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Hitting lows...is this the "honeymoon"?

Discussion in 'Parents of Children with Type 1' started by Sassy, Dec 29, 2011.

  1. Sassy

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    My son currently is on 1 unit of Novolog to every 20 carbs and gets 12 units of Lantis at bedtime. The lantis has been dropped a couple times due to him hitting some unusual lows lately. 88 in the morning, 104 at lunch, 73 at dinner, 150 at bedtime then 69 at 2am. This seems to be the norm for the last couple days. I'm also giving him about 30 carbs before bed because I know he's going to hit a low. We're supposed to call the clinic tonight, but I'm just thinking we may need to make the ratio between novolog and carbs a little higher to cover those lows (like doing 1 unit for every 30 carbs). I am still all new to this (only 3 weeks in) so I don't feel comfortable enough making those calls.

    Is this what the honeymoon phase is?
     
  2. Amy C.

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    That is correct. The pancreas recovers a bit and makes some insulin, so the need for injected insulin is less.

    Your endo should be working closely with you to make changes quickly so that you don't need to feed the insulin.

    He will probably recommend that the Lantus needs to come down more -- that is the only way to prevent the night time low without excessive feeding.

    I don't know what your son's range is, but other than the 69, I would be pleased as punch with these near normal readings.
     
  3. mysweetwill

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    My son began honeymooning three week in also (diagnosed in November). His lantus is down to 2 now, we began at 10, his carb ratio is 25 now, we began at 15 ( on active days it's actually 50).
    With each change in insulin, he is stable in the 90-140 range and then we start to see some random lows, leading to more regular lows which leads to another change in insulin. I recognize that his numbers are great in a lot of ways, but the anticipation of lows is frightening, especially since he drops quick when active. On a recent active day he only had 4 units of novo log all day and we still had to correct a low or two.
    I wish there was a way we could know the level that his pancreas is functioning and be able to predict how long its functioning will last. I've never been good with "unknowns" but thankfully as we get to know how our son's body reacts to foods and exercise, we are seeing trends and recognizing when his insulin needs are changing. It's a tough journey, I'm thankful for the help of those ahead of the curve here to guide us a bit!
     
  4. MamaBear

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    Yes I'd agree it's the honeymoon. And it does sound like the Lantus needs to be lowered. If BG is dropping by more than 30 mg between bedtime and wakeup, the basal insulin dose needs to be changed.
     
  5. Sassy

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    On his lantus, his BG was dropping by almost half at the 5 hour mark (from 9pm to 2am). He was 149 and dropped to 69. I even gave him a 30 carb snack before bed to anticipate the low. I'm so glad I did that because he dropped to a 69.

    Just spoke with the endo office, they want me to drop his Lantus from 12 to 10 (we started at 14 when he was first diagnosed). It seems to me his Novolog needs to be adjusted somewhat too, but hopefully they'll come up with a good "recipe" when we go in for part 2 of bootcamp on Tuesday! :)
     
  6. MamaBear

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    Just know that the recipe will change again, and then again, and just when by golly you've dot it down... again. ;) Eventually you will learn to change the doses all on your own without waiting for your endo/CDE to tell you what to do. Hang in there.
     
  7. Sassy

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    I've changed his Novolog from 1:20 ratio to 1:30 and he is still low today. His BG was 67 before lunch. *frustrated* He's eating ramen noodles, 52 carbs, now. I might just do 1.5 units of novolog and see if that will keep him from going low between now and dinner with a snack in between.

    Last night before bed he was 129. I gave him his 10 units of Lantus and then gave him about 40 carbs to anticipate the low during the night. At 2am he was 160 and then at wakeup he was 119...awesome numbers! Endo wants him between 80-180. I managed to keep him between those numbers. I'm learning!!! :)

    Just when you get the hang of things it changes all over again. LOL
     
  8. MamaBear

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    Hmm still sounds to me like you need to lower the Lantus a bit. Seems like a lot of carbs to keep from dropping overnight.
     
  9. Peanut6

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    My son is 7 and was diagnosed on Halloween this year he has had some crazy numbers too we started with 10 lantus and 1;15 ratio few days ago they took away lantus and we are on 1/2:45 and he was still having lows so now they flipped him they put him back on lantus and took away the Novalog he gets 1/2 unit of lantus at night and no shots all day does anyone know how normal this is for the honeymoon period we are happy for a break but I do worry when he starts to climb back up that he will feel like he is learning and starting this dease all over again Hang in there believe me I know it is hard but eventually you will get it worked out
     
  10. jbmom1b2g

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    We were told it was a possibility for Taylor to go off insulin in her honeymoom phase but we never hit that mark.
     
