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Increase Lantus again?

Discussion in 'Parents of Children with Type 1' started by MyPumpkin, Jul 15, 2013.

  1. MyPumpkin

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    I sent in our numbers to our doctor today and they want to increase my son's Lantus again. I am feeling a bit nervous about the increase and wanted to see what others opinions are. My DS has hit puberty and for the last couple months we have been struggling with his numbers. At the end of June his A1C was 8.4, up from the previous visit of 7.5.
    Around the middle of May his Lantus was 21 units. We have been steadily increasing it and we are currently at 26 units. Which to me seems like a lot. After sending in our last week of numbers they want to increase his lantus to 28 units. I thought his numbers where looking pretty good compared to where they have been.
    The reason they want to increase his Lantus is because he has had some night time numbers in the 200s. However he has also had some night time numbers in the 100s. I was wondering what your guys take is on his numbers. Would you feel comfortable increasing his Lantus to 28? I want him to be in range but I am also so afraid that all these changes are going to make him crash really low. I really felt like I had all this stuff down pretty good... then puberty hit!:rolleyes:

    Today
    5:00pm - 126 blood sugar
    3:20pm - 81
    11:00am - 179
    9:00am - 182
    3:00am - 216
    12:00am - 172

    Sunday 7/14
    10:00pm - 142
    9:00pm - 118
    6:00pm - 219
    3:00pm - 244
    11:00am - 171
    8:45 am - 135
    2:40am - 136

    Sat 7/13
    11:00pm - 111
    9:00pm - 145
    5:00pm - 162
    2:00pm - 97
    11:30am - 208
    8:45am - 113
    2:00am - 158

    Fri 7/12
    10:00pm - 192
    8:30pm - 277
    4:00pm - 88
    12:00pm - 198
    7:30am - 363
    3:00am - 283
    12:00am - 206

    Thur 7/11
    10:00pm - 166
    9:00pm - 175
    5:00pm - 86
    12:00pm- 161
    9:00am - 189
    3:00am - 257

    Wed 7/10
    11:00pm - 187
    9:00pm - 281
    6:00pm - 251
    5:00 pm - 83
    1:00 pm - 165
    9:00am - 223
    3:00am - 176
    12:00am - 218

    I know that's a lot of numbers! :cwds: Thanks for any input you may have. Oh also his ratios are 8:1 for everything except night time snack which is 12:1. They also want to lower his ratio for breakfast to 7:1.
     
  2. Amy C.

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    He is having more than a few random highs. Get those numbers in range and adjust the ratio for the meals to counter the less insulin needed.

    At an 8.4 A1c, you don't need to worry about lows so much.

    Don't be afraid to give more insulin. Your son certainly can't produce it himself and needs the right amount as an injection.

    I would raise the Lantus and when that isn't enough, change the ratio.
     
  3. Ti'sMom

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    Have they ever mentioned splitting his dose? When Tristan was on lantus and had some higher numbers the dr suggested a 50/50 split. Half at night, half in the a.m. Worked like a charm without increasing elsewhere.
     
  4. MyPumpkin

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    The doctor said the same thing at our last visit about not worrying so much about lows with his numbers being so high. :eek: We have just had so much changes in both his carb ratios and lantus over the last 2 months its just been a bit overwhelming.
     
  5. MyPumpkin

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    I will have to ask our doctor about that possibility. Thanks for the suggestion. :)
     
  6. MomofSweetOne

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    It looks as if he needs more basal, but it's hard to tell exactly what is happening without information about if you gave correction doses or not. On Friday, if he was at 206 at 12, 283 at 3 a.m., and 363 in the morning, he definitely needs a very significant increase in basal but other nights he dropped by 2 a.m. He may need more just during the night, too. That's why we switched to the pump was to have the ability to have different basal levels. It made a huge difference in how my daughter felt/feels.

    I don't know how puberty hits boys vs. girls in diabetes management, but we adjust basals constantly around here. Today I was out for the afternoon. My daughter was napping, and the CGM alerted my husband her BG had climbed by 70. He called me, and I was able to walk him through increasing her basal while she slept on. If at all possible, I would recommend getting one.

    Have you read Think Like A Pancreas? It gives great instructions on how to know if basal, bolus, etc. are correctly calculated for your child. If you follow it, you'll have his doses better figured than your endo ever could because you'll know when to disregard numbers as irregular because of guessed carb counts, exercise, etc. etc.
     
  7. nanhsot

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    He consistently wakes high every morning, except for Saturday/Sunday, so that to me indicates that yes, he needs more lantus. We've never had to do this but I know some people have a different basal for weekends, particularly if they are involved in sports and such. Or you might give a small snack on weekends before bed if there has been a lot of physical activity (or was it just a fluke that Sat/Sun had lower numbers, it's not like diabetes makes sense!!).

    He's only low or near low at and around 3-5pm (and he's actually perfect at that time, not low at all), which is a time he is awake and you are able to keep an eye on things.

    My son took 26 units at age 15 (when he was diagnosed) if that makes you feel any better! He takes 37 now, or thereabouts, it varies because he's pumping and can alter it by need more easily.

    The problem with teens is that they release a lot of hormones at 2ish a.m. and it's hard to combat that. As someone else mentioned you might consider splitting the dose to see if that helps.
     
  8. MyPumpkin

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    We always correct for a high if it has been 3 hours but not in the middle of the night unless he is in the 300s (that's what the doctor had told us to do). I really want to get our son a pump but with the insurance we have, we have to meet a $7500 deductible first. So as of right now the pump is not something we are financially able to do. I am definitely going to ask about splitting the lantus as it seems that may help.

