- advertisement -

Confused on numbers AGAIN

Discussion in 'Parents of Children with Type 1' started by monkeyschool, May 12, 2011.

  1. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    2 questions in here sorry :(

    The other day when doc called about CGM he said G's breakfast dose needed to be raised...I told him I was a little concerned because even though there is a spike there and the 2 hr post is usually right on or a little higher, by 3 hr post she tanks....

    I've been giving her more protein/fat with her breakfast to keep her from tanking, and giving her NL 10 min prior to breakfast...I am not sure if it's working because without a CGM I have no idea if I am missing the spikes when she tests....

    On Tuesday...
    Breakfast with protein
    111....
    185 tested 1hr later to try to catch the spike
    98 2hr post
    65 and shaky 3 hr post

    Yesterday....
    Again with added protein
    97
    68 at 2 hr post

    Today
    83
    130 at 1-1/2 hrs
    72 at 2-1/2 hrs


    Second question...this I don't really understand. I dropped Lantus from 8.5 units to 7 units last week...Monday's numbers were low hundreds until evening pasta dinner...Tuesday's numbers ranged from 65 to one 171 (which we purposely spiked because it was a 3 hr class with parent observation so she didn't want to keep testing in front of everyone)...by the end of class it was 79

    Yesterday's numbers barely made 100s except for #s where we treated lows.

    Overnight numbers today:
    11pm 77...but we were expecting potato to kick in so she only had 4g carb
    1am 93....potatoes still not here????
    2am 86

    by this point I did not treat to check how Lantus would do (will get to the why after the numbers)

    3am 84
    6:30 77
    8:30 83


    So here's the thing. Doc was not thrilled I dropped Lantus last time because he said the 'drop' that I see overnight is her kidneys breaking down the sugar into the urine...I read about this in the Think like a Pancreas book, but I recall it said that happened over 200??? So he thought the drop I was seeing in the overnight numbers was normal and not an indication of poor dosing

    Doc also said we probably didn't need to change the last dose even though the numbers were in the 80 or so overnight because her body would be doing some work if they went too low.....but remember I was getting these types of numbers at 8.5 units before

    So after a couple of days in the 100s we are back to 70s and 80s....although I have to say that the thing I like is that the numbers are back to being steady instead of dropping.....BUT I don't know if that's really the case (again darned CGM) or if she is going low and coming back up on her own and I am just missing it.

    From what I read I would drop Lantus....from what doc says I shouldn't. But I worry about overnight lows regardless......

    What do I do?

    ETA: It may help if I post these again

    [​IMG]
    [​IMG]
     
  2. Becky Stevens mom

    Becky Stevens mom Approved members

    Joined:
    Oct 14, 2008
    Messages:
    8,719
    It looks to me like your daughter is having a strong honeymoon. Is she more active now that the weather is finally improving? If it were my son I would drop the lantus another unit. Those over night #s would make me nervous. I prefer 100-160 over night. I think that if you feel comfortable making some changes that you could drop it a half unit for a couple days and then even further. You could tell the endo that those #s at night are lower then you are comfortable with.
     
  3. Frymom3

    Frymom3 Approved members

    Joined:
    May 3, 2011
    Messages:
    21
    I'm glad you are posting this... we are just about 3wks into this whole diabetes thing and my daughter is having low's quite often in the night. Scares me to death. They did drop her Lantus from 10 to 8 units and the first night it was great, but last night we were back into the high 60's at 2am. :cwds:
    I have my biggest fears when she is not with me and at night when we are sleeping. :(
     
  4. Becky Stevens mom

    Becky Stevens mom Approved members

    Joined:
    Oct 14, 2008
    Messages:
    8,719
    Hello, I know you may not feel comfortable making insulin dosage changes on your own yet but do call the endo and tell them that that low of a number makes you very uncomfortable. It sounds like your daughter is also in a strong honeymoon and probably needs alot less insulin right now
     
  5. Wendy12571

    Wendy12571 Approved members

    Joined:
    Aug 8, 2007
    Messages:
    476
    If you want to catch her highest number post meals test at 1 hour and 15 minutes after the shot. This is according to Gary Schriener. I wouldn't think she needs more insulin for breakfast, right now. I am also thinking could be a honeymoon thing too going on.
    Wendy
     
  6. Heather(CA)

    Heather(CA) Approved members

    Joined:
    Jun 18, 2007
    Messages:
    10,153
    I adjust insulin based on the three hour number for this reason. The ratios need to be lowered:cwds:
     
  7. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    You had me at your first case.
    Here's what we learned in year one on Lantus, when our basals are too high we see exactly what you described on your breakfast example.
    What happens is that your I:C ratio is set wrong, you don't give enough insulin for the carbs that get eaten, so you get a steep spike. But by hour three or four, the overdosage of long-acting has dragged your bg back into range or lower again.