  11. AnjelTeacher

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    We've been using 10 Lantus since Thursday and it still isn't making much of a difference. I have been doing the 1:30 ratio also for the Novolog over the weekend because we were told nobody would be available at the clinic because of the holiday. But he is still low overnight even when we boost his carbs before bed. He is dropping a lot overnight and it worries us so much. Hopefully tomorrow there are some answers.
     
  12. MamaBear

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    The next step I would make would be to drop Lantus to 8 units and test test test.
     
  13. Mommy For Life

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    MamaBear is right...the lantus is dragging him down. You are essentiaily feeding the lantus in the day. I hope you find the right dose soon. We were giving 8 units when we left hospital now it is .5 for lantus and 1:50 on novolog.
     
  14. Sassy

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    We've dropped him down to 9 and that seems to be working better, but he's still hitting just a couple of lows during the day. The endo office asked us to wait 48-72 hours before dropping again. If he hits another low today (day 3 of 9 units) then we'll drop him down to 8 and see if that helps. I think 8 is going to be our magic number (at least for now...lol). Puberty is going to hit very soon and then we'll be back fighting for another recipe that works...LOL Hang on Candi...this is gonna be a wild ride!! haha
     
  15. AnjelTeacher

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    Yeah the dropping him down to 8 seems to have done the trick for now. Were still checking overnight but his numbers are much better. Were doing his novolog at 1:30 so I think we hit a good balance, for this week at least. LOL.

    Puberty, aaaggghhhh so not looking forward to that!!!!!!!!!!!!!!
     
  16. wilf

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    Folks if you're giving Lantus in the evening and seeing overnight lows, then it's worth considering switching the Lantus to the morning. Lantus has a peak which causes drops in blood sugars which can lead to lows in many children. If you give it in the evening, the drops in blood sugars and possible lows come overnight. If you give it in the morning, the drops in blood sugars come during the day and with some planning can simply be used to help cover a meal or snack. It's your choice. :cwds:
     
  17. mistyz

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    Yes, it does sound like it. My son is still in the honeymoon and is currently on 3 units of lantus at night (we started at 7.5)...and I think I may lower it tonight or tomorrow because he has been waking up under 100 lately.
    And is on a 1:40 carb ratio...sometimes 1:60.
    It's tough to figure things out and I still don't like making a lot of changes on my own.
     
  18. MommaKat

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    While I completely hear, have experienced, and agree with this, our endo does not, and neither does the mfr. of lantus. They state that it's rare for a child to have a peak with lantus, but they got so bad for us. We reduced, moved it to the am, tried a split dose schedule - none of it works completely. She still has lows about 2:30 to 3:00am several mornings. I'm now convinced that it's both a peak action from lantus between hour 5 and hour 6, and her honeymoon working on top of that -even though the honeymoon effect is starting to lessen and her daytime insulin needs increased. We got so frustrated with it that we asked to switch long acting insulins, but instead, it looks like we're headed toward a pump. (Dd's decision, so long as insurance stops dragging its feet. They will cover eventually, but want us to wait 3 months. I simply cannot - I need more sleep, lol.)

    Between now and when a pump happens, the best result we've gotten in avoiding the overnight lows is giving 60% of the reduced lantus dose at 7 am, changing her I:C at meals (from 1:20 to 1:22 or there about), giving 40% of the lantus dose at 7pm, and providing a bedtime snack of 15 to 20g for anything at or below 150. Even so, I'm still catching 2 or 3 overnight lows a week around that 2:30 / 3:00 am mark. It's better than several every night!!
     
  19. Sassy

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    One question I asked our endo is "does lantus have a peak time" and they replied with "no". It's a straight line insulin according to our endo. Weird how some endos have different theories on this.

    Anyway, we switched to 8 and are doing 1:30 and it seems to keep him stable. :)
     
  20. MomofSweetOne

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    We were told it does have a peak and that they prefer to start newly diagnosed kids on a morning dose to keep them safer at night. When we saw my daughter's pattern of going higher at night, then we switched it to bedtime, and it helped her morning numbers. Interesting that not all endos believe in the peak.
     

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