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Frustrated with recent numbers

Discussion in 'Parents of Children with Type 1' started by JNBryant, Mar 27, 2013.

  1. JNBryant

    JNBryant Approved members

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    I posted a few days ago about DS having strep and dealing with his recent numbers. At this stage in the game, he's been on amoxicillin since this past Friday, and his numbers have spiraled completely out of control. I called his endo this morning, and she strongly advised against changing I:C ratios or his basal and told me to just correct when necessary. The only issue I have with that is that's exactly what we've been doing and it's not working. I'm not sure if the antibiotic is what's causing the issues with his numbers, or if it's the strep, but we're regularly seeing numbers anywhere between 250 and 410. Against the endo's wishes, today I increased his Lantus from 4u to 4.5 to help battle overnight numbers, and I reduced his breakfast I:C ratio from 1:30 all the way down to 1:20. I checked at the three hour mark and he was sitting at 350 even :eek:. I gave a 1u correction along with fluids to help flush out the excess sugar, and even went so far as to replace both vials of insulin with new ones just in case.

    I've been checking for ketones regularly seeing as though his numbers have been high for quite some time, and thankfully there haven't been any. I'm just so frustrated right now because it seems that nothing I'm doing regarding giving extra insulin seems to be working. I was up with him all night last night giving corrections. Before he went to bed he was 270. I gave him .5u as a correction which typically brings him down about 100 points. I checked two hours later and he had only dropped to 250. After two more 1u corrections over the span of several hours and constant glucose checks, I was finally able to get him down around 180. I continued checking him each hour after that just to see what was happening, and his glucose just kept rising, resulting in a 260 when he woke up this morning.

    I know that insulin resistance while sick is a fairly common issue, but my son is absolutely miserable and I can't blame him. Is this something I just have to ride out until the 10 days of antibiotics finish this coming Sunday, or is there a better way to go about this? Any suggestions or advice would be incredibly helpful right now!
     
  2. Christopher

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    I know those correction ratios have worked in the past, but if it were me I would be increasing the amount of insulin given for a correction. So instead of giving two or three 1 unit corrections, I would give one 2 or 3 unit correction. Obviously, you are going to want to check his bg more frequently.

    I think you were right to try and change his basal and bolus. Now that you see it is not really bringing his numbers down, you could change it even more. It all depends on your comfort level making changes.

    Hope he feels better soon.
     
  3. JNBryant

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    Thanks. I started out with a half unit correction to see what would happen because I was afraid that if I gave too much at once, he'd drop too quickly and then we'd be battling lows. I always tend to start out small and then increase as needed. Lunch has gone well so far. I gave him that 1u correction around 11am for the 350 reading, and then at 12pm he had his lunch. I checked his bs before he ate and he was down to 168, so I decided to wait until after he ate to give him his bolus for the carbs he was eating. I took into account the IOB from the correction because it did bring him down fairly quickly this time, and it'll still be working in his system for at least the next two hours. I just checked him a few minutes ago and he's sitting at 145, so I just have to keep an eye on him to make sure that I didn't miscalculate.
     
  4. Jaredsmom

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    Jared used to get either strep or sinus infection on a pretty regular basis. Every time he gets sick it really screws with his BG high usually and low if it's anything stomach related. We adjusted dosages as needed and just tested a lot more often. Like hourly at times. Boy sure wish we had a Dexcom back then. They seem to get insulin resistant when they are sick. Your normal corrections aren't going to work we topically found when Jared is ill he needs about 25% more insulin. But you have to be carefull particullarly at night that once the illness goes away there insulin needs will decrease abruptly this is probably why you endo told you not to increase lantus or bolus ratio. We avoided this by having Jared sleep with us so we could do hourly testing. Now he has a Dexcom and we only test once around 130 am overnight.
     
  5. shannong

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    After a winter of much sickness with my DS, I am much quicker to change basal levels. Honestly, I never found I could get any control over his numbers unless I increased his basal by at least 20%. Sometimes after the illness was over, he would need a decrease in basal - but other times he would continue on the higher dose (partly because I think he continues to come out of the honeymoon phase). If I relied only on using corrections with rapid while he was sick, I think I would have been injecting him every hour. Trust yourself.
     

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