Issues with how quickly, or slowly, insulin works

My kid isn't a grazer, and her basal is around 70%. Everyone is different....

 

Raising basals does sound pretty scary, but at this point it seems to be the only option:frown: My son can out eat a growing teen and even a grown man! I never undrstand where it all goes LOL. But this is the way he has always been and always keeps a good weight.

 

We don't have much choice. I have called and called other endo's for miles aroung but they always only see adults

 

Thank you for the link kiwikid! Going to read it now.

 

But why is this scary? I think being high for years is scarier.

 

Think Like A Pancreas has an easy to follow, very understandable explanation of how and why to change dosings. It's worth adding to your library; it's a resource I use frequently.

Gary's practice (Integrated Diabetes Services) also offers appointments to teach you how to adjust, and he also has the Type 1 University courses.

 

I agree with this. The book is very helpful. You don't have to make huge changes. I think your on the Animas .Just change by .025 starting a couple of hours before he is been high.
Like for example, if he was .3 change to .325. A tiny amount of change for a few hours could make a difference and a place to start.

 

I would be more concerned with, what too high of A1C is doing to everything you don't see, and worry less about his outward weight. (unless you are concerned about other possible conditions)

 

It can be hard to come to the realization that your child simply isn't getting enough insulin and that changes must be made. You have the evidence of his high blood sugars indicating that he needs more. If he is home much of the time, you can monitor his blood sugar and head off any lows. I would start giving him what his body needs -- more insulin. He might become less hungry as the cells would be fed rather than the sugar that the cells need end up literally going down the toilet.

 

I am working on raising basals and getting good results. This is the first day, but already it is helping. And then - the Dexcom sensor died Got it up and running again - now hoping for good trends and adjustments.

 

I missed you had a DexCom. There is no reason you can't be quite aggressive in treating the highs -- you have the information at your fingertips. It is up to you to continue to take action.

 

A1c from 9.3 to 7.4 in 3 months.

I pass you my experience when we had -I think- a similar problem last year, and solved it:

BG was out of control, and we were increasing basals (we do MDI), as it seemed that BG would never go down. We tried everything for 9 months (diet, timing, dose, exercise, etc.), and A1c from a 7 and change value moved to 8.1%, 8.4%, and 9.3% every quarter. Last A1c was way high and since we had tried it all, we went to a Diabetes Center with no much relationship with our endo to see if we could start from scratch.

The nutritionist took a bold approach: We were at 2 shots per day of Lantus (97 and 53, that's 150 units per day), and corrections every 2 hours, that would never work. And A1c was reflecting it.

The bold approach was: she cut the basals to 67 once a day (we ended up in 75 after some tweaking), and the corrections, that used to be 1 unit of fast insulin for each 50 mg/dl of BG, or 15 grams of carb, were moved up to 3 units per carb / 50 BG. We did a bit of tweaking again and ended up making 3 units during the day, 2-2.5 at night (to prevent lows while sleeping). We also moved the Lantus time from evening to 9am, and then we had the best results when making the shot at noon: That, I cannot tell why.

Also, we started on Dexcom 4, which allowed to see when the insulin injection would start changing the slope (not reducing) of the BG, and found out that it was 30 minutes after. And maximum effect would come at 2 hours. So we started to prebolus 30 minutes before meals, with say, 3-4 carbs, and add up more if the meal needed more.

Bottom line: A1c from 9,3 to 7.4 in 3 months. Total daily insulin (say 250 grams of carbs per day) from 150 + 17 (actually more) = 167, to 75 + 50 = 125 (actually a bit less), from 6-7 finger pricks a day and 10 insulin shots, to 2 finger pricks and 5 insulin shots.

I do not know if this fits your scenario exactly, but we had a horrible year with A1c through the roof and running behind BG without any results, and with this dramatic change things seemed to improve a lot. We have our bad days of course, but the worst day does not compare to the average days of last year. Maybe you can discuss this with your endo.

Cheers,

Ed

 

Your child was going low and rebounding, which causes insulin resistance. Very impressive work by your nutritionist to recognize this and act on it.

 

Hmmm, I don't see an evidence to belive that posthypoglycemic insulin resistances have been the reason for increasing A1c's and insulin doses.

To me it looks more like a deal with heavily downregulated insulin receptors.

Regards
Joa

 

Playing devils advocate here.

wouldn't heavily downregulated insulin receptors, look like insulin resistance?

What is the "cause" of insulin resistance?

 

They do, if you understand “Resistance” as a higher need for Insulin (see also Typ 2 Diabetes).

In puberty for example there is a higher level of resistance caused by the hormones.

In case of posthypoglycemic insulin resistance (phir) the resistance is temporaily hormonal caused and only following BG lows (rebound effect/counter regulation). The resistance lasts for round about 9 hours.
In case of downregulation (the number of insulinreceptors is generally decreased due to increasing TDD’s) a higher need for insulin is constant, until it comes to a upregulation (the number of insulin receptors is increasing due to sinking TDD’s).

There are miscellaneous reasons. Here are some:

- different hormones are causing resistances.
- high levels of free fatty acids in the cells are causing resistances.
- missing insulin for food with significant amounts of fat an/or protein can cause resistances.
- missed basal insulin is causing resistances (fatty acid resistances).
- larger amounts of ketones are causing resistances.
- fever is causing resistances ...
- … and so on.

So it is helpful to figure out what kind of resistance you see (what is the reason behind) to turn the right screw to solve problems - hopefully easily.

Regards
Joa

p.s.
I hope my Enlish is half the way understandabele?

 

But I think in the case that brought up this conversation, I believe the thought is that they were never out of the of the "counter regulatory" reaction.

 

You're posting big fancy words that do little to convey any meaning..

This child was getting 97 units of Lantus in the evening. My hypothesis is that this was hammering the child into lows, every night. The lows caused rebounds in blood sugar and insulin resistance. The reason I think my hypothesis is sound is that a major reduction in the amount of insulin given plus a change in the time the Lantus was given led to significant improvement in A1Cs.

If you have a better hypothesis to explain the known facts then by all means let's hear it. In the meantime, I'm sticking with mine.

 

I hope I'm not the only one who isn't understanding these big words?? Wilf - you make perfect sense.

 

I found this very interesting and informative, Joa. Thanks for taking the time to post.


And your English is excellent!