Normal carb ratios and lantus doses after honeymoon

I am trying to figure out how to manage the post honeymoon period when it arrives.

My son currently gets about 1 unit per 30-40 grams of carbs at meals, and 1 unit of Lantus. He currently wakes up in the low 90s every morning.

What do I need to expect in terms of dosing when the honeymoon period is over?

How many grams do long term T1Ds cover with 1 unit, and what kinds of lantus levels are eventually needed.

 

How old is your son? I think your answers of what to expect will be all over the map depending on if he is a toddler, teenager, etc.
My daughter didn't have a honeymoon and we started out with 10 units of Levemir/ day and carb ratios of 1/25-1/30. She was 4 at the time.

 

There is no way to predict it, really. Your kid will need what he needs and you'll just keep making changes until you find one that works...and then change it again and again and again

 

In order to get answers to your questions you need to get some reference texts and get reading. I can highly recommend:

1) Type 1 Diabetes by Ragnar Hanas

2) Using Insulin by John Walsh

3) Think Like a Pancreas by Gary Schooner

Do it now! It is never going to be as easy for you and you'll never have as much time for this as you do now. :cwds:

 

He's 9. The problem I have is that if I give him more per carb or less per carb it doesn't change any of his numbers. It just seems that his own pancreas turns up or down to compensate at this point. His breakfast, lunch, dinner and bedtime are averaging about 100 for several months really since the first 2 1/2 weeks. I've given him almost a full breakfast with no insulin and he came to lunch at 75, and I've halved his dose when he was in the 70s at school and it doesn't change anything. I also tried to add a half unit to keep his peaks down a little (I thought 170 was a bad peak) but the extra half unit didn't change the peak or the numbers later on. I have also been told by a PhD in childhood endocrinology that non-diabetic kids peak at 170 all the time after meals, and 200s are not uncommon, but people just don't check non-diabetic kids that much. I am happy to stay with 1/30 or 1/40 and not worry about lows, but what if I can get the same numbers with half a unit per 30? Should I do that, or is the insulin helping to save his own pancreas longer?

I thought that I might just be way under dosing him but his strong honeymoon is taking care of everything right now

 

170 is not much of a peak and it does sound like he is having a pretty good honeymoon. If what you are doing is working, I'd just stick with it. You could try stepping down the insulin and giving it a few days. If he starts to go higher them just go back up a bit. The only reason I could see to do this would be to maybe avoid potential lows. But again if it works don't fix it. There will be enough time soon enough when D is hard and nothing seems to work. When he does need more some day just remember that he needs what he needs. It's not bad to need more it just is.

 

Personally I would not risk the lows to get even tighter numbers. I'm far from an expert though. My son is 14. Diagnosed one year ago at 13. There are other variables for us to consider (I have less control over his choices, he's alone more often, very averse to cgm or pump etc).

In reference to your OP his ratio is 1:10 unless he has activity planned, then we adjust the ratio or he has uncovered carbs or both. He takes 21 units of levemir. He does not struggle with insulin resistance like some teens - at least not yet.

 

Right now it doesn't much matter what you do, you're going to look like a demigod of diabetes - so don't waste your time too much on finicky details regard his insulin regimen. Just make sure you're not giving too much insulin and putting him low.

I would get yourself Using Insulin. Learn how to calculate insulin doses. Figure out what a kid his weight will normally need later on. Learn about calculating carb ratios and correction factors. There is a theoretical framework which if mastered makes D management easier - now is the time to learn it. :cwds:

 

Carb ratios are as varied as much as kids are different. Basal needs are whatever it takes to keep them level. What another child needs may be very different from you child. My daughters lunch ratio 3 years after diagnoses was 1-119, now it's down to 1-65 a little over 4 years in to it. I know other T1D kids that are 1-8. So as you see it can vary a lot! Just always be open to changing needs. For many kids, probably most, to peak at only 170 is something we dream of.

As long as your not getting lows I would give as much insulin as possible to keep the load off his pancreas and keep the honeymoon going. But as soon as you start getting lows, back off. For us lows are under 75 (depending on activity), for you, whatever your comfortable with.

 

Couldn't agree more. Those books are so full of information that takes much of the guesswork out of D. After the unpredictability of the honeymoon, you can fine tune ratios, correction factors etc. and have some good stable numbers.

