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Inexplicable stubborn lows today

Discussion in 'Parents of Teens' started by Helenmomofsporty13yearold, Mar 28, 2013.

  1. Helenmomofsporty13yearold

    Helenmomofsporty13yearold Approved members

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    DD has been low today for the last 3 1/2 hours. She woke up at 100 (5.5), had the "usual breakfast" and usual bolus 4 1/2 hours ago. She was in the 30's (high 1's to low 2's) for the first 1 1/2 hours and it took 180 carbs altogether to get it to 70 and keep it there. She turned off her basal 3 hours ago. She just dropped again to 62, had another 100 carbs and is currently at 90 (5).

    This happened several times at night when she was going through puberty, but this is a first to happen in the morning. She has been exercising a lot lately, but her last activity ended at 5 pm yesterday. She is showing no signs of illness. She is expecting her period in about a week.

    I think I recall Connie saying she has to shut off her pump sometimes.

    We just received the new Enlite sensors yesterday, but she has not inserted one yet, so no CGMS history.

    Hoping someone has insights to share.
     
  2. StillMamamia

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    Hi, I'm not a parent of a teen bu do have a couple of thoughts on this.

    First, test for starvation ketones. It'll just give you an idea that maybe her insulin is too high for now (just confirms what you're seeing anyway). Best thing would be to test them at awakening, before breakfast - it may she's going low overnight.

    Second, sports can affect BGs for up to 24hrs, if I recall correctly.

    For now, what I'd do is use lower temp basals and bolus conservatively until BGs go up. As for turning off the pump, we sometimes do that, but only for 1hr at a time max.

    It may just be pre-menstrual hormones doing their thing too.

    Hope this helps.
     
  3. Helenmomofsporty13yearold

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    I will check for starvation ketones tomorrow morning. She was at her Dad's last night, where overnight checks are deemed unnecessary:rolleyes:. She had a sandwich at 9pm and bolused for it. BG was 7 at midnight when she went to sleep and she reduced overnight basals by 30% for the exercise. She did everything right except a 3 am check.

    Her BG is 250 (14) now from turning off the pump for 6 hours, and I have never been so pleased to see a high number!!! Hopefully, whatever that was is over. Your suggestion to turn down the basal is also a good one. She is off to a pizza party with her team right now after sleeping for the last couple of hours. Pizza is the perfect food for a day like today. She wants to go indoor-rock climbing tonight with her friends:eek: so the reduced basals will be on-going and I will drive her crazy checking tonight. I am going to insist on a sensor tonight, also.

    She missed a biology test and her day at school, but is feeling better right on time for the socializing.
     
  4. Megnyc

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    Was the activity that ended at 5 pm last night rock climbing? That is actually very similar to swimming for me in the need to significantly reduce basals later that night.

    I have had plenty of days though where I only need a .05 or .075 basal though and never know why :confused:. Hope tonight goes better!

    Edit: Also, I'm sure you know what you are doing but I would have 4.5+ ketones after suspending my pump for 6 hours. If I feel the need to suspend it I will usually do a .05 temp basal so there is at least a tiny amount of insulin to keep ketones as low as possible as BG rises.
     
    Last edited: Mar 28, 2013
  5. Helenmomofsporty13yearold

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    The .05 per hour versus straight suspend is a great idea. We did not expect her to be off basal for so long. Luckily, she is not a big ketone producer.

    Last night's activity was rugby practice, a new sport for her. I watched the last hour of practice and she only ran the ball twice. They were listening to instructions the rest of the time. She said they were practising throwing and passing the first hour. Compared to an hour of hockey or a couple of hours of rock climbing, this looked like a stroll in the park.

    Megan, did your insulin needs drop off sharply as you grew out of puberty. DD's peak TDD was 75 units, and is currently 40-50 units depending on how many carbs she eats. I will be watching to see if we need to drop those basals again. She has had more highs than lows lately (due to sloppy carb counting), so this is all too mysterious.

    How long does the reduced basal need last when you have it?
     