    I feel a lot better about uping the Lantus amount. I was just feeling nervous and I needed other minds but mine right now! :p
     
  9. missmakaliasmomma

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    I understand not correcting until a certain amount because that's what the dr told you to do but to be even 275 with no correction for a few hours is not good either and that's attributing to his high a1c values. When my daughter was on lantus, we had to let her be in the low 200s because her lantus would peak in the early morning and she would wake up with good numbers (this is why we went on the pump). However, if she was higher than that, I wouldn't feel right about not correcting it. I would correct it and monitor closely.

    This is one case where I don't think the dr is always right.
     
  10. Helenmomofsporty13yearold

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    I think you are 100% right to be nervous. I only see 1 night (July 12) where his BG went up through the night. For the most part they stayed where they started or dropped, so the Lantus did its job. I would correct to your target BG before bed and then see if the Lantus keeps him there as it should.

    I think your carb ratios may be off. DD's is 1-6 or 1-8 for breakfast, then 1-10 the rest of the day. We used to use 1-12 for bedtime, but it does not seem to be enough anymore. His lunch ratio may be causing those afternoon drops (and maybe some activity?).

    What time of day does he take his Lantus?
     
  11. MyPumpkin

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    He takes his Lantus at 9pm, so about an hour and a half ago. I did give him the 28 units. I pulled the mattress from the spare room and I'm going to be sleeping next to him on the floor. I really just have a gut nervousness about this change. Hopefully it will work out good but I am right next to him just in case. I was thinking maybe the nighttime ratio was off also. He usually has a snack at night so maybe that is causing those higher nighttime numbers.

    Thanks again for everyone's input. It helps to hear other peoples points of view. Sometimes your looking at something so hard that it makes things hard to see (if that makes any sense!). ;)
     
  12. mmgirls

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    Can you let us know when you corrected his bg?

    And also, let us know the ratio and how you correct?
     
  13. MomofSweetOne

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    I'm surprised your doctor says not to correct until 300. We were never given such high correction numbers, even at diagnosis. My daughter wouldn't be able to function the next day if she'd spent the night in such high numbers.
     
  14. nanhsot

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    Does he have an uncovered snack at bedtime? This is pretty essential information to add to the mix. I don't understand the concept at all of uncovered snacks, except in cases of high activity days, not as a regular thing/daily. When you give an uncovered snack you are basically feeding insulin, vs giving insulin for needed food. Does that make sense?

    I know you already made the change, how did it go? I would seriously consider eliminating the night snack so you can see what's truly happening with his lantus. If you do that you might go back on the lantus to the 26 though.

    I'd also have a conversation with your MD about being a little more aggressive with corrections, not correcting until 300 is something they recommend with very small children and new diagnosis, I'd think they'd want to start being a little more refined now.

    How did his night go?
     
  15. MyPumpkin

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    His correction for night time snacks is 12:1. And our correction factor is
    BS - 120/ 30 for the day and BS - 150/30 at night. I always correct him when he is awake and have corrected him at night if sleeping also. It was just at our last visit that the doctor said if he is over 300 between midnight and 5am correct otherwise do not. ?? We very rarely ever see a 300 anyways at night.

    So last night he did not go low at all, like I was worried.:eek:
    At 9pm he was 248. His BS correction was 3.26 plus he had a 26 carb snack so we had a correction of 2.16. We gave him a total of 5.5 units.

    We went to bed at 11pm. Checked before bed was 205. We did not correct because it had not been long enough. I woke up at 1am and he was 169. Then at 3:20 he was 224. I thought about correcting because of the advise you all have given me but I decided not to because I wanted to see what the Lantus was going to do. This morning he woke up at 226 (8am). :(

    So I have decided to correct at night if he is above range and just watch him closely. And I was also thinking maybe I should drop his night time snack (if he has one) to 10:1.
     
  16. mmgirls

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    what is the dinner ratio?
     
  17. MyPumpkin

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    His dinner ratio is 8:1

    His BS was 126 at 5:20. He had 84 carbs so 10.5 units for dinner. We did have hot dogs for dinner and even though I get the lower fat ones they still tend to make him go high.
    Its like trying to crack a code! :p Things have really gotten crazy BS wise over the last couple months. I'm thinking that he is out of his honeymoon now and he is hitting puberty.
     
  18. hawkeyegirl

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    I find it impossibly hard to figure things out at night when a night snack is thrown in there. It will make it much easier to get the Lantus sorted if you skip the night snack for a few nights, or just give something that doesn't require insulin.
     
  19. mmgirls

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    I agree, especially when the snack ratio is vastly different from the dinner ratio. Skip the snack and try to have lower fat meals while you get lantus squared away.

    I would give the newest dose a good 3 days and personally I would not correct at night while figuring out the Lantus. For me it is better to see if there is a drop or rise or if steady.
     
  20. MyPumpkin

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    I think the change to the Lantus is finally working. The first couple days it didn't seem as if much had changed. We were still seeing quite a few 200s. But last night and today have been really good number for us.
    The highest we have had was 170 and that was at 4am.

    He was 137 at 2am
    170 at 4am
    92 at 8:40am
    92 at 10am
    157 at 12:30pm
    96 at 5pm

    Its nice to see numbers more in range. I'm not really sure why he peaks higher in the early morning hours but that seems to be the trend. Then he came down quite a bit between 4am and 8:40.
    I'm sure we will be changing everything again soon (nothing seems to stay the same for too long!) but for now I will enjoy the in range numbers and hope they continue! :cwds:

    Again Thanks everyone for helping me with his numbers. I really appreciate it!
     

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