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Please Help!

Discussion in 'Parents of Children with Type 1' started by klostien, Dec 21, 2011.

  1. klostien

    klostien Approved members

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    It will be a year in January since my daughter's diagnosis and we still have not be able to get her numbers under control. I have worked extensively with her doctor and she even had an ipro on for a week. Right now her insulin (novolog) ratio's are 1 to 12 for breakfast, 1 to 20 for lunch (doctor's office just had us change yesterday from 1 to 15), 1 to 12 for dinner, 1 to 12 for snacks, 1 unit for every 50 over 200 during the day, 1/2 unit for every 50 over 250 at bedtime and 9 units of lantus at bedtime.

    I have a copy of her diet records that I sent to the doctor's office on Tuesday to review. If anyone would like to help me I can email her records.

    I just don't know what to do anymore. Any suggestions would be greatly appreciated!
     
  2. lisamustac

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    Post what her numbers are before and after the meals. We can help you better if we know the numbers you are up against.
     
  3. pianoplayer4

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    it would help if we could see some of her numbers, maybe a day or two just put the time you tested/ what her number was/ how many carbs she had/ how much insulin was given we can't really help unless we know what the problem is
     
  4. mandapanda1980

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    I agree, post numbers. But just as a mention, she is getting a lot of insulin..all of her ratios and corrections are higher than allis. And we've been at this for trip years. Not saying those are strong, ydmv, but just an observation. is she having highs or lows that you are trying to work out?
     
  5. Becky Stevens mom

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    Krissy, is she getting Lantus or Levemir? What exactly do you mean by "under control" are her #s all over the place every day? Mostly highs and then crashing lows in between? Highs every morning? Lots of lows? Definitely post a few days worth of numbers so we can see whats going on
     
  6. klostien

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    Here's what her numbers have been for at least the last few days.

    12/19
    6:32 am - 208
    10:00 am - 238
    12:10 pm - 312
    2:00 pm - 309
    4:04 pm - 59
    5:18 pm - 114
    7:57 pm - 201
    8:21 pm - 236

    12/18
    8:18 am - 291
    10:56 am - 136
    2:16 pm - 143
    5:23 pm - 237
    7:28 pm - 180
    9:00 pm - 150


    12/17
    9:19 am - 225
    1:25 pm - 80
    3:00 pm - 350
    5:38 pm - 220
    7:01 pm - 159
    9:26 pm - 152

    12/16 - This was almost a perfect day but has not happened since
    6:36 am - 121
    9:00 am - 111
    12:10 pm - 80
    2:00 pm - 181
    6:14 pm - 53
    8:46 pm - 112

    12/15
    5:07 am - 177
    6:45 am - 138
    9:00 am - 241
    12:10 pm - 186
    2:00 pm - 285
    3:40 pm - 62
    5:44 pm - 142
    8:15 pm - 139

    12/14
    1:00 am - 103
    5:48 am - 74
    6:39 am - 95
    10:00 am - 344
    12:10 pm -307
    2:00 pm - 290
    3:39 pm - 56
    5:07 pm - 129
    5:27 pm - 167
    7:07 pm - 205
    8:46 pm - 254
     
  7. klostien

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    Forgot to include the insulin


     
    Last edited: Dec 21, 2011
  8. Becky Stevens mom

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    Oh good, thank you. First of all, Im thinking growth spurt as it seems like her #s have steadily risen the last few days or she may be coming down with something like a cold virus, even if she's not showing symptoms her blood sugars will rise when the virus has just infected her because of the immune response.

    If at all possible I would try to do at least one test in the middle of the night. This will hopefully help to figure out why the high #s some mornings, if its a rebound from a low or if she just went high and kept climbing. If you catch a high during the night and correct it there's a better chance of a decent wake up # and not as much insulin resistance from a high # thats been there for most of the night.

    Im seeing some lows after high #. Are you correcting those highs? You may need to cut back on her correction insulin especially in the afternoons as that seems to be the time that shes more insulin sensitive.

    I sometimes see variabilities from the Lantus shot with Steven if I give it in an area of his buttocks that is over used and has fatty tissue build up so I have to be careful to avoid those areas.

    I see now that youre not correcting the highs in the afternoon. Is she getting her lunch time bolus before or after lunch?
     
  9. klostien

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    We have made a few changes to her insulin. She was on 12 units of lantus a little over a week ago. We have also changed her breakfast and lunch ratios so incorporated with all of these numbers are some changes.

    She gets checked at 2:00 pm before she gets on the bus and when I get home I check her around 3:30 - 4:00 and she is usally going low. This is why I think they changed her lunch time ratio to 1 to 20. She has recess, then get her insulin and then has lunch.
     
  10. tiger7lady

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    I'm seeing quite a few times where she was either normal or higher, had uncovered carbs, and then ended up higher. You might need to start covering those snacks. However I see later in the week you gave some uncovered snacks and she was fine...hmm.

    12/19
    6:32 am - 208 - 2.5 units - 24 carbs
    10:00 am - 238 - 0 - 12 carbs
    12:10 pm - 312 - 5.5 units - 40 carbs
    2:00 pm - 309 - 0 - 0 carbs
    4:04 pm - 59 - 0 - 19 carbs
    5:18 pm - 114 - 4 units - 48 carbs
    7:57 pm - 201 - 9 units lantus - 15 carbs
    8:21 pm - 236 - 2 units - 19 carbs

    12/18
    8:18 am - 291 - 5 units - 24 carbs
    10:56 am - 136 - 0 - 0 carbs
    2:16 pm - 143 - 0 - 8 carbs
    5:23 pm - 237 - 3.5 units - 43 carbs
    7:28 pm - 180 - 1.5 units - 20 carbs
    9:00 pm - 150 - 2.5 units + 9 units l - 29 carbs


    12/17
    9:19 am - 225 - 4 units - 36 carbs
    1:25 pm - 80 - 0 - 35 carbs
    3:00 pm - 350 - 8 units - 65 carbs
    5:38 pm - 220 - 0 - 0 carbs
    7:01 pm - 159 - 7 units - 83 carbs
    9:26 pm - 152 - 9 units lantus - 24 carbs

    12/16 - This was almost a perfect day but has not happened since
    6:36 am - 121 - 1.7 units - 20 carbs
    9:00 am - 111 - 0 - 0 carbs, 10:00 about 12 carbs
    12:10 pm - 80 - 2 units - 30 carbs
    2:00 pm - 181 - 0 - 0 carbs
    6:14 pm - 53 - 4.5 units - 62 carbs
    8:46 pm - 112 - 3 units + 9 units la - 35 carbs

    12/15
    5:07 am - 177 - 0 - 0 carbs
    6:45 am - 138 - 1.5 units - 24 carbs
    9:00 am - 241 - 0 - 15 carbs
    12:10 pm - 186 - 2 units - 30 carbs
    2:00 pm - 285 - 0 - 0 carbs
    3:40 pm - 62 - 0 - 21 carbs
    5:44 pm - 142 - 3.5 units - 42 carbs
    8:15 pm - 139 - 9 units lantus - 17 carbs

    12/14
    1:00 am - 103 - 0 - 0 carbs
    5:48 am - 74 - 0 - 3 carbs
    6:39 am - 95 - 3.5 units - 42 carbs
    10:00 am - 344 - 0 - 8 carbs
    12:10 pm -307 - 5 units - 33 carbs
    2:00 pm - 290 - 0 - 0 carbs
    3:39 pm - 56 - 56 - 25 carbs
    5:07 pm - 129 - 0 - 0 carbs
    5:27 pm - 167 - 1 unit - 12 carbs
    7:07 pm - 205 - 0 - 0 carbs
    8:46 pm - 254 - 3 units + 9 units lantus - 34 carbs
     
  11. klostien

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    Please take a look at the comments below.


     
  12. Christopher

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    Normally if you don't give insulin for carbs, you are going to see her bg go up. It seems she needs an increase in her long acting insulin as well.

    What does your Endo say is the solution to all these high numbers?

    I agree with the previous comment that you should be checking at night. She is waking up high almost every day. Checking and correcting her at night will help her wake up in range.

    Also, you said:

    Who are "they"?? The school personnel? Why would they be making changes to her ratio that you don't know about?

    Additionally, if she is getting insulin after she eats there is a good chance you will see a spike in her bg afterward. I know sometimes there are reasons why insulin needs to be given after the meal, but I am just saying that could contribute to the high numbers.
     
    Last edited: Dec 21, 2011
  13. klostien

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    The doctor's office advises us on all changes.

    Yes, I do realize this. Some weeks are a little bit more crazier than others. The doctor's office said not to treat for her morning snack. She has gym at 9 am a couple days a week, has snack at 10 am and then recess at 11:55 am and lunch at 12:10 pm.

    We just did some decreases to her long lasting insulin last week. Her numbers were actually worse than this and she was going low a few mornings. There has been a few changes over the last couple of weeks working with the doctor's office.

    I had just sent the endo's office all of these records on Tuesday. The only thing that they said was to change the lunch time ratio back to 1 to 20 from 1 to 15 in which they had me change that last week from 1 to 20 to 1 to 15. Told me to round down on the insulin, to make sure she if getting her insulin at least 10 minutes before eating and to change her nighttime snack ratio to 1 to 15 from 1 to 12.

    The week before we did a few checks at night time. I do not have those numbers with me. I have told my husband that we need to get back to checking her a night a few times, but the doctor's office has never told me to make any corrections at night time.
     
  14. klostien

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    She does not get insulin after she eats, always prior.
     
  15. Becky Stevens mom

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    Ah, ok. Thank you for giving the extra info. I think that it may be fine if she gets the uncovered snack in the morning but only if her blood sugar is under a certain #. If its high to begin with such as on this day:

    10:00 am - 238 - 0 - 12 carbs - This is her scheduled snack time at school and we have been instructed not to give insulin for this.
    12:10 pm - 312 - 5.5 units - 40 carbs - Lunch time 2.5 insulin for lunch and 3 units adjustment

    It will continue to rise but if its a in range # to begin with its probably going to be fine.

    The endo is probably figuring that her activity at recess is going to pull her down as well which may be causing some of the lows that are happening in the later afternoon. She's having recess, insulin and then eating. Is this correct? She may need more protein in her lunch to deal with that delayed hypo in the afternoon.

    Some afternoons she seems to drop rapidly after the 2PM test . Is the nurse making sure that she washes her hands carefully? Is she retesting after getting high #s like these? And the nurse is not giving any corrections for these #s, is that correct?
     
  16. klostien

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    Yes, she has recess then insulin then eating. That's a good point on the protein. Her typical lunch is a salami sandwich on kid's choice white bread with no crust (11), some type of fruit, latetly clemintine (9), carrots (0), water (0), and some kind of treat (10). I pack a string cheese but she has not been eating it. Is to shy to get milk from the lunch line since she brings her lunch, any suggestions...

    They always wash her hands before testing. The school nurse does a great job with that and I have checked the meter for accuracy. The nurse will only give a correction at lunch time or if she checks with me due to having a special snack at school.

    One of the problems we were having last week is that when my daughter is dropping fast or getting ready for a big drop she get's really sick to her stomach. She was in the nurses office 7 times last week due to this.
     
  17. CheriMomTo8

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    Hey Krissy! Have you read "Think Like A Pancreas"? That book helped me SO much to sort through the sort of situation you are dealing with. It really empowered me to figure out insulin and basal changes without waiting on the endos office. There are so many variables that go into our days, I started to see cause and effect better and roll with it according to that days needs.

    Not that we have it figured out! Viruses, growth spurts, GI infections, abnormal increases or decreases in activity- anything really can throw things out of wack. Just a suggestion and it helped me not to feel so helpless.

    Blesssings!
     
  18. Christopher

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    You have been at this almost a year, I am not sure why the endo would not have you correcting at night. Especially when she is waking up so high almost every morning. If you/they don't want to do corrections at night then maybe try adjusting her long acting so she wakes up more in range? Also with the Lantus, you may want to consider splitting the dose or trying two doses of Levemir.
     
    Last edited: Dec 21, 2011
  19. mom2ejca

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    I would start with cutting out the bedtime snack (at least for a few nights) so you can see what is happening with her overnight basals in the absence of food. If you have food and active insulin going on in the hours after bedtime it can be very difficult to sort out what is basal vs. bolus problem. If she must have something for a bedtime snack then she could have no carb-low fat, something like sugar-free jello.

    And ideally, you would want at least 1 overnight check on those nights, 2 would be even better. So bedtime, midnight and 3 am would be good times to check:)
     
  20. klostien

    klostien Approved members

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    I have started reading but have only made it to the pump section. I have been taking a little break from all of the reading trying to rest my mind. I will have to get back in gear and continue reading. Just hard to find the time.
     

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