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Corrections that don't do anything

Discussion in 'Parents of Children with Type 1' started by quiltinmom, Apr 12, 2016.

  1. quiltinmom

    quiltinmom Approved members

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    So I'm pretty sure I'm not the only one who has experienced highs that won't budge no matter how much insulin we throw at it. It seems like it happens mostly at night. Some nights he is steady at 100-120 ish. Other nights he sits at 350 and won't come down despite several (at least 3-4) corrections. I haven't established a pattern really, although it seems to be worse of he goes to bed high, and not so much if he's in range at bed time. But not always. It isn't consistent enough that we can change his basal to compensate.

    It seems that by the time we know it's a stubborn high it's too late to be more aggressive (if that makes any sense). He will override the pump suggestion and increase a correction sometimes, but it's kinda scary to do that, especially at night.

    Is it one of those things we just have to ride out (I assume it's teenager hormone-caused), hoping it will stop eventually? How do you decide if it's safe to give aggressive corrections? He would need double, or even triple, corrections some nights.

    Any suggestions on how to handle this?

    Thanks in advance. :)
     
  2. andiej

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    Oh you aren't alone believe me. We recently changed our correction factor at night and i don't know if it's that that worked or lack of recent growth spurts overnight but it's working right now, though no idea for how long. I tend to think they don't do anything if it's a hormonal rise so without the correction would have risen further. Though I have had to now set it up with different correction factors pre midnight and after midnight as he's super sensitive to insulin pre midnight and almost resistant after.
     
  3. msschiel

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    We had one of these the other night, and I can't remember what food we had, so not sure if it was food related. If he is running high with corrections, then I usually set his temp basal to between 130 and 150 and just watch dex (when it is working properly). Even then we don't see results until 2-3 hours later.
     
  4. Lakeman

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    Yes we get these. I would suppose that there are a few categories some of which are: the high that once you correct becomes a low, the high that responds right away, the high that requires more than one correction, and the high that requires many corrections (usually by the time you get it under control it is morning).

    And yes you don't generally know which you are dealing with until after the fact. When I do start to get an inkling that it will not be an easy to correct high I correct and set a temp rate of 200% and watch the numbers carefully. If the correction does not work then the 200% basal will help sooner or later. If the 200% is not needed then I turn it off when numbers are in better range. If I see numbers going too low then I set a temp rate of zero to make up for the extra insulin that has been given. Looking at the IOB is helpful in figuring out how long the zero rate should be set for. It is not perfect but it is better than doing three or four ineffective corrections.

    A super bolus should work faster (and with a limited amount of insulin) but it is really a one time thing whereas with the 200% temp rate it keeps going until you decide it has been long enough.
     
  5. dpr

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    I do it pretty much like Lakeman. Temp basal is your friend. If I don't see Dex flatten or start to drop in 45min-1 hour I'll go for a super large bolus. Double and triple sized corrections take some getting used to but after a while it becomes old hat. Just try it and keep notes on what works and what is too much. For us at 180-200 double down I got to 50% basal for 30 min with 20 grams of carb and 9 time out of 10 she levels off between 100-120. Your results may vary:smile:
     
  6. susanlindstrom16

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    I can totally sympathize! For us, when she is high at night its like the first correction does almost nothing. And then when its time to do a second correction (around 3-4am), I have a hard time deciding what to do because the outcome seems to vary so much. We are starting the dexcom soon so hopefully that helps.
     
  7. Lakeman

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    The Dex helps a lot. With the dex and a pump you can give multiple corrections as often as you want without waiting hours between corrections.
     
  8. quiltinmom

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    Yes! Without dexcom I probably wouldn't even know this was happening. Lol. It's great too because I don't get up at night just to test his blood and have it be a perfect number. Meaning, I could've stayed in bed. ;)

    But it csn be a two edged sword because sometimes Ds is tired of waiting to come down (after 60-90 min) and takes another correction too soon (without consulting me) and is low later. He doesn't seem to have stubborn highs during the day unless it's caused by food he ate. At night, though, it seems completely random.
    .

    Thanks everyone for your responses. I will have him try a more aggressive temp basal next time. That's something we haven't experimented with as much at night.

    We saw the endo today, a1c is 6.7 (up .1 from last time) so not too shabby. :). So at least these crazy nights aren't affecting his a1c much. He also suggested some tweaks to his basal profile. I'm hoping that will help some, too.
     

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