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I think we're getting somewhere

Discussion in 'Parents of Children with Type 1' started by HelenaHandBasket, Jun 26, 2011.

  1. HelenaHandBasket

    HelenaHandBasket Approved members

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    He's still high, but seeming to be running stable.

    I've been giving the 3u of Lantus at 9p and checking his BG at 2a.

    The first night at bedtime he was 448. :eek: at 2a he was 302. :confused: By breakfast he was 193. So I was thinking his Lantus is still too high with that kind of overnight drop.

    He was 340 at lunch. 303 at dinner. Negative for ketones. I gave him an extra 1.5u of Novolog to cover a S'more and 2 roasted marshmellows after dinner at around 7:30p. At bedtime he was 270. At 2a he was 300. So a 30 point rise. Then this morning he was 239. A 31 point drop from his bedtime reading. So I'm *thinking* he stayed pretty stable overnight, right? Maybe the 3u of Lantus is pretty decent?

    I'm still struggling to get his numbers down into his goal range. I've tried to liberalize his diet a little and not freak out so much. He had a banana at a neighbors house yesterday afternoon before dinner and didn't tell me. He opted for the banana over the popsicle, so I know he thought he made the right choice. We had a talk and he agreed to just call me before he eats anything at anyone else's house for the time being. He's doing so well. :cwds:

    These kids are my heroes. *wub*
     
  2. Amy C.

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    It sounds like the Lantus may be correct.

    What may need to be changed is the amount used to correct a high blood sugar -- he needs more insulin to bring down the highs and perhaps the ratio used at meals.

    Are you giving extra Novalog for a high blood sugar?
     
  3. HelenaHandBasket

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    Yes. The Novolog before meals is to cover high sugars and the meal about to be eaten. Even if he was 100, I'd still give him 2.5u of Novolog to cover the meal.


    They don't have me covering him at bedtime. Just giving the Lantus at 9p. I give him a 5-10gm snack at night depending on how high he is.

    He's really hungry though (which I expect). Last night he had two scrambled eggs and two sausage patties for a snack. :eek:

    This after eating a hot dog w/bun, a turkey patty and cucumbers with dip at dinner followed by a S'more and two marshmallows!

    At 8a today he had 1.5 biscuits with sausage gravy. Is hungry again and is eating 3 ham slices. I'm going to pop some popcorn to put i baggies and will hard boil some eggs for him. He's not a cheese eater so I'm running out of no-low carb snack ideas!
     
  4. Amy C.

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    I would ask your endo about the amount of insulin you are to give to bring down the sugar -- it doesn't seem to be enough.

    If your child is hungry, have him eat more at meals, or ask your endo about giving an extra shot for carbs eaten at snacks. Eventually, this is what most folks do -- give insulin for the food eaten whenever it is eaten. You don't have to be restricted to eating carbs just at meals.

    In a few weeks, he will stop being so hungry. His body is still in starvation mode.
     
  5. HelenaHandBasket

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    Thanks Amy. That's what I'm figuring.

    Based on his consistent high 300s today I'm thinking maybe 4u of Lantus and an increase in the sliding scale might do it.

    I'll be updating the Endo tomorrow.
     
  6. bibrahim

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    It is good to call them often in the beginning for adjustments. He may need different I/C ratios at different meals and you will need to look for patterns and then do adjustments in mealtime does, correction doses, and basal insulin doses.

    Do they have a class for you to take to learn all of this? If so, it is great to take them as soon as possible, especially if you want to get a pump. We did not get ours untial 8 months in as my DD was not ready yet.

    One thing I learned ~ if they are running high, they need more insulin. It changes day to day, especially when they are honeymooning.
     
  7. Heather(CA)

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    I would leave the Lantus alone and concentrate on getting him down to normal range at the three hours after meal fastacting mark. Lantus is not for highs, it's to keep him stable and it's doing a pretty good job of that at the moment.

    For example..Lets pretend that he was 130 at bedtime instead of 270...That would have made his numbers...

    130
    160
    99

    Not too shabby now eh? :)

    If anything he needs the Lantus lowered again, not raised. The drop could be honeymoon though so I would wait to lower it after getting more info. I'm assuming the 160 is due to the snack you gave him.

    I would add fastacting (Change ratios) every couple of days until you see good 3 hour after meal numbers. Call the Endo for help if you need to:cwds:
     
  8. Heather(CA)

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    Usually but not always, sometimes they need less...:cwds:
     
  9. monkeyschool

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    I like to run mine a bit lower, but she is also older and more aware of snacks/carbs, etc she takes in so this may not apply to your situation.

    I was seeing a huge drop in overnight numbers with Lantus up to a month or so ago and kept lowering the dose. This last month it has been very steady overnight to the point where she can go to bed and wake up within 20-30 difference.