    If you are seeing other evidence, like nighttime lows, that the Lantus is set too high, I would definitely think Lantus myself. You can reduce the Lantus and increase the fast-acting.

    I'm sure honeymooning plays a part. My understanding is, yes, that it's generally at over 200 that you pass glucose into your urine, although I'm sure it's different for different people. In any case, it's irrelevant. Here's why.

    Let's say I start the night at 100 and the Lantus would keep me steady all night normally. Wouldn't that be pretty?
    But my kidneys break down the sugar so that I drop 50 points overnight.
    Obviously, even if the Lantus isn't causing the drop, if the drop happens but the Lantus keeps working on me, I'm gonna drop too low.
    Now, this is mitigated by the fact that at some point the sugar in my bg will not pass into the urine. But you don't know what that point is. So saying that the drop is from sugar going into the urine so the Lantus shouldn't be changed is silly. The kidneys might stop their bg-lowering action at some point, but the Lantus won't.

    In any case, I find the whole story odd. I guess our endo tends to err on the side of caution for lows. Still, if I'm concerned about highs, he will listen and try to help. But if I were concerned about lows and wanted to reduce insulin, I can't see him discouraging me. After all, nothing is set in stone, if I'm wrong I'll see so in less than a week. Raising bg from 80 to 130 isn't going to risk DKA.

    In addition, knowing the risks as I do after three years and seeing folks here post about middle of the night seizures and other episodes from lows, if I thought my kid were going low from Lantus I'd reduce the Lantus. I guess an alternative would be to check every half hour or hour all night. :( I don't see that as sustainable.

    However, I'm not a numbers gal -- others here may have better info and advice.
    I could be all wet. :p
     
  8. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    Thank you all for your replies. I'm sorry it took me so long to get back on...I'm trying from a wifi spot while I wait for DD at dance....

    No changes in exercise patterns/activity.

    I am still not sure how to do the ratio of basal to bolus thing....we are at 7 units Lantus and the Bolus varies because she doesn't eat the same amount of carbs each day....her ratios are 1:28 / 1:28 / 1:30 right now. I want to say that on average she gets 60g per meal , but it can range from 30-100g.

    The feeling I get from doc is that he does not want to drop insulin to try to prolong the honeymoon period as long as possible. Meaning the more artificial insulin the less the beta cells have to work, but I could be completely wrong as I didn't get to ask (he was paged on a call).

    I have to believe though that if this is the case and I have to keep giving uncovered snacks to combat the lows, I am making her pancreas work all of those times too, so I don't understand how not lowering the dose would help.

    I agree with the Lantus overlapping the breakfast ratio, that was the thought I was having as well. To that I had spoken with the nurse and she said "even though she has some highs, her body is doing a nice job of bringing them down after the NL wears out". Personally I don't think it's her body, I think it's the high Lantus. I have no idea though, will figuring the basal/bolus ratio help determine this?
     
  9. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    Everything you say confirms my bias. :rolleyes:

    Selah's ratios are more like 1:15. So my four year old is getting twice as much insulin for her carbs as your child is. But your daughter is going low by hour four without a snack, consistently, right?

    That tells me she needs more fast acting insulin and less (maybe much less) Lantus. Why your endo is so determined that the heavy insulin dose he likes has to be in basal insulin instead of bolus is something I don't understand, so maybe I'm missing something, but insulin is insulin. Setting your ratios so she doesn't get enough insulin with meals and then gets too much insulin 24/7 doesn't prolong a honeymoon, it puts you in a position where you both get highs that are too high (not good for prolonging a honeymoon) and lows that are too low (not good for anything).

    Of course, your diabetes may vary, so others may say 1:30 is perfectly normal. I know we were on a ratio like that when we were honeymooning, even 1:45 sometimes.

    What's the lowest lows you're seeing? Would she go to 40 if you didn't feed, or rest at 80 for hours (which would be more of a honeymoon thing, although I think with us we would see her own beta cells bringing her down to 70 overnight but Lantus would continue the drop, it was frustrating).
     
  10. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    Last night she seemed to hold steady, although I have no way of knowing for sure what happened in between my checks. During the day if she is not on a rapid drop she feels weird around 70 so we've been treating then. 60s to 70s we tend to catch because of our testing frequency and feel, not sure if they'd go lower. Sometimes DD feels weird and tests at 80+ and says she can swear shes low...not sure if she's coming up from a low then. Do I think she'd go lower? Yes, absolutely.
     
