- advertisement -

It is finally time to ask for help

Discussion in 'Parents of Children with Type 1' started by Kalebsmom, Mar 6, 2010.

  1. Kalebsmom

    Kalebsmom Approved members

    Joined:
    Aug 29, 2008
    Messages:
    3,134
    Here is the deal. Kaleb has been hm'ing for over 2 years. It has now stopped and we are having a hard time. This is worse than it was at dx.

    I have talked to his endo three times in a week and ahalf.

    Kalebs number has only been below 200 once or twice in 10 days.

    We changed his I:C to 1;17 all day
    His basal rates are 12:00am -12:00pm .4025 and 12pm to 12 am .450

    His numbers went up this am and he had not eaten anything.

    I do have 3-4 days of numbers but not sure if it would help for me to list them.

    He has been running high enough that he missed school yesterday because he was drinking all the time, had a headache as well as a stomach ache.

    Today when he changed his site we used new everything. I opened new insulin and, box of sites

    I am lost
     
  2. Jensmami

    Jensmami Approved members

    Joined:
    May 17, 2007
    Messages:
    2,082
    Sorry he is having a hard time. If he goes up without eating, that to me is an indicator that he needs more basal. I would start by giving him more basal around the clock, and of course testing, testing, testing. Good luck :cwds:
     
  3. buggle

    buggle Approved members

    Joined:
    Mar 24, 2008
    Messages:
    4,267
    Can you get a CGM trial? When we go through this, we have to aggressively adjust insulin doses -- I'm talking double to triple. If you have a CGM, it's much less scary.

    You can still do this with fingerpokes. Here's what I'd do. I'd aggressively correct every 3-4 hours until you get him in range. Each day, add up the corrections you used and add them to the basal for the next day. You may have to go through a few days of this if he needs a huge increase in dose. Since you're on a pump, it's way easier than Lantus. We were doing it on Lantus for a year. :( Each day, keep going after it and correcting until you get his BG down. And sit down and recalculate your basals and bolus ratios each night. Eventually, you'll get it. But I know it's scary the first time this happens. But don't freak. If he starts to go low, you can suspend his pump and then lower the basal. So you can always deal with it, whether you have to keep increasing his insulin or treat some lows as you adjust it.

    But be careful, because once he's in range, his pancreas may kick in again and he could run low. When they come out of the honeymoon, it can be rocky for a while. If Kaleb is like Brendan, it could go on for some time. But you won't know until you watch and see what happens. Kaleb may just settle down into a new range and be fairly stable like he has the last couple of years. Just watch and respond. That's really all you can do.
     
  4. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    He is clearly getting way too little basal insulin. At his basal rates, he's getting maybe 10 units a day. Not enough, not near enough.

    DD who's 5 years younger and likely 50 pounds lighter and is physically very active gets 50% more basal than he is getting.

    If it were my child, I'd up the basals to a unit an hour and measure hourly for a day. You'll quickly see how much he really needs - my bet is that it will be around there.

    So you have to decide if you're willing to take that deep breath and give him the insulin he needs, even though it's way way more than he needed a short time ago. It is so hard to increase insulin dosages, but that's what has to happen.

    If you post weight and TDD for the last few days I can crunch the numbers too, but I'm sure it's going to be in the ballpark of at least a unit an hour.
     
    Last edited: Mar 6, 2010
  5. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I am with Wilf.

    Thats not allot of basal or bolus for someone his age, he must have been honeymooning strongly.

    Take the plunge and drastically increase his basal, shift those corrections to basal and see what goes on for a day or two.
     
  6. deafmack

    deafmack Approved members

    Joined:
    Sep 22, 2006
    Messages:
    3,209
    I am sorry you are going through this. I agree with the others that his basals are too low. I see that he is 18. Hello puberty and raging hormones. His basals definitely need to be increased. Some basal testing is definitely in order here.
    Just to let you know that one of my ASL interpreters has a son going through the same thing. Hang in there. The parents here are awesome.
     
  7. bbirdnuts@aol.com

    bbirdnuts@aol.com Approved members

    Joined:
    Oct 21, 2009
    Messages:
    361
    This sounds familiar. Carolina's basals were set at:

    12am -7am - .40
    7am - 1pm - .50
    1pm -7pm - .40
    7pm - 11pm - .45
    11pm -12pm - .40

    The second day she was in the 200's, I changed the pod and kept making corrections. Numbers continued to run high. Next day I started running temporary basals to see if I needed to change basals in the PDM. I increased basals that were set at .40 to .50, .45 to .55, and .50 to .60. The one I increased a little more than any other was during the night around 2am I set the temporary basal to .55 to catch the rise pattern that was happening.
    Last night the .55 was too much (after 2 days of .55 being good) and I have treated her twice over the past 2 hours. When her number was in the 80's I turned off the temporary basal and went back to .40. Two hours after I stopped the temporary basal she is still running that now.

    I do believe Wilf has much wisdom and great knowledge and can teach and help us all a lot. Nothing against you Wilf, but I do believe the increase he suggests may be too much. You will have to try and figure out what works for Kaleb.

    Carolina's numbers were also going up without eating. That is clearly a need to increase basal. I did also change her carb ratios a little. I would have her check her blood sugar and bolus her for a meal. I had her to check one time at 1 1/2 hours and she was below 150 (can't remember the number). Then by 2 or 2 1/2 hours she was over 200. This let me know it was a basal issue.

    Does Kaleb pre bolus? I hope this helps.
     
