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lows in honeymoon

Discussion in 'Parents of Children with Type 1' started by Lakeman, Jul 9, 2014.

  1. Lakeman

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    Well, we are unfortunately going through honeymoon a second time but with our other child. It's a punch in the stomach for us but we are coping better than we did the first time. He was caught really early with an A1C of 7 during a monthly BG check and definitely has some of his own insulin working for him.

    So here are questions for the smartest group of parents out there: If he has no basal and has not had a bolus for several hours can he go low? What would be the mechanism that would allow him to go low while persons without diabetes would not go low? The doc has him on a sliding scale. Does anyone know if having a carb ratio and correction factor would be better or even work?
     
  2. caspi

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    I don't have an answer for you but know I've read of a few kids here that were on trace amounts of insulin in the beginning. Hopefully one of them will chime in.

    I just wanted to tell you how sorry I am for your son's dx. :(
     
  3. StacyMM

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    I can't answer your question as we've never been in a post-diagnosis, no basal scenario.

    However, I am replying so I can tell you that I'm sorry that your family has a second diagnosis. Dealing with diabetes was easier the second time but the emotional impact was much harder. My son had watched life with diabetes for years and knew what was coming, which made it very hard. You and your family will be in my thoughts.
     
  4. Adrian

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    In my opinion, he shouldn't be able to get too low. That means he shouldn't be able to loose consciousness.

    But: What I consider a low (below 80) might still be a level at which nondiabetics function perfectly fine and can even do sports.
    The mechanisms therefore would be the same as with any other person - just the definition of low would be changed.

    There are 2 reasons I try not to have my bg drop below 80:

    1st) A safety margin has to be there
    2nd) The adrenal glands will pump adrenalin on low BG levels that they are not used to.

    Even if I could magically switch off the risk of loosing consciousness for a couple of hours, which would make a saftey margin not necessary, I'd still want to keep my ability to feel lows (and wake up) before they get too low.

    Adrian
     
  5. Sarah Maddie's Mom

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    I have only one kid, my D kid, so have have no clue about an early dx in a second child. I suppose a G4 would be very informative at this time, but really I just wanted to say that I'm sorry to hear of a second dx in the family.
     
  6. Mish

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  7. mmgirls

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    Hi there,

    We are now just now starting to see lows in our honeymooning newly DX second child, too. A1C in March 5.8, in May at up to 6.8, started insulin pump an back down to 6.2 on 7/1/14.

    We are to opposite of you, giving basal and only bolusing if needed. Insulin lasts longer than a few hours, and our kiddos no longer have a normal counter regulatory process because the cells that are now decreasing in number that used to produce insulin can not talk loud enough to the cells that help release glucose to fend off a low in a normal person. Also, it this is happening often enough then kiddos just do not have good stores of available glucose, well really no one does, its like 2 days worth for non d people.

    Once I started to see 300's on the CGM I decided to put her on the pump. We already had her on the CGM since March and I had an idea of her spikes already. so she is currently close to 2units of basal and only a breakfast bolus of .30 if a normal fasting BG, which is normally the case. I will bolus her if she has had a lot of carbs and is starting a meal above 150.

    I see a big difference in the AM with just the slightest basl going over night! Even when she woke up with a normal fasting BG (below 90) she would be starving and want breakfast right away. After getting basal going overnight (we started with no overnight basal) she would wake up and go and play for awhile before she said she was hungry. the starving in between meals has subsided and is eating a more normal timing of meal/snacks.

    The body does not know that you have given insulin, so it is trying its best and once insulin is released you can not take it back.

    My dd is only 38lbs at 6yrs old and she is pumping 2units of basal and bolusing upto 1unit more. (if you can believe I:C about 1:125 and ISF of 1:500)

    Personally I would try a switch to some basal insulin, I truly believe that it is easier for the body to deal with a little basal all the time compared to bolus insulin. In our case she is getting over 50% basal. I am actually waiting for her to be firmly always over 2units basal and want to try Lantus with her like we do with mu oldest, love the Lantus.
     
  8. mmgirls

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    I just had a second thought, well several, bolusing on a sliding scale is being "reactive" and giving basal knowing that your kiddo has impaired glucose is being "preventative".

    How are to overnight numbers/fasting numbers?

    Sorry for your second DX, it is hard no matter how much you think you will be ok with it. My newly DX DD is taking it much easier than anyone else, it was hard for my oldest too.

    The Dexcom G4 has been the best way for me to see, and not just be guessing along the way. It is the only reason I knew that I would want to put her on Basal first, and I am hoping that she will stay in the honeymoon for awhile.
     
  9. Adrian

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    Nice find! The studies I've seen so far did conclude, that glucagon production might be impaired after many years (20+) but didn't examine if the release could be impaired earlier.

    But as I interpret the charts, this stabilizes the bg at levels of 55 or below. On higher levels there is even more glucagon with people with diabetes.
    Usually people without diabetes don't drop that low, as they have another quite powerful regulatory system: They stop releasing insulin at levels of about 90mg/dl. And: Insulin is given much more directly to the liver through the portal vein (or in this case not). Lack of insulin already triggers the liver to release glucose.

