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Lantus issue ... again? not sure.

Discussion in 'Parents of Children with Type 1' started by VinceysMom, Dec 9, 2011.

  1. VinceysMom

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    We reduced it one unit... I will report back tomorrow.... right now he is at 69...so having milk and bread with peanut butter... i will check him in 1.5 hours and see what we have... I think he will be ok... but who knows... Thanks for all the input.... I really do appreciate it all.

    Kathy
     
  2. Heather(CA)

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    Your welcome, tomorrow reduce it again. :cwds:
     
  3. VinceysMom

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    5:45 am - 169 - now the weekends are way different than week days... carb ratios are different, too...and he went to bed late AND he had a carb snack uncovered cause he was 69 earlier... I'm telling you, no two days are ever the same. We are off to The Ohio State University (2 hour car ride) today so we will be sitting a lot (car ride) ... I will report back later today!

    Kathy
     
  4. VinceysMom

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    What a day... after his breakfast number of 169....

    5:39 am - 169 (wake up and light breakfast)
    11:04 am - 98 (breakfast at restaurant)
    2:45 pm - 57 (no doubt over carbed for pancakes earlier, corrected with milk - i KNOW we should have re-tested, but he said he felt fine and refused to test:()
    5:32 pm - 85 (dinner)

    I will report back at some point...

    Thanks again!!

    Kathy
     
  5. Heather(CA)

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    You may need to lower the Lantus again...But maybe not:cwds: What time was the 69 the night before and how long after his last fastacting was it?


    Do you normally treat lows with milk?
     
  6. VinceysMom

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    Back to our normal routine today...school...

    9:30 pm 188 snack covered and 1 correction vs 2 as he normally drops a lot when given insulin at night
    4:00 am 176 (slept thru 2 am)
    6:00 am 167 breakfast
    10:15 am 217 lunch at school
    1:38 pm 50 :eek: juice box and retesting right now at school. This lower number has just got to be the exercise effect from gym at 8:30 am...that's how I am reasoning it!:p (... OR maybe...his 6:15 am insulin is not yet out of him and we are "stacking"???????????????????)


    That one unit of Lantus truly makes a difference in Vince.

    I think I will go one more day at our current breakfast ratio 1:7 and then go back to 1:6 (sometimes that is a 2 - 3 unit difference which probably would have been perfect).

    Prior to decreasing the Lantus one unit, he was perfect at lunch time.

    Also, I guess we need to tweak the lunch carb ratio again... we used the same ratio as last week before we decreased the Lantus one unit, I figured he would be higher:confused: Lunch is currently 1:12... so, maybe we need to change to 1:15.

    I will have to look up what his BG was yesterday at wake up, I dont remember what that was. I do know it was in the mid 100's.

    I've been waiting for a call back from Endo (daughter's test results for just about everything under the sun...) so I will also confer with her when I hear back.

    Thanks for the feedback!

    Kathy
     
  7. VinceysMom

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    No, not always milk... He has juice box, go-gurt, milk, he just LOVES milk and prefers that sometimes ...
     
  8. Christopher

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    Kind of confirms what I thought would happen, overall numbers went up. I am not saying to not do what you are doing, maybe by tweaking the bolus insulin you can make it work, as the others have suggested. Good luck!

    As for the 50 and your guess that maybe the 6:15am insulin is still working, I would guess that after 7 hours it is pretty much done. Could be the exercise, the lunch bolus or maybe a combination of both. If he added a correction at lunch that could be a factor too.

    Thanks for checking back in. :cwds:
     
    Last edited: Dec 12, 2011
  9. VinceysMom

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    I mean.. he is getting insulin at aroudn 6;15 am, and then again 10:15 am... four hours... maybe the breakfast insulin is still working and then the lunch insulin coupled with the correction...? who knows...:confused:
     
  10. Christopher

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    Or maybe because it is Monday?? :rolleyes:

    I see what you mean now. It is always possible, but as long as you are giving insulin for carbs, stacking normally doesn't come into play. You could bolus for meals ever other hour and it shouldn't be an issue.

    It is usually only an issue with corrections, when you give a correction and then try and give another correction while the original one is still working.

    With all the variables, diabetes is really frustrating (can you say massive understatement?) :eek: :p
     
  11. Heather(CA)

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    But they didn't really go up. He stayed stable. So, the trick is to start him off at a good number now. Imagine if those numbers had started at 120 rather than 188...

    9:30 pm 120 snack covered and 1 correction vs 2 as he normally drops a lot when given insulin at night
    4:00 am 108 (slept thru 2 am)
    6:00 am 99 breakfast
    He only had a 21 point drop...Perfect :)

    See what I mean?

    If he got insulin at 10:15 it was too much, if he didn't it was probably the exercise...
     
  12. Christopher

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    Yes, they did go up.

    Look at the original numbers, not too bad overall.


