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What do you do for highs that hang on for hours

Discussion in 'Parents of Children with Type 1' started by mylemonadelife, Jan 3, 2012.

  1. mylemonadelife

    mylemonadelife Approved members

    Jan 3, 2012
    This is Rae, I just changed my username (s0ccerfreak).
    I could use some help. What do you do for highs that hang on for hours? You know those obnoxious highs that just stick around. Bg hits 200 (or more) and stays there for hours, seemingly forever. Prompting a larger bolus, temp basals, and lots of liquids, yet seems resistant to insulin. No ketones, just high bg.

    I am having one of those days. I went to bed at 212 then woke up at 5:30 to find that I had disconnected my site during the night and was 434. How does that happen? Put myself back together, took a good sized bolus, cranked up the basal, drank some water, then hit the pillow for a few more zzz's. The lowest I have been since then is 177. I have not had ketones. I have tried my pump, shots, different site, new insulin, basal at 200%, but nothing seems to make a difference.
  2. Freudie1

    Freudie1 Approved members

    Jan 4, 2012
    A couple of things:

    First when you are disconnected for any amount of time you have lost basal infusion time.

    This can/will affect your future BG's as much as 24 hours later. In fact in the case of one of my kids, its a full 12 hour cycle (what we her basal rate 12 hours ago was will affect what we see 12 hours later).

    So keeping that in mind you are now bolusing to fight the high AND you have less basal on board due to the disconnection. So I 100% would expect a high fight in this scenario.

    What to do? I recommend bolusing more than what you normally do. How much? Not for me to say as I don't know your sensitivity ratio. More importantly, DO YOU?

    By that I mean, do you know on average how much insulin (by units, or smaller) will drop you X amount of BG points?

    Case in point: I know that my oldest daughter with T1 will drop approximately 20 points for every .1u of Novalog. So if she has had a site pulled out, took a long shower, sick, etc lets use the following example:

    She is high. She meets the criteria above. BG reads 250. NORMALLY I would bolus 0.7u of novalog. This based on our known sensitivity ratio should drop her 140 points bringing her to a great reading of 110. Now, unfortunately she is behind in basal in this scenario AND is a bit sick. What to do? I would bolus 1.0 units. Using the NORMAL sensitivity ratio (note the optimal term is "normal") this would drop her 200 points resulting in 50. However, two things to understand:

    My daughter can/does handle lows that high with no seizures, issues, etc (other than the half cup of apple juice to fix that).

    Second, NORMALLY she will not drop that low in the above scenario. What we do is we test 1 hour after this "large" bolus so we can get a handle on anything more serious before the actual 2 hour peak (Novolog peaks around 2 hours on the action curve for most people). If I am right, she will drop slightly and we bolus more (or not at all). I I am wrong we give a small amount of apple juice to correct.

    Now, keep in mind this is all educated guess work. No one is psychic, but we sure do have a good fine tuned intuition into what our kids react to now. You should be able to do the same!

    Take care.
  3. mmgirls

    mmgirls Approved members

    Nov 28, 2008
    Are you still doing untethered?

    Have you tried new vials? You went to bed a bit high, where you higher before that number? Just wondering if you where on the way up and the pulled site is a secondary.
  4. mylemonadelife

    mylemonadelife Approved members

    Jan 3, 2012
    Yes, I'm still doing untethered. I have been since I was 12 or 13 and it has been a great help.
    I was 130-200 during the day on Monday. I have opened a new vial of novolog and my lantus pen is new.

    Thanks, as I mentioned above I had been taken larger corrections than my typical based off my ISF. I am very careful in doing this; I have a cgms and I test more frequently.

    This isn't a pattern; just a one day fluke of crazy numbers.
    Last edited: Jan 4, 2012
  5. Lee

    Lee Approved members

    Oct 5, 2006
    Rae - I wonder if your correction factor is off - are your corrections bringing you back into range? If not, you may want to bump that up. I find that a bad correction factor will ruin good numbers quicker then anything!

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