  6. Megnyc

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    Yes, my insulin needs have dropped quite a bit. I went through puberty pretty late just starting around 14/15 and was at one crazy point using 90 units a day at age 16 when I got my first period. I actually used Metformin for awhile to get that down to 25 units a day. I now use around 15-20 units a day, I think the average is 18 or so. I am around 5'3 and about 40 kilograms. I am really active though (I run 5+ miles most days and ski a few times a week) so a lot of the carbs I eat are not actually bolused for so I am not sure that I am a very good reference point.

    For something like rock-climbing I would have reduced basal needs until around 8 am the next morning if it was in the afternoon. I would probably set a .075 temp basal for the night ending around 6 am.

    I can have strange reduced basal needs for up to 5 or 6 days at a time. Having a cgm really helps to figure out how to use temp basals to manage this. I do take a birth control pull continuously and have since age 16 and that really helps to maintain somewhat consistent basal needs. It doesn't sound like you need that but I thought I would put the suggestion out there so you know the option. I was already on it and my doctor had mentioned I could skip the placebo week to skip a period if I wanted and I do that probably 10 months out of the year (only time I don't is if I forget to refill it) with my doctors blessing.
     
  7. Helenmomofsporty13yearold

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    DD is chasing highs now from being disconnected for so long. Zero ketones, however. She just inserted her new Enlite sensor, but I will still test like crazy tonight while she grumps at me to get lost.
     
  8. Megnyc

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    Sorry about the highs. If it makes you feel any better I still get annoyed with my parents for telling me to test when I am home from college ;)

    With regards to basal needs I would just keep watching. The enlite sensor will really help (I am a bit jealous over here).

    "That is a very tiny amount of basal. DD does a lot of rock climbing and usually just reduces basals by 30 -50%."

    My overnight basal rate is .15. So .075 is 50% :D I have pretty low basal needs.

    "We have considered the pill, but so many friends that take it for skin problems, etc. complain of the side effects that she is not interested at this point. I would have thought it would eliminate the fluctuations, but you are still experiencing those crazy days. I know I could never get DD to agree to this, but (you seem so much more mature) would you consider basal temperature testing to determine if you are experiencing hormone fluctuations at the those times?"

    Thanks. I'm doing my best :cwds:

    The pill has made things much much more stable. While things are crazy now my CGM graphs from age 14-16 are truly horrifying. I was using anywhere from 20-90 units of insulin a day and either super high or super low all the time. I honestly have no clue how my parents survived, they tested me every 2 hours overnight and that was with a CGM. I hate the term but I was the definition of a "brittle diabetic." I have crazy highs and lows now but nothing too extreme and it is totally manageable though frustrating at times. I don't think I could manage on my own if things were still that crazy so fortunately they are not!

    I have no side effects from the pill (that I know of). Almost all of my friends are on it and I really don't know anyone who has problems but I know a decent number of people do. In an ideal world I would personally prefer to use a non-hormonal form of birth control but with diabetes I think the benefits (for me at least) of maintaining somewhat even hormone levels outweigh the risks of the pill. But that could certainly change in the future. I think it is a personal choice though :cwds:

    I have actually considered charting temps. I even bought an app for my phone to use maybe a year ago. But because of work and school I just can't see myself actually being able to take a temp at the same time each day and from what I understand it has to be taken before you get out of bed. I may try it when I am older or if I have a break from overnight EMS shifts.
     
  9. wilf

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    Please don't take this wrong, but is there any chance she had a few drinks last night? Night-before alcohol can lead to this sort of experience the next morning.
     
  10. Helenmomofsporty13yearold

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    I did consider drinking as I tried to analyze this. She said she did not have a drink. I believe her as she was at her Christian youth group meeting the night before which is the least likely place for her to have a drink. Also, she had her Dad's car and I am quite certain she would not risk her licence or Dad's car. I like the "0 %" law for teen drivers.
     
  11. Ali

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    Adult now but once a teen t1. Ideas- 1. hormones, 2. if on a pump uneven insulin delivery, 3. exercise or even just running around doing unusual work ie cleaning a room, 4. playing games at youth group. Like Meg I before going thru menopause would have days and several months of greatly reduced insulin needs. My Endo could see it on my pump and had no answer, the guess was hormonal when it lasted more than a day with no other change in diet or ongoing ex or medication change, Sorry, if you have a CGMS it can help to at least limit the hours out of control. Ali
     

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