  11. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    I will say all bets are off during a honeymoon, I do remember some rough times when you lower the insulin to avoid lows, lower and lower and lower and then suddenly you have to raise it and raise it and raise it. It's like when you get into a nice place suddenly those beta cells raise their heads and add their part, and you go low. and then you reduce insulin and depend on them more and the immune system says, "I seeeeeeeeee youuuuuuuu" and they get knocked down again and suddenly your kid is high. :cool: Ugh all over.

    Hoping you get other good answers here, but I really think the Lantus is too high. What does your endo base the dosage on, just weight? Ratio of basal to bolus? I am making assumptions there that may be very not accurate, but I do think a lot of medical folks go "by the book" and I don't know if I've ever seen anyone here who's diabetes has read all the books and followed all the rules. :p I've stuck "Think Like a Pancreas" in front of Selah's belly button but it doesn't seem to work. . . :p

    I've been very burned by a few medical guys and very lifesavinglykissthemfullonthemouth helped by not a few doctors and nurses, so I tend to easily say gut beats doctors orders when you're talking about good evidence of imminent deep lows and the doctor is disregarding it. But the more advice you get here the better prepared you'll be to evaluate.

    In other words, this is my best advice but only you can decide how useful it is for your situation, of course. Wish I could help more. :cwds:
     
  12. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    Thank you so much, again. I don't really know what they base out dosages on. When we were at the hospital they had a starting number and until I started changing the Lantus it never really got adjusted. Only the I:C ratios were being adjusted. I don't have another appointment until late June, but I will make sure this is one of the questions I ask.

    Thank you :)
     
  13. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    On those CGM charts, I see she doesn't go under 70 hardly ever.

    Is that just the natural ebb and flow with food and insulin, or are you correcting when she's high and treating when she's low?

    If you were treating every time she approached 70, does the doctor know that? Or does he think her body just maintained her above 70 all the time?

    See, I get trying to preserve beta cell function. But if you're driving a diabetic low with too much insulin, she is using her alpha cells to keep her blood sugar up, right? I don't know how wise it is to tax them overly, if you're looking at the long term. But, then whadda I know.

    Mostly bumping the thread up the list here so folks will see this today and give you their opinions!
     
  14. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    We are treating them when they hit 70s unless we don't catch them. Here's what our log sheet looks like (we sent these to doc along with the returned sensor, so he is aware how we manage the numbers....and when he was on the phone with me he was reviewing the logs so he's seen them)

    [​IMG]

    If you can't get that to come up big, here's the link:
    http://smg.photobucket.com/albums/v125/mum2003_second/cwd/?action=view&current=__________abcd.jpg


    ETA: We don't really see highs (as rebounds from lows)...when we see them with food we correct after 3 hours.
     
  15. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    It's an entirely different way of approaching diabetes, even when we were honeymooning we'd never have cut it that close to the mark for that extended period of time, but my kid was 18 months.

    Has your endo discussed with you the risks with lows?

    I don't know, you'll have to go with your gut here, nothing has changed in my estimation, though, it seems to me you're using too much insulin if you have to feed extra to keep her from going low when nothing else is going on. That seems pretty basic. And it seems to me that since it is not just a problem directly after meals, it's a basal problem.

    But diabetes varies quite a bit. Maybe you could cut the Lantus in half and still see the same numbers. Maybe if you don't risk a low 20 times a day then you will end the honeymoon sooner. My crystal ball is cloudy!

    I know there are members here that have similar numbers, I am inclined to think those folks 1) have kids with bodies that work differently than my kid's does and 2) are extremely diligent and sharp and have great relationships with their kids so that it's team play and all the time. So maybe this is the way to go, but since the thread started with you believing there might be an issue I'd say not to ignore that. Personally, I wouldn't rest on those numbers, I'd be concerned about deep unseen lows, particularly overnight.
     
  16. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    Thank you :) We gave it one more day at 7 lantus....and just now she tested for lunch and was 56....never felt it! So to answer yesterday's question, yes...she'd go lower. I'm gonna go to 6 units tonight (weekends we tend to get higher numbers) and by next Tuesday if they are low still to 5 units....

    I am curious if it is okay to do a different Lantus amount for weekend than for other days of the week...any ideas?

    ETA (I keep leaving something out, lol)....endo discussed what a low is...on passing while still at the hospital. He does not seem worried about lows right now. As a matter of fact, the nurse had us treat if under 140 at night, and if under 150 for exercise. Doc changed that to 100 at night and 120 for exercise and said the 120 should last her unless she feels low (but as you can see from the exercise numbers 120 won't hold at all....she is carbing constanty for exercise)
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice