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Things that have helped, but...

Discussion in 'Parents of Teens' started by mariaweber, Nov 3, 2010.

  1. mariaweber

    mariaweber Approved members

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    Thanks Wilf, yes it certainly is a lot of insulin! Especially for a runner.

    Anyway, to answer a couple of your questions:

    The apple was a big, juicy, Honey Crisp. She weighed it on the Salter Scale and used bolus wizard. It was 35 g according to the scale, however, I believe that those particular apples may have a lot more sugars in them...but, I don't know so we go by the scale.

    She bolused for the apple only 10 minutes before she ate it, instead of the 1/2 hour that she usually does for breakfast. This is what I think the issue is.

    As for rebounds from lows -- I don't know that we've ever experienced that except as the result of over-treating (which we see to be doing all the time). Soife is super sensitive to lows and feels them even in the 4.0s. We're trying to get her to treat with a light touch at this stage -- only 5g of carb instead of 15.

    I think, personally, that she simply needs MORE insulin at these key times. We are upping her basals slightly today during the key times, and instituting the early bolus.

    As for exercise, she had a day off yesterday as she is recovering from a cold and an injury -- so it was a lazy day.

    Thanks for your help.
     
  2. mariaweber

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    Thanks Fran. I needed that. :)
     
  3. emm142

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    I might have missed this, but have you done any daytime basal testing? When my basal is a bit low, I tend to get big post meal spikes. On a normal day, I run the daytime basal a bit higher than I woukd need when fasting, which tends to make things less spikey (although I do have to remember to eat!).
     
  4. Brenda

    Brenda Junior Member

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    For reasons that are not clear, your daughter seems to need more insulin than the average teen with type 1. Though I know almost nothing about it, how about trying U-500 insulin? It is my understanding that it can be prescribed for those with insulin resistance, those taking more than 200 units a day. Now, I don't know anything about its use in a pump.

    Other potential options: I am not sure if it is prescribed for children and I don't know much about its use, but I know some people inject Symlin. I'd do some research, starting at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000314

    Some people who seem to be insulin resistant take metformin.

    I think both Symlin and metformin have side effects.

    Some random thoughts which may or may not help your daughter.
     
  5. Sarah Maddie's Mom

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    I'm pretty sure the OP said her dd's TDD was about 60u. Though perhaps I misread her comment?
    Which doesn't seem to me like a crazy amount for a hormonal teen, no matter how active.
     
  6. mariaweber

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    Yes, you're right. She's at about 60u per day. I'm thinking the the issues is just MORE insulin.

    We're jacking up the basals -- especially during the day when she is the most spikey.
     
  7. Sarah Maddie's Mom

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    Fwiw, my, lax/fieldhockey/"if it has a ball, I'll play it", 12 yr old has had 70+ u days ... make that weeks.
     
  8. Brenda

    Brenda Junior Member

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    I did not mean to imply she was taking 200 units or more of insulin, just that she was exhibiting signs of resistance that maybe could be helped by U-500 insulin, Symlin or metformin. Tried to explain that I am not an expert at this. What struck me as unusual was the basal/bolus ratio, that her insulin to carb ratio was high/low (not sure how to say taking a lot of insulin for few carbs). For a thin athlete, the young lady in question is taking a lot of insulin, in my opinion.
     
  9. StillMamamia

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    Another thought, especially with your child being an athlete. Maybe contacting Gary Scheiner would help? At integrateddiabetes.com or .net, can't remember.
     
    Last edited: Nov 4, 2010
  10. mariaweber

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    Thanks again for everyone's suggestions. They are all really helpful.

    We're thinking that more insulin is in order -- plain and simple. It's just difficult to wrap our head around it, but it's just the way it goes. Diabetes is so tricky with exercise too. I've been reading that aside from the differences between competition and workouts -- aerobic and anaerobic workouts, there are issues with "exhilaration" in exercise. So if Sofie goes out for a training run by herself, and it's just a slog, she might go low, but if she's with a bunch of her team mates and they are all feeling really frisky, she may go high due to this "exhilaration" factor -- fun! :p

    As for working with an athlete, there's an guy on the Canadian Olympic rowing team named Chris Jarvis who is type 1 and has been working with Sofie.

    I know, I know...with all this help you'd think that she'd be fine. Believe me, we're trying. That's what makes this so difficult.

    We are going to continue to raise basals with the hope that things start to level off.

    Is 1:4.5 that low a carb ratio? What are others doing?
     
  11. Sarah Maddie's Mom

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    I agree that her I:C ratio is very high. But her TDD falls within the range of #'s presented by other parents of teens, so it's hard to know.
     
  12. mariaweber

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    Sorry, I'm "junior". What does TDD mean? :confused:
     
  13. Sarah Maddie's Mom

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    TDD - Total Daily Dose
     
  14. Jordansmom

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    Just as a comparison, my DD is 14 at hers is 1:9.
     
  15. Sarah Maddie's Mom

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    Maddie's is 1:9 and 1:10
    She a muscular, 5' 4" with a TDD ranging from 60-72u usually a basal/bolus 40/60 split ... though we've been tweaking things and that may have changed a bit.
     
  16. mariaweber

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    Hmmmmm.... interesting.

    Our endo insists that basal/bolus ratios should be 50/50, that's why we keep bumping up (or down, I guess) the carb ratios.

    Perhaps we need to experiment with higher basals and lower (I mean higher) carb ratios.

    Just out of curiosity, what is your highest basal rate and when? I'm amazed that you range from 60 - 72 units with such a low carb ratio. Sofie's highest is at 10 am until about 1pm and it's 1.95.

    It's so interesting to hear about how others are dealing with this.
     
  17. wilf

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    Actually it's about par for the course for a girl that age. About 1.2 units per kg body weight per day - it can go as high as 1.5 IU/kg/day for some girls.

    But things should get easier going forward a year or so. :cwds:
     
  18. kiwiliz

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    We have been dealing with the same problem. TDD has been over 80 uinits - 13yo very athletic, currently around 65 - 70. I think it might be your basal. We ignored the basal/bolus 50:50 ratio thing and have daytime basal around 2 u per hour (overnight it goes down to .85ish). This has helped immensely. No breakfast spikes. The basal seems to be much more efficient than the bolus insulin. When she wants a sleep in I just move the start time of the "day" basal. Carb ratios 10:1 for breakfast up to 16:1 for dinner. We drop overnight basal by 12% on training days.

    As a footnote I was just sent this article which explains that exercise can raise blood glucose levels. http://www.diabeteshealth.com/read/...ten-raises-blood-glucose-in-type-1-diabetes-/

    I think you are on top of this and have probably already read similiar articles but it helped explain to me why it is so unpredictable. I have been logging religiously since this season started - I think that is all I can do. I also read that machines giving off emf can raise levels - does she train on a treadmill or have those low energy lightbulbs anywhere?
     
    Last edited: Nov 5, 2010
  19. chbarnes

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    Our I:C ratio is 1:5 for breakfast. I don't think the amount of insulin you are using is so very high for a growing teen. All of these calculations are used by professionals when they start someone on therapy - it always needs refinement. That is what you are doing now. Just keep looking at the numbers, isolate individual variables, make small changes, and see what happens. It is awfully hard to get everything written down from your meter, and organized in a way that let's you see what is going on every day. When you and your daughter are comfortable resuming CGM it will make the process much faster each day, and also reveal the patterns that are sometimes hidden between the fingersticks.
     
  20. wilf

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    Certainly having more basal in the mix tends to make for a "smoother" ride.. :cwds:
     

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