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Honeymoon - When do I know it's coming to an end?

Discussion in 'Parents of Children with Type 1' started by njswede, Jun 20, 2015.

  1. njswede

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    The last couple of weeks, it's been pretty much impossible to control DS' blood sugar. Wild swings with 300+ highs and lows in the 40s. We try to pre-bolus, but it's almost impossible to hit the peak, because it's so all over the place. Sounds like end of honeymoon, doesn't it? The funny thing, though, is that his total insulin dose hasn't changed in months. We tried to increase his Lantus a little to see if it could calm things down, but that resulted in nighttime lows. No bueno! Also tried to increase bolus, but it resulted in crashes a couple of hours after a meal. No bueno!

    He seems very healthy other than his D, so I don't think it's an infection. Maybe it's growth hormones, who knows? Or maybe his poor little pancreas is in some kind of death spasm.

    Either way, it's extremely frustrating to feel you're not in control.

    Any input/comments?
     
  2. wilf

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    Typically you'd see bigger swings in blood sugars, and increasing insulin needs..
     
  3. MomofSweetOne

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    My daughter's insulin needs increased dramatically about 5 months post dx. I think her needs tripled in just over a week's time. I increased her Lantus nightly by 1/2 unit until we saw better numbers. In the years I've been reading and participating on the forum, I've noticed that the 5-7 month span seems very typical for kids to go through a dramatic need for more insulin. This may be the beginning of what you're experiencing or it could be any number of effects.

    I had thought of this in reference to the vacation thread, that packing 2-3 times the normal insulin might not be enough considering the point past dx that the poster's child is.

    How carefully do you count carbs? Have you changed methods or diet? If carbs are not done carefully, the easier estimating times of early on become more problematic as the pancreas does less and less. If I remember, I think my daughter was on a 1:60 ratio at one time. There was lots of wiggle room for carb counting without it mattering too much. Now that she's on 1:8, the need for accuracy is heightened or we see swings like you describe.
     
  4. njswede

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    Well, in all honesty, there are times we estimate the carbs rather than counting. Up until a month or so ago, we did just fine doing that. I guess we became a bit complacent.
     
  5. Sarah Maddie's Mom

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    Not complacent, I mean, it worked, didn't it? But if you are seeing wild swings, I agree, it's most likely lazy blousing, not the basal. Try a few days of really carefully carb counted foods and see if that doesn't help.

    And remember, the "honeymoon" isn't an "On/Off" switch. I think it took 5 years before my kid stopped making "helper" insulin, though I'm sure at that time I would have sworn she was "out" of honeymoon.
     
  6. StacyMM

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    No honeymoon with DD. With DS, the numbers gradually became more extreme. He started going under 70 and over 200. The insulin increase was gradual but steady and at some point I realized he was over that .5u per kg mark, or whatever number that is.

    And I agree that careful calculations may be a good direction to take. As ratios get smaller and the pancreas helps out less, the difference between guessing a meal is 80 and knowing that it's actually 72 or 88 becomes more apparent.
     
  7. njswede

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    Yeah, to my untrained eye this looks like a big time bolus issue. Check out that graph below! We painstakingly counted carbs this time and bolused accordingly. 35g carbs at a 1:30 ratio comes out to 1U, so that's what he got. Notice the little plateau after the meal at around 250 mg/dL. That's when the insulin would normally have kicked in. This time, it just created a small bend on the curve. We gave an extra 1U when he reached 300+ just to break the crazy upward trend. The little plateau tells me that the insulin tried to do its job, but there was simply too much glucose to handle. Makes sense?

    I'm thinking of changing his ratios from 1:30 breakfast/1:40 other to 1:20 breakfast/1:25 other.

    bolus issue.JPG
     
  8. wilf

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    Sounds like a good adjustment on the carb ratio. :)
     
  9. jenm999

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    You might try increasing Lantus and adding an uncovered bedtime snack with a lot of protein that will really stick around all night. We did that for awhile.

    If he's dropping at night you are probably still honeymooning though as that's most likely endogenous insulin.

    I believe the medical definition is something like a half unit per kilo TDD.

    My son was 6.5 at dx and it took about a year.
     
  10. jenm999

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    Duplicate post, sorry
     
  11. BarbDwyer

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    We had a big increase in insulin at 6mos and I sort of think he is out of honeymoon because of the increased insulin needs and free foods are not free anymore. If he eats 10 carbs he goes up and stays up. On the other hand he might still be because he continues to bolus after he eats and while I'm sure the spike is significant he is back in range before the next meal with only a few exceptions. Unless we really don't know we weigh/measure/count everything.
     
  12. Theo's dad Joe

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    How much does he typically come up from those 10 grams of carbs?
     
  13. quiltinmom

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    My two best thoughts:

    1) large swings in bg don't signal end of honeymoon, necessarily. You have to figure out why it's happening, whether highs are after meals or after low corrections, or "just because."

    2) end of honeymoon is usually marked by dramatic insulin increases. ( Ours ended about 9 months post dx, or at least, that's when we noticed it, but didn't realize it until after the fact, when we realized his lantus almost doubled and his meal ratios changed a lot over the course of about 3 weeks or so.) It also doesn't mean much beyond increased insulin, in all honesty. You still test, dose, correct, balance bgs and lifestyle and try not to forget your kid is a kid, not a science experiment. Lol. :wink: highs might be a little higher, lows may be a little more stubborn, but you deal with it the same way. a lot of emphasis is put on honeymoon ending here at CWD, but it doesn't mean that much. IMO, it's one of those "nice to know" things, but it doesn't drastically change how d is managed. With so many variables, it's hard to pin something down to one specific cause. At least, that's our experience.


    PS we were always advised to make dose changes no more than 10% at a time. Those I:c ratios seem kind of steep so you might want to crunch some numbers based on how many carbs he eats before you go that drastic.....unless you arrived at those numbers based on corrections, etc.
     
  14. Theo's dad Joe

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    Can you explain the graph a little? When is breakfast?, when did he get his breakfast bolus? Also curious what he ate for that meal of 35 grams of carbs.
     
  15. sszyszkiewicz

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    I was asking similar questions about a year ago. i wanted to know "is this it?" "are the training wheels off?" "will it get worse than this?" "is this as bad as it gets?"

    Take every assist you can. If his pancreas is still spitting out a few units now and again, those will be very good days. Of course you will not know it is doing it. So just basically roll with the changes.

    One of the pieces of advice that I remember was based on how well the numbers react to pizza. If you still get good numbers after dosing for and eating pizza, there is a pancreas there helping. If your numbers stink for a day after pizza then the pancreas is not helping that much.
     
  16. BarbDwyer

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    If being very active or correcting a low he'll come up 5-25 points. If he is just sitting around at say 100 with no activity and no insulin on board it will be much higher. That is with juice which is 14. I wish I could say we kept that good of notes/logs but that would be a lie :). I'd guess more than 50. He was 70 last night at 2am and ate Cheezits before bed. I don't know how many but he's usually good about counting or weighing one serving. That is 17 carbs (probably a little more) He was 245 at 6am. Corrected and he was 101 at noon.

    However. He eats pizza and comes into range with one bolus before the next meal so...yay! Cereal is a killer. He'll stay high. He has pretty much quit eating it at midnight. Goes much better if he eats it during day before activity.
     
  17. andiej

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    Hi the honeymoon is technically defined as needing less than 0.5 units of insulin per kg of body weight. 12 months after diagnosis my son got a virus which caused highs, followed by Xmas break highs, these high's didn't come down when he returned to school in January. Before the high's he was on 12 total daily units. We had to keep increasing basal especially early hours and in the mornings and change all ratios, we were getting no lows at all. His needs within a month jumped from 12 to 34 units. Now i do believe sometimes he still gets help from his pancreas and may continue to do so for many more years but technically speaking the honeymoon is over. We don't get away with things anymore that we once did, inaccurate carb counting shows. I was really worried about the end of the honeymoon thought we would be then dealing with a different beast but essentially things haven't changed other than more insulin and having to be more on top of things. We saw his HBA1C go from 6.2 to 6.9 but that should be coming back down nicely in time for clinic...it's just a rough ride whilst you try to get on top of it again.....then wait for the next change....you know it's coming!
     

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