    Adrian
     
  10. Lakeman

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    Thank you for the link - it was helpful in understanding alpha cell impairment!
     
  11. Lakeman

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    Your posts have been helpful and encouraging and I cant thank you (and everyone else) enough. Really thank you to all of you!

    Yes I have been concerned that the sliding scale is too reactive. We have been attempting to adjust the amount of carbs eaten per meal so that the insulin that is given does cover some of the carbs and is not a correction only. We are also trying to figure out on our own what ratio and correction factors would be appropriate if at all. Its been a week since we have been in contact with the clinic so hopefully we will get some better guidance today.

    I see that Madison is on the CGM - wow how great for you all! How did you accomplish that? What data did you need to get to convince the dr and insurance to approve a cgm?

    Again thank you to everyone out there for your support.
     
  12. bamaboyd82

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    My son was also diagnosed quite early. He only had a 6.5 A1C and a BG of 258 on the day of diagnosis. He is extremely insulin sensitive, so we didn't use any basal for several months and, for a long time, were giving less than 1 unit TDD of Novolog. He even spent a few weeks taking no insulin whatsoever. He did experience lows with no insulin on board, even as low as in the 40s. Our endo explained it as the pancreas possibly kicking in late or overreacting out of sync with digestion.
     
  13. glko

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    My ds was dxd about 1 year ago through TrialNet and is still honeymooning. I think it depends on how you define "low". At school this year he would be on 0.025U/hr basal (lowest basal his pump setting goes), have no bolus insulin for 40gm CHO with protein at breakfast and at lunch his BG was commonly 65-70mg/dl, not symptomatic at all. Freaked out the school nurse every day, but I told her I can't really give him LESS insulin. When I discussed with our CDE she reassured me that since he is in such a strong honeymoon his body is trying to get back to "normal" BG and 65-70mg/dl is normal in nondiabetics so not to worry about it. Which I conveyed to our school nurse so by the end of the year I no longer got frantic calls for every BG <80.

    I do agree with pp that adding low dose basal did help us avoid those highs after meals. It was hard to do with Lantus though since we did find that even 2 units/day of Lantus had enough peak to make him symptomatically low at lunch. Starting the pump helped, his current basal rate is 0.025 - 0.05U/hr with a TDD of around 6-8 units most days. He gets much more bolus than basal. I:C ratios are 1:30 in the evening but he only gets a bolus in the AM if eating >50gm CHO and then it is 0.25U. He is 10yrs and weighs 80lbs.
    Sorry about the second diagnosis - our 13yo has impaired glucose tolerance and 2 antibodies, so we are preparing for the same in our family at some point. Since DH is also Type 1 this would be our 3rd diagnosis in the house.
     
  14. Lisa - Aidan's mom

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    Very sorry to hear about your other child being diagnosed as well.
     
  15. Kimby

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    I'm sorry for your second diagnosis!!! Kaitlyn was diagnosed over two years ago through TrialNet. She doesn't take insulin yet, but she does complain of feeling low sometimes and will test around 61. We usually give her a complex carb instead of juice like we would Andrew when he has insulin on board.
     
  16. mmgirls

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    I just stuck her sisters on her at first, but she now does have her own system. We have never had a problem getting a Dexcom thru any of our insurance carriers. our dr will easily write a medical need letter. and this time around I did not even have to do logs or anything just the rx and letter.
     
  17. Teacups

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    For our son who also had an early dx, his insulin needs were minimal at first, and he did have lows as adjustments were made. He was on Lantus, which kept being reduced until we hit 4u. As for boluses, well, it was tricky. Sometimes he didn't need any, especially before activity. We ended up doing .5u of Novolog for anywhere from 50-75 carbs if I recall. Having a range helped so much! I always thought it had to be a single number for carbs. This meant that lower carb meals had no bolus at all. Things did gradually change, of course, but this is how it looked in those early months for him.
     
  18. 321

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    Like others I am sorry to hear about your 2nd diagnosis, but well done for catching it early.
    During our daughters honeymoon she was going so low I instructed the school to give NO insulin for lunch, and yet she still returned home 15 mmol, 270
    This is information for you and not advice. I corrected those highs only, and while at home only gave small amounts of insulin for meals, she would still go lower through night, needing carbs.
    Definitely check through night, as many times as you feel uncomfortable.
    It didn't last long for us. I don't feel a few highs would do any harm, especially with an A1c of 7
    As you check more than required, you will see the end of honeymoon.
    Oh all of this for us was on MDI and no CGM
    Our thoughts are with you and your family
     
  19. wilf

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    Hey I'm sorry to hear about the second diagnosis.

    Regarding your question if he is not getting basal insulin and has had no bolus for 4-5 hours (I'm assuming you're using Novolog or Humalog), then the risk of going low is minimal (and similar to that of someone without Type 1 D).

    Depending on the strength of his honeymooning, the best approach might be to just give basal insulin and let his own insulin cover meals (except for really BIG ones)..

    Wishing you all the best. :cwds:
     

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