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ok .. pleeeease help

Discussion in 'Parents of Children with Type 1' started by arggggg, Feb 9, 2010.

  1. arggggg

    arggggg Approved members

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    so frustrated atm , i help care for my brother who is 10 years old and was diagnosed with type 1 about two years ago, we have never really managed to get him all that stable with readings bouncing around at any given moment.

    in the last week his levels are shocking , he was waking up on LO and then either shooting up to HI or dropping every half hour after being treated everytime. they admitted him to childrens ward over a weekend for monitoring and his levels balanced out so they discharged him saying he is testing and giving insulin correctly , but now we are home and doing excatly the same thing and hes all over the place again

    he was bullied at school last year and never wants to go , could this cause this ? or would it be more? we have done everything how we have been told to, nothing is missed, nothing is over administered , nothing is being done wrong but this is still happening

    frustrated because nothing we do at home is keeping him level , any ideas?:confused:
     
  2. Mikker

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    Welcome...

    We would need more information to be of any real help. What insulin/s does he take? How much does he usually take and when? What are his blood glucose numbers like?

    It would be most helpful if you could run through a recent day including times, bg readings, insulin intake, carb count for meals, etc.
     
  3. diabetesgoddess

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    As Mikker noted, to truly help more details on the regimen used would be helpful. A few things though...we have been living with this disease for 10 years and readings still bounce all over the place. Stress and hormones can play a major role in creating highs. Certain insulins have different absorption rates as do different sites. Does he have any lypotrophy from injecting in only one favorite spot? Are the meals extremely different each day with different carb counts and fat content? Lots to think about but there are also a lot of people willing to help with some guidance. Usually a nurse or nutritionist can also help to get you on the right track.
     
  4. Toni

    Toni Banned

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    I would suspect Rebound blood sugars (was the high number very high, like in the mid 300s to high 300s?). Because you say he wakes up LO and then drops every half hour after being treated everytime. I would reduce the insulin right away. If he drops a half hour after you treat a correction, it could also mean his correction factor is too low. Or his insulin-to-carb ratios for meals is too low. But overnight I would suspect the basals. So I would reduce insulin and immediately do an evening/overnight basal test. I would give low fat dinner but with carbs. Check two hours after dinner to see if you can pinpoint problems with ICR. This may be difficult if basal is off but if you see a huge spike or drop, you can watch for this after the basals are set. So low fat dinner at 5pm. Test 7pm to get a broad idea, very broad, of his ICR. Test 9pm, 11pm 1am 3am and 5am if you can do it. Log in those numbers. Then post them here or you can PM someone privately. Wilf is a great help with this. You want his numbers to rise or fall no more than 30 points overnight. P.S. There are some who think Rebounds don't exist. We just had one last week where I woke up late holding the second alarm to my chest. So did not get up to check her after an 88 (which I had bumped up with juice). Cgms not on but her BS was 387. Plus she had another low later that day. Rebounds can occur, though rare.
     
  5. wilf

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    Thanks for posting and welcome to the site. :) Some questions:

    1) How old are you?

    2) Who has the primary responsibility for your brother's diabetes care?

    3) Which insulins is he getting when, and in which amounts each day?

    4) Who gives him his injections?

    5) How much does your brother weigh?

    6) Do you guys carb count, or how do you know how much insulin to give for each meal?

    Your answers to these questions will help us give you some good advice.. :cwds:
     
  6. arggggg

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    hi

    hi thank you all for replying ,

    im 26 , the care of my brother is shared between my father and i ,
    J's insulin is Lantus 13u with breakfast and Lantus 13u With dinner, he is on a sliding scale of Novorapid with Breakfast, Morning Tea, Lunch and dinner (with occasional afternoon tea novo doses if high ) his novorapid sliding scale has been given to us by the diabetes team and is based on his bsl at the time it usually ranges between 2-7 units . His meals are usually around the same carb and fat amount. although he does eat a lot , he can keep going for a long time before hes full, usually i can anticipate this and give him extra novo (though he stills shoots up)

    We are in regular contact with the diabetes nurse and we are trying to level him out with her help, but i saw this forum and thought id see if anyone has any ideas , living with it , while the hosp team doesnt. is this enough info? not sure of weight atm, will have to get it

    thanks everyone
     
  7. arggggg

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    hi,
    the waking up on LO and dropping every half hour and is the reasin he was admitted , he then shot up and stayed up. other days he did wake up on 1.2's ect , this was all at home, in hosp he leveled out after a day or so . On the low days he was having less insulin and enough carbsm so unsure what happened there. Could hormones be causeing him be everywhere?
     
  8. Lee

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    It sounds like your brother is experiencing a typical rebound.

    What happens is he has to much Lantus right now (remember - it will always flucuate and need to be adjusted based on a three day pattern) so he is going low.

    Sometimes, you catch it in time and are able to give him carbs to bring him up naturally. It sounds like he needs alot of carbs to bring him up, so you retest, and if he is going low, you give him more carbs...

    But sometimes, the body's natural defense mechanism kicks in and his liver dumps a bunch of glucose into his system. That makes him go high, but then you add carbs on top of that - and he goes even higher!

    So, the problem is not the fluctuation - the problem is trying to get rid of that AM low.

    Your endo should have you lower his Lantus dose at night to get rid of this low. This can be dangerous, so I would talk to them TODAY!
     
  9. wilf

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    We need the weight, and we need the details of the sliding scale please.

    Once we have those we can get to work.

    But my guess at this point is your brother is getting too much insulin, which is causing lows followed by "rebound" highs.

    About how much insulin in total (Lantus plus Novo) has your brother gotten on an average day the last few days? I'm guessing about 40 units - does that sound about right?
     
  10. Heather(CA)

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    If your brother is waking LO then shooting up he needs a LOT less insulin. What insulin is he on? Lantus? A pump? The highs are caused by rebounds, less insulin will stop the roller coaster...

    I would be aggressive with lowering the Lantus, Maybe go to 11 units morning and night, or even 10. You can always put it back up but all those lows need to stop.
     
  11. Becky Stevens mom

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    Hello and welcome :) Hey good on you for helping take care of your brother. I lost my Mother when I was 18 and helped care for my 2 younger brothers.

    From looking at your post it seems like your brother is getting alot of lantus of course thats comparing it to my son. Steven is almost 9, is 69 LBs and gets 10 units of lantus per day at night. During the day he gets 1 unit humolog to 15 grams carbs. If hes very active or going to be very active that will change. More like 1:30 or even 1:50 at times. Activity really drives my sons blood sugars down fast. Is your brother very active? He may be having delayed hypos at night. If hes lo then going very high he may be having rebounds. I would check with the endo nurse about cutting the lantus dose a bit.
     
  12. wilf

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    Just for comparison, my daughter who is almost 14 and weighs 120 pounds gets about 7 units each in the morning and at night..
     
  13. mmgirls

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    Just want tot say to the original poster that I have seen Wilf help so may people on Lantus get to the bottom of basal issues that create a roller coaster for everyone. You have come to the right place for help. Be as detailed as possible and those that can help you will be by your side.

    Your answers to these questions will help us give you some good
     
  14. frizzyrazzy

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    I think you both nailed it...without knowing anything else, he simply needs less insulin. A lot less. If your in contact with his diabetes team they shoudl be giving you new amounts.
     
  15. arggggg

    arggggg Approved members

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    hi,

    his weight is 40.1 kg
    height 1.38m

    novorapid sliding scale is breakfast, bsl under 10 = 3u
    bsl 10-15 = 4u
    bsl over 15 = 5u

    morning tea , bsl under 10 = 2u
    10-15 = 3u
    over 15 = 4u

    lunch , bsl under 10= 3u
    10-15 = 4u
    over 15 = 5u

    dinner, bsl under 10 = 5u
    10-15 = 6u
    over 5 = 7u

    plus 13 lantus with breakfast and 13 lantus with dinner

    as to who injects , sometimes its j who draws up the insulin (for lantus using inject ease) others its dad or i , same with dialing up his novorapid pen , again either he gives it or we do, but he is always fully supervised and the correct dose is given

    when he was in hosp over the weekend (for persistant lows) he started to level out on 13 lantus morning and night , but now we are home is all over the place again, havent sent him back to school as they are so out of wack atm. we have done everything we normally do , as per instruction from the diabetes team and are having issues , he was at diabetes camp in january and levels were fine there as well , it only seems to be when he is home that we have problems, its frustrating as now people are wondering if we are doing something to cause it and we know we arnt.. hence i came looking for the forum and ideas from people who live with children with type 1

    xx
    thanks heaps for your help
     
  16. frizzyrazzy

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    and when you called the diabetes team what did they say? He's obviously having problems and given the fact that he's been recently hospitalized for this, you really really really need to be talking to them.
     
  17. arggggg

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    he is normally very active and at school, just the last couple of days hes not been as active and has been home so i can monitor him
     
  18. arggggg

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    i know we need to be talking to them and have been , but they are puzzled as well, just thought id ask here as well
     
  19. Becky Stevens mom

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    Its fine that you came here, glad you did :) Im still thinking hes getting too much lantus. I know everyone is different but he more then twice what my son is and Steven is only about 20 lbs less then your brother. It is true that activity can really bring down blood sugars. I would ask the diabetes nurse if you should be cutting back on the lantus dose to make sure that hes not going low at night then rebounding in the morning.
     
  20. Jacque471

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    So does he get novorapid based on the carbs he is going to eat or is he just getting a shot based on his BSL at each meal time? Or do they have him on a fixed carb diet and that is factored into the ratios for each meal above?

    Here is what my son's basic MDI regimine was. (he is pumping now and BTW he is 3 so his ratios are smaller but you should get the idea).

    We had a sliding scale for corrections. So during the day for each 50 points he was over his target range of 200 he would get 1/4 unit. So 200-250 was 1/4 unit, for 250-300 it was 1/2 unit and so on. At night it was 1/4 unit for each 100 point over 250 because he was more sensitive at night and they didn't want to risk lows.

    Separately we also have carb ratios. Whenever he eats anything with carbs, he gets a shot. Depeding on the meal we had different ratios. Right now Breakfast he gets 1 unit for every 12 carbs. The rest of the day it's 1 unit for every 16 carbs.

    If he is high at meal time he gets his carb ratio amount plus his correction amount and that is the total shot he gets for that meal. Then we check at 2 hours post meal and if we were off he gets corrected again using the correction scale (or a snack if he is low and not high)
     

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