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Help with enless highs

Discussion in 'Parents of Children with Type 1' started by Just Jen, Feb 6, 2016.

  1. Just Jen

    Just Jen Approved members

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    So for the past month we've been having many issues. But the bottom line is that I cannot get Molly in normal range for anything. I've been running increasingly higher temp boluses all the time hoping that something will stabilize her. We've run 250% for the past 56 hours and I can't get her lower than 250. I have suspected that her little butt (the only place she will let me put a site) has shut down even though we have a pretty steady rotation worked out. So after much pleading, she let me try a thigh site on Wednesday. But despite taping everything down, she went through four sites in 48 hours as it kept ripping out, so I put another butt site in yesterday. Considering we only get ten sites a month, that's a big problem. I'm beyond frustrated. On Monday I will see if I can switch our sites from insets to inset 30s but what else can I try? Here is her current set up, but keep in mind we've been running this plus a 250% temp bolus with no results:
    Start Rate
    00:00:00 0.275
    03:00:00 0.2
    07:30:00 0.275
    10:00:00 0.225
    14:00:00 0.25
    20:00:00 0.275

    Any suggestions I can try? Can't get a hold of the clinic and don't want to wait until Monday. She isn't coming down with anything - I've been waiting for that since the issues started but so far she is healthy but feels like crap from being high.
     
  2. Sarah Maddie's Mom

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    I'd probably try having a super low carb day, do whatever is necessary to get her into range via increased basal and correction and then try an across the board basal increase of 25% and watch like a hawk for lows. If she's in a period of stuck highs, just increasing the basal won't do much. We have found you just have to blast that stuck pattern high, sometime with an injection, and keeping carbs out of the picture for a day or even 12 hrs before you can see clearly the new basal needs. She's 9? and D for almost 2 years? those are to my eye, pretty small basal amounts for a likely non-honeymooning, pre-pubescent kid so I think that's why she's stuck high.

    Good luck!
     
  3. jenm999

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    Can you try a new vial of insulin? Sounds like you did everything else I would have done.

    Could also be that she's getting sick or going through a crazy growth spurt?

    Do you have another BG meter you can use to make sure that it isn't a factor?
     
  4. mmgirls

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    Have you changed the ratio and correction factor? do the sites look ok? is the cannula clogged? what insulin are you using? This is on the t:slim?
     
  5. BrendaK

    BrendaK Neonatal Diabetes Registry

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    I would try a correction via a syringe (assuming you know the insulin is good). If that works then it's a site or pump issue. If not you know you just have to keep upping the insulin. In the past with stubborn highs I've increased bolus, basal, and correction factors all at once.
     
  6. Bigbluefrog

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    I agree with Sarah's mom, try a low carb day and push the water. It is amazing how dehydrated the kids get.

    I remember my daughter having crazy highs during her growth spurts. The growth hormone can impact those blood sugars. I had her eat pretty much clean, no carbohydrates

    Simple meals for a day. Ex. Chicken lean and veggies steamed.

    Your getting good advice, extra bg checks with an increase insulin basal and corrections.

    Good luck!
     
  7. Michelle'sMom

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    If you still see the highs after trying everything suggested here, you might consider giving a correction & running a reduced temp basal, maybe a 10% reduction.
     
  8. quiltinmom

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    Those basal rates look pretty low to me, too. Raising basal and I:ratios, in our experience, usually happen together if it's a big change in insulin needs, so if basal rate raising isn't working, change your ratios too, and see if that helps. What are her ratios?

    Sorry you're having trouble! Fwiw, thigh sites get ripped out most often for us because of getting caught on pants. Arm sites rarely get pulled out. Maybe you can get her to try that? Also, steel sets (contact detach) are a good option if you are getting bad sites a lot. That's the only one we use on stomach because we had problems with cannula there.
     
  9. wilf

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    What's her TDD (total daily dosage of all insulin from basal, boluses and corrections)?
     
  10. Lakeman

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    250% basal seems pretty high except that even 250% of a number that is pretty small to begin with will still be relatively small. I agree with Maddies Mom that sometimes we just have to blast it. We get times once or a couple times a month where our daughter just needs tons of insulin to get down. The thing is that once they have run high for a while they are insulin insensitive so we gotta get past that. Turmeric helps to get us more sensitive to insulin. It would concern me to rely only on pump sites for all her insulin so hopefully you are doing some injections too. All that being said it is very very necessary to have a well calibrated CGM and do frequent tests when one blasts it. Watch it like a hawk when she and you are awake is best. Yes, dehydration is something I have been wondering about myself as a factor in these periodic stuck highs. When we have once of these once we have identified it and confirmed that the insulin and the delivery route are good and that there are no ketones then it is just a matter of giving more and more insulin until it is enough. She needs what she needs - but if at any time you get worried that something is wrong then call the endo. They have ways of getting highs down that we can't do and can tell you when too much insulin is crazy.
     
  11. dpr

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    Exactly what Sarah and Lakeman said. Bump the basal with a normal correction. If it doesn't start working in 2-3 hours try a big correction and see what happens. It's just bump it up and try and try again until it works. Keep notes to fall back on. The second year was the toughest for us. A CGM is a HUGE help at this point.

    I just saw you do have a Dex. Don't be afraid to be pretty aggressive, just pay attention to the CGM. Some times when you finally "break through" the high you'll run low. Frequently for us it takes a very large correction to get out of the high cycle.

    My daughter has had basal rates triple at certain times of the day over a week period and sometimes has highs that need 3-4 times a normal correction to get her back down. It's scary as hell at first but it becomes old hat after a while.
     
    Last edited: Feb 8, 2016
  12. Just Jen

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    Thanks for all the suggestions! We are making progress. She has finally been under 300 for 24 hours, and under 200 for most of those 24 hours. She finally is feeling better as well, which makes her less "resistant" to trying some of the suggestions. (To put it nicely.)

    Our endo is going to send us some samples for some other types of sites to try to find one that works better for her. We also learned that our Dex transmitter, despite only having been in use 4 months, was having issues and had to get that switched out.

    I have a chart I made to increase her basal rates to find what works for the long term, but am working with our CDE to look into changing I:C and ISF at this point as well. That's the part I really do not have a clue on with her.

    Of course, all this has to happen at the worst possible time: other kids having their own issues requiring time and attention, other things in the house breaking down, and other responsibilities that cannot be gotten out of. Isn't that the way it goes?! As much as this disease stinks I am grateful to be dealing with it now rather than twenty years ago.
     

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