    Now look at the numbers after lowering the Lantus. all upper 100's and 200's. So they went up.


    No, I don't. You are making up numbers and making assumptions based on them. Those numbers are not what really happened. Yes he stayed stable, but stable with highs.

    Like I said before, I am not saying the OP should alter what you suggested, your advice might end up being perfect for this situation (I hope it is :cwds: ), I just said that the numbers went up like I expected they would. That's all.

    Hopefully with a little more tweaking the OP can find the right balance and get this sorted out. I think the next day or two will tell the tale.
     
    Last edited: Dec 13, 2011
  13. Heather(CA)

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    The only number I changed was the starting number 188, then I went up or down the same amounts she posted... What you don't want is to start at a good number them drop into the 40's or start at a high number to drop down to a good number.

    Those numbers are exactly the kind of stability he needs, now she just needs to start the night at a lower number with a little tweak to the dinner ratio. (Although I would probably give it one more day) Then...perfect without out drops into the 40's... Until the next change of coarse.
     
  14. Heather(CA)

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    The only number I changed was the starting number 188, then I went up or down the same amounts she posted... What you don't want is to start at a good number then drop into the 40's or start at a high number to drop down to a good number.

    Those numbers are exactly the kind of stability he needs, now she just needs to start the night at a lower number with a little tweak to the dinner ratio. (Although I would probably give it one more day) Then...perfect without out drops into the 40's... Until the next change of coarse.
     
  15. Becky Stevens mom

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    I beg to differ. Anytime there are 2 days in a row with 40s during the night time I treat that very seriously and would drop the Lantus. Steven was 48 at 3AM after dropping the lantus a 1/2 unit last night. I will be dropping it again and if his day time #s rise thats what I:C ratios are for. They can be lowered if there is a need for more insulin to cover carbs.
     
  16. Christopher

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    I agree, 40's are not good. I am not saying that they are. My original point was since the OTHER basal numbers were pretty good, maybe there was a way of dealing with the lows without completely changing the entire basal numbers. When the OP lowered the Lantus, the overal numbers went up, which is what I thought MAYBE she could avoid.

    As I said, lowering the Lantus may be the best option, but I just thought it was worth exploring other solutions before that.

    I am not an Endo and I am not an expert, I have only been doing this 4 1/2 years, so I clearly don't have all the answers.
     
  17. Heather(CA)

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    He is on Lantus, there is no other way to treat night time lows other than lowering it. It's not a big deal...You just get the night time right then raise daytime ratios IF needed. But if you look at her last post he had a 50 at 1:30...This is after lowering the Lantus. I would watch it for another day or two then make more changes if necc... It's a process. A process that needs to happen (Like she is doing) because lows during the night simply need to be fixed, especially 40's with snacks.
     
  18. Christopher

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    I know and I agreed, so I am not sure for the need for this post. But now that you posted I will have to respectfully disagree that the only reason for night time lows is Lantus. Yes, it is probably the most LIKELY reason, but why not explore other possibilities? As many people see with children who are into athletics, vigorus exercise during the day can cause night time lows. So that is just one example of looking at other possibilites instead of just automatically lowering the Lantus.

    I think we are getting a bit off track here, so if you want to continue we can do so off line.

    Again, lowering the Lantus is hopefully going to fix the OP's issue.
     
    Last edited: Dec 13, 2011
  19. Heather(CA)

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    Chris, I didn't say the only reason for night time lows is Lantus, I said the only way to treat those lows is to reduce the Lantus...Two totally different things. As my son is a year round athlete I am all too aware of exercised induced lows as I'm pretty sure you know. Seth needs several units less Lantus while playing sports. He even changes it for weekends.

    Sigh, I think you just want to argue, so I am done trying to help you understand that 40's are not good and that lowering the Lantus is the only way to fix it. Have a nice day...

    To the OP, your on the right track, keep up the good work. Feel free to post more numbers if you like :)
     
  20. Becky Stevens mom

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    Just wanted to add that the idea of lowering Lantus due to overnight lows isnt Heathers own idea. Its what Ragnar Hanas and Gary Shiener both suggest when a CWD is experiencing night time lows. We also have to lower the Lantus on days when Steven's been really active. What I wouldnt want to do is to start splitting the dose as it really changes things and makes it so the kids have to have another shot, which may not be necessary.

    Heather, Im pointing this out because its what most endos and experts suggest for lows at night and I didnt want the OP or others to think that you personally were suggesting this because its worked best for your CWD in the past but because its what is usually suggested before splitting the dose. Its what we've always done and what our CDE and endo have always suggested that we do. A matter of fact both the CDE and endo have frowned on us splitting the dose. They say if we feel that necessary we should switch to Levemir as that is supposed to be a split dose.

    I think one of the only reasons to split the dose would be that there is a definite peak in the Lantus but so far the OPs son hasnt shown evidence of that.
     

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