to match it. But will her blood sugar be raised even more in some cases because her body thinks she's not getting enough glucose so the liver pumps more out?

    So if I have a scr#w up and she's short insulin for a bit, will she then have higher basal needs for a few hours or even more after that?

    Not that I overthink or anything. . . .
     
  2. hawkeyegirl

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    I don't know if it's right, but it makes sense with what we see. If Jack's basal needs go up 0.05 an hour, it will take a TON of insulin to get him down to where the implementation of that additional 0.05 an hour will keep him steady. Is that kind of what you're talking about?
     
  3. Lisa P.

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    Yes, that's what I'm wondering.
    Also, when we think there's too little basal and we increase it, it seems to work well and then suddenly be too much. Of course, we're on such little doses it's hard to judge.
     
  4. hawkeyegirl

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    We see that too. After a significant basal change, we almost always have to back off of it in a few days, sometimes ending up right back where we started.
     
  5. Mom2Boys

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    I think it works the same way for us too. If his basal is a little too low and we overcorrect a low or underbolus or whatever then it will take major amounts of insulin to bring him back down into range again. We find that stubborn highs from not enough basal come down best with a bolus and a higher temp basal.
     
  6. Darryl

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    I don't know if the reason given is correct, but I do agree with the outcome. In our experience, if basal is too low, BG starts to rise and once it gets above the nondiabetic range it gets very hard to bring down. That is why we have our CGM high alert set to 100 and begin correcting as soon as BG hits 101 (target is 80-90). If we wait until the CGM shows 120 rising (meaning the BG is already at 140+), then it takes a lot more insulin to bring it down. All that extra insulin not only costs money, it can't be good for the body in terms of hyperinsulinimia (excess circulating insulin) and effect on the tissues under the skin. We've sometimes had to give 20 or more units of extra insulin if we don't correct a high fast enough. We also run basals a little to the high side of what is "normally" needed. If her BG drops below 80 once she'll eat a few carbs, if it happens again she'll cut the basal rate. But it's much easier to start each day with a little more basal than is normally needed, then to spend half the day pumping 10's of units of extra insulin to make up for a shortfall in basal rate.
     
  7. chammond

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    When Logan was dx'd we were told that it was important for him to wake up with good numbers so it will "turn off" the glucose output from the liver. Sounds like the same concept to me.
     
  8. Lisa P.

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    I've been trying to climb the learning curve on temp basals, so this is helpful.

    I wonder if this, combined with Heather's rule about the liver always wanting its own back, explains our lately trend. She'll stall, stall, stall, GO . . . both up and down. Her CGMS lines look insane, all vertical.

    So I'm thinking she gets high, then shoots extremely high because we haven't caught it soon enough and now there's a ton of basal glucose added. We have to supercorrect to even start it down. Then it starts down, and when it gets to a point around 200 suddenly she drops like a rock. I'm thinking that's the liver taking the basal glucose back. But, of course, we have to overtreat because the carbs can't keep up with the 73 and double arrows down. . . .

    So, just put in an overbasal for the next 12 hours, we'll see if we can get off the ride for long enough to return some sanity to the system.
     
  9. emm142

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    Recently I've come to the conclusion that my BGs are best when my basals are 0.05u/h or 0.1u/h HIGHER than what would keep them flat. It doesn't make sense. It means I have to eat about 3g carbs every hour or so, but seems to give more buffer against going high.. I don't get it, but it works for me, and I like grazing anyway.
     
  10. mph

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    I see this on Nick's graphs and we tend to follow the "basal a tad bit high" for that reason........but it sure makes it rough to adjust it back down when he will not be with me.......it takes half a day to get back on track when he is home again.:rolleyes:
     
  11. Lisa P.

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    We tried a 20% increase in temp basal just for the daylight 12 hours yesterday and today.
    She definitely would have gone low if she hadn't snacked, but we actually had fewer fast drops than when her basals were more "right". Then at night, less wild swings, too, even though we didn't change basals.
    Of course, it could be just self-fulfilling prophecies since we "feel" this out more than record and calculate, but it's been a nicer couple days.
     
  12. mph

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    Well, it's working so just enjoy it for now.;)
     
  13. TheFormerLantusFiend

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    Fits what I see too.

    But from a theoretical standpoint, my understanding is that the glucagon from the pancreas is telling the liver what to do- and the body releases too much glucagon in many type 1 diabetics when they are high.
     
  14. Charlotte'sMom

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    I see this too.
     
  15. Lisa P.

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    Do you know if this is when they are high from any cause or just when they are high from a deficiency of insulin?
    O.k., that sounded stupid, but you know what I mean -- if I give her 100 carbs of cake but only enough insulin for 50 carbs of cake, does that provoke a glucagon response the same as if she had a 12 carb piece of bread but no insulin?

    Is it the high bg that causes the glucagon response or is it that the body is not getting enough carb fuel to feed the brain so it spits out liver glucose because it actually thinks it's low?

    I guess the difference would be, for me, whether I shoot to combat those highs more by leveling out her carb intake throughout the day or by increasing her insulin ratio and snacking her later as she drops.
     
  16. sam1nat2

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    Lisa, My kid just won't follow the rules.
    There are times when he is very high, we wash and confirm, and give a correction and he will drop 400 points in an hour:eek:
    Other times he won't budge.
    No real pattern to it:rolleyes:
     
  17. Yellow Tulip

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    Lisa, I remember reading in Dr. Hanas's book that the body is in a way stupid, and does not recognize that there is D at play. So when the cells don't have enough fuel, whether from an actual low, or a high without matching insulin, it spits out glucagon to remedy the lack of fuel.

    What I definitely see in my DS, is that when he starts to rollercoast, it is usually a basal issue. Increasing the basal by just a tad often stops the wild swings.
     
  18. TheFormerLantusFiend

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    I just read through pubmed; see attachment. Basically, the answer to your question is nobody knows.
     

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