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Question for you pros out there . . .

Discussion in 'Parents of Children with Type 1' started by Lizzie's Mom, Oct 19, 2009.

  1. Lizzie's Mom

    Lizzie's Mom Approved members

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    Hi All,

    Up late checking bg #. Here's the scoop:

    Hubby takes 6 of 7 children to bonfire and hayride. Baby and I stay home - too cold for an 11 week-old!
    • Elizabeth before they left: 144 at 3:52pm
    • She eats 2 oz cashews on the way there, runs and runs - 113 at 5:23.
    • Eats hot dog, has diet soda (BIG treat), hot chocolate, they run out of marshmallows so no s'mores (dang for her, relief for me ;)) - 126 at 7:57.
    • Is home, has some chicken soup and buttered bread, milk, dosed per appropriate ratios.
    • Running late for bedtime AGAIN. Tests. 81 at 10:11. D-girl talks Daddy into 2 more oz. cashews. la la la Daddy not keeping track of time while mommy is up nursing baby. Mommy has D-girl re-test at 11:02 - 69 (yikes). I give her 8 oz. milk.
    • Re-test at 11:19 - 113. Better, and don't want to overdo, so I tell her to get settled for bed and re-test again after teeth are brushed, etc.
    • 96 at 11:50. Going the wrong way again. Get a bit more aggressive, wanting to counteract all that activity. I give 4 vanilla wafers with 1 Tbsp. Nutella and 4 oz. milk, about 27 carbs. D does have its perks. None of our other children get to have cookies with chocolate hazelnut spread at midnight!
    • Test at 12:20 - a comfortable 155. Off to bed with her.
    • I checked her at 2:20 - 276 :rolleyes:. One unit correction. And I'll be up to check her AGAIN, just to be sure she's not going low again. I know I could let her run high, but she's been grazing lately and I really don't want to go there, KWIM?
    So, could I have done better? Or is this just how the game is played?

    Tricks? Suggestions?

    Thanks!

    Wendy
     
  2. Barbzzz

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    Wendy, I think you did amazingly well, especially given you've got a bison for a daughter! ;) (My Alex is a grazer, too, makes me nutty.) It's likely the Nutella and the milk peaked her bgs a bit later, hence the high number at the 2:20 check.

    We had a similar deal yesterday, Alex went to bed at a nice 6.7 (120 for you) and woke me up at midnight to say she felt low and she was right -- 2.5 (45). Gave her a couple of Lucozade tablets and a bit of French bread with butter, but she wanted more -- a stupid cupcake with chocolate cream filling. :rolleyes: Naturally, at her 2:00 am check she was high -- 12.9 (232) -- and I had to give her a 1U correction... that should have only dropped her 5 points mmol (or 90 mg) but instead, it dropped her all the way to 3.2 (57) at 6:00 am. And all that with no IOB at all from last night (except for Lantus, but that's only 4U).

    Go figure. :p And, yes, this is the way the game is played. With no rules, and no fair fighting and no holds barred. :D:eek:
     
  3. wilf

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    Do you know how much 1 g of carbs raises her BG? Do you have a target for bedtime?

    27 grams sounds like way too much in the way of carbs to keep her from going low.

    The way we play the game is we know where we want to be in terms of BG, and whether we're treating lows or correcting highs that's what we aim for..
     
  4. Lizzie's Mom

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    Thanks, guys. Crazy busy day. Couldn't post 'til now.

    She was 220 at her next check and I decided I really needed to sleep, so didn't correct again. She was 230-ish this morning. Sigh.

    Barbara, thanks for the encouragement :). The Nutella might have been a bit much - I was just wanting to get her in bed and I knew that would do it, KWIM?

    Wilf - yeah, I'm still getting a handle on which carbs affect her how. A few nights ago she needed some carbs before bed and I gave her glucose tabs . . . was nursing and they were the handiest and quickest. they brought her up nicely, but she dropped to 55 in the middle of the night :eek: and I ended up feeding her a half a PB sandwich and 8 oz. milk (not in that order) - 32 carbs. She came up nicely and was at 120 something in the AM.

    I have a feeling that once I think I have it figured out . . . . it'll change again . . . . :rolleyes:

    Thanks!
     
  5. joan

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    I think you did great, especially because you weren't there to see how much running around she did. Sometimes at night I tend to give a little too much carbs if my son is low because I hate the night time lows. This is all about learning and we learn by doing. Is that picture a havanese? My dog looks exactly the same. Joan
     
  6. fredntan2

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    I sometimes feel like this raising a child with diabetes is equivalent to teaching your child to drive a car, but your eyes are closed.
    it would be much easier if we could just drive the car(have the diabetes)
    or would be much easier if we could open our eyes(have all the info)

    This is how we play the game.

    and yes the rules will change:D
     
  7. 2type1s

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    Wendy...I think the nuts and nutella probably caused a little fat spike. I've noticed as my girls get older, I see more evidence of fat spikes. I never saw them when they were little. I wouldn't worry about it too much. Exercise causes crazy lows in both my girls, but especially my younger one. It's a daily chemistry experiment, isn't it?

    On another note...where in Md. Tn are you? We had a Md TN mom's night out and 5 of us CWD moms got together for dinner..would love to have you join next time! We also get the kids together when we can arrange the schedule! Are you going to Vanderbilt FAmily day this weekend?
     
  8. Sarah Maddie's Mom

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    Nutella is a pita for us. She never has it at home but a hotel we stayed in on vacation this summer had it out with the breakfast buffet and even one of those tiny tubs (less than an oz. I think) wrecked havoc on her bgs. :rolleyes:
     
  9. Tweety8

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    Well, I think you did great!!!
     
  10. lynn

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    I think you did wonderfully. The goal was to keep her safe from an impending low and that's what you did. As you gain more experience with your daughter's diabetes you will learn to shoot for a more precise number. Then you will either hit that number (and feel GREAT!) or you won't hit it and you'll move on.

    Prolonged activity really affects Nathan for a long time too. It sounds counter-intuitive but sometimes I give him small amounts of carbs as we go. That seems to help. Also, if you ever go with a pump, it gets easier to deal with those night time drops because you can turn the basal down for a couple hours.
     
  11. Lizzie's Mom

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    Thanks, you guys, I feel so edified :D!
     
  12. Lizzie's Mom

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    The dog pic is just one I found online. I thought it was cute and expresses my general expression on the inside about D :eek:. We have a Beardie/Scottish Deer Hound/Something Else Mutt and this dog looks a lot like her, only she's all black.

    Learning by doing. I'm getting that ;).

    Thanks!
     
  13. Lizzie's Mom

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    Adjustments and Georgeous #'s

    I called Elizabeth's D-team yesterday as I'd seen a LOT more 200's than I'd like, even taking grazing into account.

    We raised Lantus by 1 unit and reduced her supper ratio to 1:15.
    • 171 before supper
    • 181 before bed
    • feeling like she was dropping around midnight, 91, 1 cup milk
    • 30 min. later only 97, but found out she forgot to drink her milk at supper :rolleyes:. Added that other 1/2 cup milk, gave 3 saltines with 1T PB
    • 120 at 1:32am
    • 137 at 4:19
    • 112 at 7:33
    • 127 before breakfast
    . . . :D
     
  14. wilf

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    It is odd that she's dropping like that in the late evening. That was part of the issue in your original post as well.

    I'm wondering if the timing of the Lantus is causing this - when does she get her Lantus?

    Certainly the numbers from 1:30 am through to before breakfast look great, but you shouldn't be having to deal with nightly big drops in the late evening..
     
  15. Lizzie's Mom

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    In the OP her low was due to LOTS of running at a bonfire/hayride (read chasing the tractor on a 20 acre farm :p) which is why I hit that low a little harder than I normally would have.

    Last night she forgot to drink the 12 oz. of milk we dosed her for :rolleyes:.

    Looking back at some of our 200's and the grazing, a bit of a growth spurt makes sense. I was totally on board with upping the Lantus 1U and did ask about the time we give it (9pm), and they said it should be fine.


    I'm very happy with her #'s through the night and today. Today's #'s so far:
    • 112
    • 127
    • 128
    • 148
    • 98
    • 91
    • 84
    Actually, I'm quite thrilled with those readings! I think bumping the Lantus was just the ticket - for now ;).

    We'll shoot for around 130-150 at bed time and see if she holds as steady as last night . . .
     
  16. wilf

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    She is at a good dose of Lantus right now - the steady night last night attests to that. :) The question I am raising is whether you'd be better served moving up the time she gets her Lantus from 9 pm to say suppertime.

    Lantus peaks in many children, and at the time it peaks it pulls down BG and tends to cause low BG levels. In most children that peak is at 4 to 6 hours after injection, which is about the time that you're maybe seeing a tendency to be on the low side.

    If you move the Lantus to supper time, the peak may help cover a bedtime snack.. :cwds:
     
  17. Lizzie's Mom

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    We eat a pretty late supper, 7-8pm most nights. And she only gets a bed time snack if she's low . . .
     
  18. Mary Lou

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    Hi! You sound like a very concerned, but understandably busy, Mom.

    What is your protocol for treating lows? Glucose tabs (or any fast carb) on their own will indeed raise BGs quickly, but once BG is raised, slow carbs (carbs + fat/protein) are needed to hold the BGs up.

    I think you might want to try to keep careful records as to how you are treating lows and lowish numbers and with that information you will be better able to bring up lows without causing a huge spike or another crash later.

    My younger son (who is 8), generally only needs between 5 and 10 carbs when his BG needs to pick up a bit. 27 carbs unbolused would send him through the roof.

    D is hard, but it does get easier. :cwds:
     
  19. wilf

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    Well, then a set, earlier time (say 6 pm) is something to think about for her Lantus.

    You'll know this better than me, but the common theme in every night you've posted about in the thread is her going lowish in the early overnight. If that is indeed a pattern (either longer-term or just developing), then what I'm telling you is that moving the timing of the Lantus forward is one possible way to deal with it.. :cwds:

    Good luck! :)
     

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