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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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    hi,

    they have got him taking doses using the sliding scale depending on bsl at the time , plus have said to keep carb amounts the same every time,
    example , 30g carbs breakfast needs to be the 30 next breakfast , 20g lunch carbs , same amount the following lunch

    so if we use sliding scale plus keep carbs the same for meals he is suppose to be leveling out , but isnt
     
  2. wilf

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    So he's 88 pounds/40 kg. Normal amount of insulin for his age might be 30-35 units or so, depending on how active he is and whether or not he's still producing any insulin. About half of that (anywhere from 40% to 60%) would normally be Lantus, so say 12 to 20 units.

    By any measure I can think of, the Lantus your medical team has you on is way too high.. :(

    Right now he's on 13 am and 13 pm Lantus. I concur with Heather's earlier post and would suggest that you drop immediately to 10 Lantus in the morning and 10 in the afternoon, with the possibility of further reductions as needed. That is still on the high side of what he should normally be getting, but is a big step in the right direction.

    The other thing you need to do is test maybe more frequently than you normally would. Every 1.5 -2 hours for the next couple of days. Keep posting the insulin he's getting and his blood sugars here if you're game, and we'll walk you through to the insulin regimen he needs to be on. :cwds:
     
  3. wilf

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    So how many carbs is he getting each meal on a normal day?
     
  4. arggggg

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    im about to call the nurse and give her an update, plus just got home with a new meter from chemist to make sure its not a fault with the one we were using, and i will, thank you heaps x
     
  5. wilf

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    I'm hoping she's on board with dropping the Lantus - I'll tell you even if she's not I'd drop it if it were a child in my care. Clearly the clinic don't have any idea at this point what is happening or how to help you get things under control. We do.. :)

    The immediate juxtaposition of LO then HI on the meter is a classic pattern for a child getting way too much insulin. The insulin overdoses cause the lows, and then the body's defence mechanisms kick in and through a combination of different hormones blood sugars will be kicked way high and insulin resistance will be very high as well as the body tries to protect itself from further lows.

    If those high readings are treated with further insulin (eg. more Lantus), then it won't have any measurable effect for hours until finally the insulin resistance from the last HI is gone and then suddenly the child will go low again. That pattern is exactly what you've described to us, and we have the remedy - less Lantus. :cwds:
     
  6. arggggg

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    nurse has told me to drop his lantus to 12 and 12

    levels in the last little while have been

    941am - bsl-22.9
    10.06am - 1st test 1.6 but 2 minutes later was 4.2
    12.24pm - bsl- 6.0 - did not give any lunch novo , wasnt sure with his lows
    1245pm- bsl-3.6
    221pm - bsl-9.2
    225pm- bsl-3.1
    256pm bsl-HI

    using brand new meter i brought today and normally for a hypo has a 125 ml twist drink and a sandwich made with peanut butter and 2 slices brown bread


    ?? :(
     
  7. Heather(CA)

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    Normally that would be fine, but if he's still waking up LO, that's not enough of a drop in insulin. I still think 10/10. You can always put it back up. Also, where is he getting his Lantus shots? If it's not in the bootie. That's the best place to help keep him stable:cwds:
     
  8. wilf

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    Thank you for posting these numbers - so helpful! :)

    If I am understanding you right, then he went into lunch at 6.0 (108) and you gave no insulin. Nonetheless 20 minutes later he had dropped to 3.6. :(

    Please help me understand the readings at 2:21 and 2:25 - were they really 4 minutes apart?

    I am gravely concerned that your brother is badly overdosing on Lantus, and that the medical staff advising you are not competent to deal with what I consider to be an emergency situation.

    Having seen these numbers I would not just drop to 10 and 10 Lantus - based on these numbers I would drop to 7 and 7. Immediately.

    These are not at all normal numbers. Everything I'm seeing indicates he is being overdosed with insulin, and could be badly harmed by an approach of "business as usual" which is what the 12 and 12 Lantus represents.

    I can imagine your quandry, trying to decide what to do given conflicting advice from your medical team and a bunch of well-meaning strangers half a world away.

    I would just have you ask yourself deep down, do you think your brother's insulin regimen is working well for you and for him? Because the nurse has implicitly (by not making any meaningful change) indicated that in her opinion everything is fine.

    We are telling you that things have gone badly astray, based on poor advice you've received from your medical team. In my opinion your brother is at serious risk of harm if he continues on this regimen. Please do what you think is right to help him.. :cwds:
     
    Last edited: Feb 9, 2010
  9. arggggg

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    we will drop him to 10 lantus at dinner and ten at breakfast and see how he goes , hes just had another low of 2.5 which is not even an hour after reading HI , nurse told us to drop him too 10 but its not going to be enough

    i have a new question if you dont mind , we were told when he was diagnosed that he most likely would crash with a bad hypo ,, that most children do in the first few years ,j has not crashed and has not really stabalised since being diagnosed. i have just today been told by a non medical professional that if they "crash" their body then resets itself and bsls level out , just wanted to know if this person is correct? just wondering if maybe the advice we are being given is intended to cause a crash for this reason , this would not be good and im not impressed if its the case. it jus seems strange that we are being told too give him to much insulin, just a thought
     
  10. Becky Stevens mom

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    I agree with Wilf. It does sound like your brother is getting too much lantus. Im not sure if they are trying to use this as a bolus insulin also but its not made to do that job. The Novorapid is supposed to be the one to take care of carbs and the lantus is the backround insulin. I think with all the lows hes having he needs to be dropped back to what Wilf suggested the 7/morning and 7/ nightime. Then you can work on the bolus doses for him. If its not enough basal we can gradually increase that. Im not sure why the nurse isnt taking this alot more seriously but Im very concerned about your brother having severe hypos again
     
  11. Becky Stevens mom

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    Oh no he should not be crashing. My son has not had a severe low that caused a seizure or unconciousness in the 5 1/2 years since hes been diagnosed. Actually when they crash it takes some time for the liver to recover from this so when that happens its very important to keep them from having a severe low again anytime soon. I dont like to think about what could happen then
     
  12. wilf

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    10 and 10 Lantus is good, 7 and 7 would be better.. But it is your call, and I'm glad you're taking this major step in helping your brother.

    I am not going to second-guess the thinking/motivation behind the dosing advice you were given. But from the bottom of my heart I know it to be wrong under your current circumstances.

    If you are going 10 and 10 Lantus then I would not bolus for any meals until his blood sugars are safely up to around 10 mmol (180)..
     
  13. arggggg

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    dads at work and im talking to him on thetelephone while i reply to you , thank you very much in case i havent already said it ,
    dad is saying we drop him to 10 lantus at dinner and keep a close eye on him , will be doing hourly checks thought the night and see how we go, thinking that 7 is a bit much and we can always drop it again if need be in the morning , he woke up on 19.1 this morning so my problem today has been daytime lows.
     
  14. arggggg

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    im just going to leave a big *SIGH* :) j has just noticed and said "you sigh a lot lately" :) cute
     
  15. Heather(CA)

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    This is going to sound weird, but you REALLY need to ignore the really high numbers right now. They would not be happening without having a low first.

    The body can protect itself, but it doesn't go back to normal right away, especially if you give full corrections, they can stay high from a rebound for 24 hours or longer:eek:. That's what your brothers highs are from. They are hard to get back down right? Next time try giving less insulin, that will bring him down faster.

    I'm glad your giving less, (Don't forget to give it in the bootie :cwds:) if he wakes up really high or low, lower it some more. Also since he is very active. The "Normal" amount for his weight is probably going to be too much. Exercise has a huge affect of bg's and insulin needs.

    A rebound is the body's panic mode, it happens with undiscovered lows. The liver kicks out glucose making the blood sugar go into the 300's. The thing is that this glucose is a loan, the liver wants it back. It doesn't feel comfortable taking it back if you keep giving full corrections so they stay high for hours even days. If you don't correct they will come down eventually as the liver takes the glucose back or if you give a partial correction they are usually down in a few hours because you leave wiggle room for the liver to take the glucose back. Does that make sense?

    Rebounds aren't fool proof, so lowering his Lantus like your doing is very important. His stored are probably low which makes me nervous:(

    Keep us posted:cwds:

    I just wanted to add that your brother is lucky to have a great smart sister like you :D How does he feel about bootie shots?
     
  16. jewlzann

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    reading this for education

    can somebody please explain rebounds to me? i dont really understand when u pros talk about these? wondering if we are experiencing this?
     
  17. Heather(CA)

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    Check out the post above yours:D Feel free to ask questions, I'm tired so I'm not sure I explained it well:cwds:
     
  18. arggggg

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    told him hes getting booty shots tonight and he squeeled like a girl and is now sitting on the sofa glaring at me haha :D
     
  19. Becky Stevens mom

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    Yep, Heather explained it real well:) When the BG goes low you will have a rebound, especially at night. this is called the Semogyi affect for the Doc who discovered it. BGs can go low at night then the liver will kick out glucose but cant regulate how much so it will usually be too much and the CWD will wake up with high numbers. Often this makes you think that they need more insulin which can set them up for even worse lows. Thats why if we see high numbers in the morning we will do more night time testing to see if its rebound or dawn phenomenon.
     
  20. Heather(CA)

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    HA HA Show him Seth's pic and tell him Seth is 14 and until he recently went on the Omnipod that's where he got his Lantus... Oh and...It hurts less;)
     

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