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Is it over already?

Discussion in 'Parents of Children with Type 1' started by britbabi84, Nov 4, 2011.

  1. britbabi84

    britbabi84 Approved members

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    Ok, so the other day I posted that we were in the honeymoon phase. My son is 2 and was diagnosed about 5 weeks ago. Well these past 2 weeks he has barely had any insulin. He was taken off lantus completely and was only getting novolog after meals if it was an extremely high carb meal. His numbers would stay pretty steady around the 120-160. It was great! But now, he has had a couple of spikes the past 2 days. Yesterday we checked him and he was 330. So we gave him 1 unit of insulin. But then 2 hours later he was getting very whiny and complaining of being hungry and his belly hurting, and he was at 50! Today, another jump up to 320. This time I just gave him 1/2 a unit to see if it brings him back down in range. But anyway, because he is having these spikes is it a good chance that his honeymoon period might already be over? He isnt eating anything high in sugar or anything.

    :confused:
     
  2. BittysMom

    BittysMom Approved members

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    Someone far more knowledgeable than me will come along and post I'm sure, but no, that doesn't mean it's over. There can be swings in BG levels while they're in the honeymoon, and their insulin needs go up and down as well.

    There is a formula (which escapes me), using weight and total daily dose of insulin that is generally used to determine if a person is honeymooning.
     
  3. obtainedmist

    obtainedmist Approved members

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    Here's a formula I found for determining if you are still honeymooning: The TDD (total daily dose of insulin) reaches 1/2- 1 unit of insulin per kilogram of body weight per day when the honeymoon is over. Divide pounds by 2.2 to get kilograms.

    I think it's really common for the needs to go down after the bg comes down from the time of dx...and then increase. Also, there are growth spurts to think about with a young child.
     
  4. Lisa P.

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    Honeymooning comes and goes. Those beta cells are still trying to put their heads up over the trenches and get back to work, when the blood sugar numbers are good they turn up again. But once they do, the immune system "sees" them and attacks again. They get beaten down, you need insulin. The insulin works, good numbers start again, the beta cells start contributing again, they get "seen" and attacked, etc.

    There's a chart Buggle posted once that shows the variation and the cycle, it's really very cool if you don't have to deal with it!

    One unit is an awfully big correction for a two year old. How much does he weigh? Selah is 5 and weighs 40 pounds, and one unit will bring her down 200 points. So if you have a number in the 300s and his own insulin is still in the system (somewhere! :p), I'd try half a unit before going to a unit. When we were (might have been, you never know) honeymooning her body sometimes seemed to act like a type 2 diabetics. If her blood sugar got up to, say, 180 but started back down on its own, then her own body took care of it. But if she got to, say, 300, her own body couldn't handle it and she'd keep going up. But if you give her enough insulin to get her down under 200, her own body kicks in again. So if you give her insulin to get her from 350 to 150 but once she comes down under 200 her own body tries to take her down to 70, we've got double dosing, essentially, and we're in trouble.

    If that's clear as mud. :p

    I think some folks handle times like yours with an incredibly small amount of lantus and no novolog, just helps the body along throughout the day, but I'm not sure you could get a small enough lantus dose in a little kid for that to work.

    In any case, do know as you move on in the coming weeks that numbers over 300 are nothing "special" in toddlers. :(:p You sound like you're taking it in stride, but I always like to remind moms of little ones that those are not atypical numbers. You will learn how to minimize their appearance over time and checking for ketones is always wise because 300 with large ketones is dangerous. But don't let 'em shock you!

    If you haven't heard, by the way, a good way to check for urine ketones without trying to get your toddler to play target practice is to put a cotton ball in the diaper and squeeze it out on the stick. Blood ketone meters are also fabulous for little kids, you test blood sugar and use the blood on the ketone meter sticks at the same time and get a really accurate reading of his ketones level right this minute. Urine ketones can be hours old.

    Best of luck!
     
  5. AlisonKS

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    do you have half unit syringes? those were necessary for us in the early days because we would correct with .25 units-long story but he is not a good candidate for the pump. Even today at age 6 we only correct with .5
    His honeymoon was over according to his endo team 6 weeks after diagnosis, there are some anecdotes that the younger the child is at dx, the shorter the honeymoon. I was actually relieved when it was over because the body stopped kicking out it's own insulin at the most inconvenient times!
     
  6. britbabi84

    britbabi84 Approved members

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    Thanks everyone! We had given him the 1 unit correction because he was about to eat a snack at the same time that would usually have a 1/2 unit worth of carbs in. But he was also running around wild between snack and lunch which I think had a major part in the BIG drop, He is 31 pounds right now.
    I have a question about ketones though.... so when my meter says Ketones? does that mean I should check? and what am I looking for? I never really understood all that even though Ive asked my endo several times. I dont know why I just dont get it.

    I am hoping he actually gets out of the honeymoon soon because I want to get him on a pump, and dr said its ok as soon as they honeymoon period is over!
     
  7. Amy C.

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    The meter always says to check for ketones when over a certain amount. Your endo should have prescribed strips to measure ketones and given you directions on when to test and then what to do with the results. Most of us use blood ketone strips.

    With the blood ketone measurement, anything over .6 requires some action and then moderate or trace on the urine strips may require some sort of action. Your endo should tell exactly what to do. Personally, I wouldn't do anything.

    I would also hold off on giving a whole unit of insulin at once, unless he has lots of food.
     
  8. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

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    It seems that a number of new posters are under the impression that one has to be off insulin to be in "honeymoon" - not so - the previously posted formula gives the true definition of "honeymooning". That said, even when folks meet the dose amount that suggests that the honeymoon is over, most, I suspect all, have a gradual loss of insulin production or the occasional resurgence of beta cell activity over time.
     
  9. Lisa P.

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    The immediate danger of highs is moving into DKA. My understanding is that once you begin DKA it kind of has a cascading effect where it becomes harder and harder to get the bg down, your blood gets acidified, and you usually require hospitalization to address it.

    So any time a diabetic is higher than 300 you need to consider whether to check for ketones. Sometimes doctors will just give you general instruction to test for any number over 300. We test at 300 only in some circumstances. If she has plenty of insulin on board or is moving back down again or I think the 300 is because she ate a lot of carbs, I won't test unless my "gut" tells me I need to.

    If she's 300 and "shouldn't" be, I will check ketones. It may mean she is not getting insulin, like if there's a pump failure or the insulin has gotten too old or hot or the shot leaked back. If a diabetic out of honeymoon doesn't get insulin she will burn fat for fuel and produce ketones, which can lead to DKA in time. So I check ketones to make sure there isn't a problem.

    If she's over 400 I usually will check ketones just because if there are ketones at that bg level things can, I understand, go bad fairly quickly. If there's no ketones, I can relax a bit.

    Signs of ketone production are a fruity smell to the urine (diaper) or breath and strange breathing. The body expels the ketones in the urine and the breath. The breathing is repeated long expirations. The smell is like nail polish remover, ketones are kinda related chemically to acetone?

    That's my amateur roundup. The two immediate hazards for our kids are fast lows and highs with ketones. Ketone testing can help us identify if the second is showing up before it becomes a problem. Normally the "fix" for ketones is insulin, sometimes with food.
     
  10. Lisa P.

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    I almost wonder if Type 1 is being "caught" earlier, before DKA, so that some kids have periods with no insulin use (we certainly never did!). Probably unlikely, but it would sure be nice. . . :cwds:
     

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