 

I appreciate this advice, given for the 3rd time, but I know how to do all of that. I've read hundreds if not thousands of pages and attended training seminars. I come here to compare what I've read with what people are really doing to see if they mesh.

 

I think you will find that the two are the same. Its not one of those things where the theory is too far from reality! Kids do use 0.5-1u/kg, depending on age etc! Multiple times I've calculated and then compared to what is working, and its super close! There are variations of course (some kids are more active, puberty puts up doses etc), but for the most part, it works!

 

Then why the questions that opened this thread?

From your reading you'll surely appreciate that each child is unique, that there is no one-size-fits-all insulin regimen, that honeymoons can be weak or strong, and can end slowly or quickly. Your job is to be observant and adaptive in providing insulin and diabetes management for your child.

Your D management job right now while he's honeymooning is to try to support his remaining beta cells by keeping blood sugars as reasonably level as possible. You can play with the insulin regimen as well as with diet and exercise to do so. As said before, right now it is easy and you should be thankful. In our case when our daughter was honeymooning we used Regular insulin (rather than Homolog or Novolog). It is a little weaker and comes on considerably slower than those insulins, and is more forgiving when you're blousing for a honeymooning child.

Anyways, if you've done all your reading and are all up to date then go play with your kid, and spend some time making memories that will help take away the sting of the diagnosis.. :cwds:

 

I think you may be over-thinking this a tad...

As for the Lantus, we're simply giving him the highest dose he can tolerate without nighttime lows. And that dose, BTW, changes all the time. The only safe way to do that is with a CGM, so if you don't already have one, make sure you get it!

 

Well, I am interested in CGM. The endo hasn't mentioned it, or pumping. She is very nervous that he wakes up at 85-95 every morning but he's on 1 lantus. She said she wants to see him over 100 in the morning.

Where do I go to learn about CGM? I started looking and most reviews were very negative, that you end up testing even more, and it is painful to insert the transmitter for sometimes several days and it gives false low warnings a lot. I've read a lot against pumping too, that if leads to insulin resistance because you over use basal and your body ups the glucagon and cortisol and adrenaline a little to balance, and that sites start becoming resistant even in a few hours, and that as long as your lantus needs are low it is less likely to cause lows during activity.

 

I think you must be reading biased info on both CGM & pumping.

Pumping Insulin, the companion to the book Wilf recommended. Also by John Walsh.
Think Like a Pancreas & Until There's a Cure, both by Gary Scheiner.

If you're interested in learning what CGM can really do, I suggest Sugar Surfing by Dr Stephen Ponder. You can order on his website, which also has some good info on the basics of T1.


http://stephenpondermd.com/about/


Very good info here
http://www.diabetesnet.com/diabetes-technology

 

I'm shocked you are finding negative reviews of cgms. Most people in the online community (and everyone I know in real life) love them. And I wish it caused my daughter to test more! She relies on her cgm (coupled her physical feelings) as gospel truth and rarely tests if I'm not chasing her around with a meter and strips. We've found it to be quite accurate (especially when you consider how inaccurate meter are allowed to be), so I don't push it. She's dosing for what she eats and quite frankly, I don't care if she doses for 111 on the cgm when a meter might show 101 or 121. In the grand scheme of things, they all could be right, so we just go with it.

As for pumping, I have no idea. I've never read that. Although guilty as charged over here about upping the basals. I can't get my kid to prebolus 15 minutes ahead of eating, so we up the basal a bit during her normal eating times to try to counteract the spike a bit. It's only evident when she misses a meal though - like today, it's 10:43am and she's still sleeping. I watched her drift slowly down from about 7:30 a.m. and finally gave her a juice box at about 9:30. She's still snoozing away and is back flat at 99 though. We leave for vacation next week though and all heck will break loose again, so I'll deal with the summer sleep in basal changes when we get back.

 

Ignore what your your endo is saying about waking over 100. Most endos don't do well with honeymooning children.

If you can afford it and your son will wear one then a CGM is the gold standard of D management. :cwds:

 

Which one is the best? If you give me a site I will order one now. Do I need to take some kind of class to use it? The last I read, you insert a transmitter under the skin about once a week? Can I see where he is from home or my phone when he's at school?

I figured that the endo would just start talking to us about it eventually. They said they like you to learn to use injections for a year first.

 

There are only 2 companies selling them in the usa
1) medtronic
2) dexcom

we have a dexcom. it is terrific.