    I do not think the Lantus is high from the information you give (as referenced against what I saw in my DD)...I think it is too low, meaning may need more Lantus. But I wouldn't change it until you get your starting overnight numbers lower (they start up to high). Once Lantus kicks it it brings the number down, but only because it is starting high to begin with. My DD tends to wake up in the morning at pretty much the same number unless her nightime meal had a lot of fat/protein, then she's a bit higher. If she starts at 125 she drops to ~100, if she starts at 100 she stays at 100 with minor variation. That just seems to be the point where 5u wants to bring her...and if she starts a little lower she tends to climb up during the night. If I do 6u of lantus she wakes up around ~85 right now. ***I am a freak and have checked her every hour on the hour to see what happens with the Lantus changes, lol. I also think your Lantus may be too low because all the day's numbers seem high.

    What I try to do is get her post-dinner number once all Novalog is worn out to be around 120 so that if I see the variation I can then figure out if Lantus is starting to be off again. I haven't skipped dinner, but tried to do dinners where there isn't a large portioning of fats/proteins to test it. Then when she eats high protein/fat I feel safer correcting at night since I know to expect the climb. Sometimes if she hasn't had excess fat/protein I don't bother to correct if she is under a certain number because I expect Lantus to bring her down.

    My biggest issue is getting her to bed after Novolog has worn out..most of the time that doesn't happen til midnight so my midnight check is the key one to determine how we made out with the dinner dose before Lantus takes over.

    As everyone has suggested this is my findings only for my own child...definitealy check with your endo, and test test test if you make basal changes.

    Good luck,
    D.

    ETA: Are you checking 2 - 3 hour post meals to see how effective Novolog is? If you see 3 hour post to be in line with pre-meal for a balanced meal, concentrate on Lantus at that point. I started out by getting all the 3 hr posts to be around the starting number....then tackled Lantus.
     
    Last edited: Jun 27, 2011
  10. Christopher

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    I am probably in the minority but I disagree that the Lantus should not be changed. I think it should be increased. He is in the 300's in the middle of the night, when all the fast acting has worn off. I also think you need to do "s'more" testing ;) I think maybe the s'mores altered things a bit too much. You need a few nights of more testing with relatively little food interference.
     
    Last edited: Jun 27, 2011
  11. danismom79

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    I would leave the Lantus alone for now, and work on getting the bedtime number lower. I find that when my daughter is in range, the same amount of basal has more of an effect on her than when she's high and resistant. Are you using a pen or syringes? If you're keen on increasing the Lantus, I'd go to 3.5 units. We find highly processed foods to be problematic, and not good for testing out insulin doses.
     
  12. Heather(CA)

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    He is starting there and staying there...Lantus is not for lowering numbers. It's for keeping them stable.
     
  13. hawkeyegirl

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    I think it's impossible to tell if the Lantus dose is right at higher numbers. We find that basal needs are different at higher numbers than at in range numbers. You need to get him into range at bedtime and then do your basal testing.
     
  14. Heather(CA)

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    It could definitely need more adjusting later. But I don't adjust both insulin's at the same time and JMO but he is staying very high after meals at this point so that's where I would focus my efforts if it were my child.:cwds:
     
    Last edited: Jun 27, 2011
  15. Christopher

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    Being "stable" at 300, with no bolus insulin working, is not a good place to be in my humble opinion. I do realize Lantus is not used for lowering numbers, but it IS used for keeping the BG in range when no long acting is working. I still contend he needs more Lantus and the OP needs to do some more night time testing.
     
  16. hawkeyegirl

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    It's sort of a chicken and egg thing. I don't think you can properly basal test if the after supper number is high. Jack needs quite a bit more basal if he's running high. And if basal is inadequate, the after supper number is going to be high. :eek: (Could be the bolus too, of course.) But if she gets that bedtime number down, she can see if the Lantus is right or not, and everything will fall into place then. You can't do anything until the Lantus is right.

    Ideally, I'd do a late breakfast, a late lunch, and a no-carb supper. (So maybe an omelette and bacon or something like that.) I don't know if that's possible for this poster or not, but it would really help "see" what is going on.
     
  17. wilf

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    I'm thinking he went to bed with way too high blood sugars..

    Is part of the overnight drop from a correction, and if not then why did you not correct?

    Also, bedtime snacks should either be carb-free if he's high (say over 200) or given with a bolus.

    Good luck! :)
     
  18. Heather(CA)

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    Are we doing it again? Where we agree but are misunderstanding eachother?

    If she raises the Lantus so that it brings the sugar down over night...Then when she tries to get the after dinner number good, the Lantus will drop him. I am confident that it's the fastacting that needs the attention at this point. Then she can take another look at whether the Lantus is still keeping him stable or not. Does that make sense?
     
  19. danismom79

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    I honestly thought you two were saying the same thing (coming from someone who also said the same thing).
     
  20. Heather(CA)

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    Me too LOL :D
     

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