    Last edited: Mar 6, 2010
  8. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    You just have to remind yourself that he's NOT getting "sicker", he just needs more insulin. And try not to think too much about what other people's basal rates are - it's totally irrelevant what another child, at a different stage of D is needing. ;) He needs what he needs and I wouldn't be surprised it Wilf is right. Unit smunit, it's not a crazy amount at all so don't get fixated on the dose. If he didn't have D his pancreas wouldn't think twice about increasing it ;)

    Good luck - you can absolutely do this.:cwds:
     
  9. StillMamamia

    StillMamamia Approved members

    Joined:
    Nov 21, 2007
    Messages:
    13,195
    So true - about being afraid to increase insulin dosages. Kids grow up, their bodies change, their insulin needs change. It is NORMAL.

    Just figured this one out myself not too long ago. And I've only been doing for so over 3 years. :(

    I compare it with driving a stick-shift (which I hate:rolleyes: so I bought an automatic car) in Paris. You have to constantly adjust your gear. Same with D, gotta adjust.

    My new mantra - It is normal. Ommm.;)
     
  10. Mom2Will

    Mom2Will Approved members

    Joined:
    Oct 11, 2007
    Messages:
    1,051
    You are not alone Kristi!! I agree with the majority, the insulin is very low. Will is 7 and averages 20 units a day between basal and bolus. All of our children are different and I know how scary it is to feel that you might be giving too much but then when you see the result you let out your breath and move to the next day. (((HUGS))) This place is awesome, you are never alone!
     
  11. AmyMCGS

    AmyMCGS Approved members

    Joined:
    Nov 11, 2008
    Messages:
    168
    While I agree that he likely needs more insulin, I just wanted to say that I understand if you're not comfortable adjusting it yourself. Many of the parents here at CWD change ratios and basals all the time, which is great if you're comfortable with that... but if you're not, stay in close contact with your endo/ nurse/ whomever and let them help you. (Personally I am just now starting to become comfortable with making my own adjustments, mostly due to the things I've learned here. That concept really kind of freaked me out when I first joined this forum.) No need to add that fear and uncertanty- if that's where you are- on top of keeping an eagle's eye on the numbers.
     
  12. GaPeach

    GaPeach Approved members

    Joined:
    Dec 29, 2007
    Messages:
    2,218
    Kristi,

    As Wilf said, you probably should look at raising those basal rates. Post his weight and TDD and Wilf will do his math whiz.

    As someone else posted, it is scary to raise the basal rate significantly. Since you have the PING, try running a temp basal of +50% for 4 - 6 hours. Check frequently and log the results. If that shows some improvement, try a +75% for a few hours, etc.

    Once you find the temp basal amount that works, you can take the total number of additional units divided by 24hrs and make an adjustment to the programmed basal rate.

    There is a certain peace about running a temp basal because you can CANCEL at any time if needed. You see the results about 2 hours after the time that the basal increases. (You also would have a 2 hour carryover after you cancel, if necessary).

    Keep us posted on updates.
     
  13. mph

    mph Approved members

    Joined:
    Nov 26, 2007
    Messages:
    964
    So true!:D
     
  14. badshoe

    badshoe Approved members

    Joined:
    Jun 28, 2006
    Messages:
    2,153
    What is the total daily dose?

    We found that as the kids grew the basal would go up, the TDD would go up and that we needed to change the I:C and correction factor too.

    Just to make things more 'fun' it seems to happens all at once. OK for a few weeks and bam! everything changes over night.
     
  15. bbirdnuts@aol.com

    bbirdnuts@aol.com Approved members

    Joined:
    Oct 21, 2009
    Messages:
    361
    I should have added that every child is different and every parent is different. I just posted what is currently going on here. The small changes I have made are working so far and her blood sugars remain under 120. I personally would not feel comfortable increasing basals by 100% + at one time, but it's up to you. Your child my need that LARGE of an increase and your child may not need that LARGE of an increase. I choose the side of caution, but you know you son better than anyone else.

    When Carolina started pumping the Endo. office had her basals set at .90 per hour. I was treating her all the time for lows, changing IC ratios and talking to them daily. They would only decrease her basal by .10 each day. After 2 days of treating lows day and night and needing some sleep I made a .20 decrease and that is where we settled and fine tuned from there.

    A child needs whatever insulin they need to keep their blood sugars where you/your child wants them. I sincerely hope that you get Kaleb's blood sugars under control very soon. (((HUGS)))
     
    Last edited: Mar 6, 2010
  16. Kalebsmom

    Kalebsmom Approved members

    Joined:
    Aug 29, 2008
    Messages:
    3,134
    First I wanted to thank all of you for taking the time to help out.

    Yes, he did have a very strong honeymoon. He is still sleeping, but when he gets up I will see what he weighs and get that and his TDD posted. I know that before all hell broke loose he was getting about 20 units TDD.

    Last night we were going to check at 3:00. Just a few minutes before that he came and woke me up saying he felt low. He checked and he was 55. First low in forever.

    Thanks again and I will post the other info later.
     
  17. blbrocky

    blbrocky Approved members

    Joined:
    Apr 25, 2007
    Messages:
    410
    My son is 18 years old and his basal runs between 16 and 17 units. He is very thin weighing approx 118. His TDD is approximately 45 units.
     
  18. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    That's quite the honeymoon.. :cwds:
     
  19. Toni

    Toni Banned

    Joined:
    Sep 14, 2009
    Messages:
    2,882
    The fact the he wakes up high is a dead giveaway.... unless you fed him, he had a high number before bed which was not corrected.
     
  20. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    To compare my son who is a 50-lb 7 year old gets more TDD than your teen. Sounds like you are in the middle of long honeymoon.

    If you post his weight you can see where he will likely end up... but unless he's a waif, you looking at it probably doubling or tripling.

    Knowing where the final destination is liekly can be really helpful. If you're only used to changing by 0.05 at a time, then little changes like that are going to doing nothing. A +50% temp basal might seem like a lot but not if the needs have doubled... sometimes there's nothing left to do besides be more aggressive.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice