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You'd think her insulin was water

Discussion in 'Parents of Children with Type 1' started by BittysMom, Jun 21, 2012.

  1. BittysMom

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    No matter what I did, I couldn't get Caroline out of the 300/400's yesterday. From breakfast until bed. So glad she was with me instead of at school considering I bolused/corrected her 9 times yesterday and still got nowhere. I thought I was being aggressive. Pssht.

    Her TDD was over 10 units yesterday, and that's not even counting the additional temp basal insulin- and that still didn't get her below 380 until 9pm. Three weeks ago when we started pumping, her TDD was about 5.75. For the past two weeks it's crept up and has been around 6-7. But yesterday, I went through 2 sites, injections, 2 different vials of insulin, ran 3 2-hour temp basals that didn't work...

    She was high 100's all night and 200 pre-breakfast. I prebolused by 20 minutes and did a 1 hour +10% basal. Her breakfast spike was up to 376 and Caroline said "Oh no, not again". She didn't seem to care yesterday but I guess a repeat doesn't seem appealing.

    I'll call our CDE for advice but just thought I'd come here and vent or see if there was something else I could have tried... I don't think it will be a one day deal.

    Thanks:cwds:
     
  2. Mrs. Russman

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    I am surprised the injections didn't bring it down.
    Maybe she is coming down with something?
    Maybe it's just a diabetes gremlin gumming up the works.

    We had a whole week like that last week. A lot of ups and downs and saw 400+ twice. Since starting pumping he hardly ever went to 300.

    This week he is hardly above 100 (but he is at diabetes day camp this week)
     
  3. Connie(BC)Type 1

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    Did you change insulin vials? Opps, meant "lot #'s" on the vials
     
  4. BittysMom

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    I feel like since starting the pump she's coming out of her honeymoon. I don't really have a basis for saying that other than the increase in her TDD but even days where her numbers are good, she's needing more insulin than on shots.

    I don't know. Maybe it's the weather. I hope your son has a blast at camp.
     
  5. BittysMom

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    The first vial was the one our CDE gave us at pump start and the 2nd was from my pharmacy, so I'd imagine they're different lot #'s.

    The nurse just told me she was 207 3 hrs after breakfast and she bolused her for snack. Now I have a sneaking suspicion she's going to go low by lunch like she did 2 days ago (I haven't adjusted any pump settings) so we'll see... 1/2 hour to go.
     
  6. emm142

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    A +10% basal probably isn't enough. In fact, if she's on low rates and the pump rounds down, it quite possibly isn't adding any basal whatsoever. I'm aggressive and go straight to +100% :eek: (it totally works though...) but I'd suggest at least doing +50% for a couple of hours.
     
  7. Debdebdebby13

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    My dd is just a little bit younger than yours and is a fairly new diagnosis as well and she did the exact same thing a few weeks ago.

    She went from a TDD OF 4-5u per day, to 12-14u per day and it's stuck. She's gone down a little and she has been at 10-11u per day for the past 2 weeks. I think in her case it was a case of her honeymoon taking a significant step down. She's not quite at the magical .5u/kg of body weight that signifies the end, but it is really close.

    We are still MDI but we are going to start pumping (Omnipod) in the next couple of weeks and I could not be more ready after all of the corrections in the last few weeks.
     
  8. Lisa P.

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    Ketones help diagnose the problem sometimes. If she is high all day with ketones, she probably isn't getting enough insulin. If she is high all day without ketones, she may be getting "too many" carbs for the insulin or have insulin resistance or an illness, etc.

    So in those circumstances I look to see if there are ketones. :)

    Just a note, after a long time we found our delivery on the pump was simply not as good as that with shots. I've heard others say the same thing. I think it's not common, but keep an eye out if you wind up seeing harder management with the pump.
     
  9. BittysMom

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    Yesterday was my first time doing a temp basal, so yeah, I wasn't much of a warrior with it :). Next time.
     
  10. BittysMom

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    So far I love everything about the pump more than mdi except the results we're getting. ;) Now that schools out I'm going to do some daytime basal testing so maybe that'll help. It's still new.
     
  11. BittysMom

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    She didn't have ketones at all thankfully. Today she's still running high but not nearly so. 120-240. I'll bet it wasn't an insulin or pump issue, but something with her own chemistry for whatever reason.

    She's swimming now. I bolused her for the basal she's missing and didn't carb her at all. Maybe that'll take her down a notch. Thanks.
     
  12. Mommy For Life

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    This sounds like the same scenario I had with Olivia. Her TDD at pump start was 5u or so ....then within the month or two her tdd was up to 10-12 u. Do you adjust her ISF when she is that high? I noticed I need to really drop DD's ISF down if her bg is above 250. 10% temp basal don't do much for us since some of her basal rates are so small during the day....30%-50% usually work for us if we increase or decrease because of high BG or activity. We have only once had to do a correction via syringe since starting the pump...eeegosh Olivia was not happy....but I had given over 3 corrections on the pump and she was still not coming down. I would suggest you keep looking for patterns...if you see consistent highs... if those highs are not food related, keep bumping up the basals. Also what is your ratio to bolus to basal? I usually see better numbers if I can get a 60/40 or 50/50 ratio. It is all overwhelming at first, but we love pumping! Hope Miss C's swim helps bring her BG down!!! I bet she is just growing and her insulin needs are increasing....good luck mama pancreas!
     
  13. Lisa P.

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    If she had no ketones at all, my guess would be illness or a huge growth spurt.

    Selah will often have a period of very elevated blood sugars for several days surrounding when a sister gets sick. I'm convinced we're seeing her body put out glucose to fight the infection, a fight she wins so we never see symptoms! :D I wonder, were there a lot of kids out with a stomach bug or a cold in her class during the last few days?

    Growth spurts also come in spurts and can show strong highs, especially when you get a high for several hours from the surprise growth spurt and then insulin resistance sets in.

    But in my understanding, if you aren't getting ketones you very likely are not looking at bad insulin or a bad pump site, because if you are not getting insulin you probably will develop ketones.

    Today good?
     
  14. FloridaMom

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    Ugh! We occasionally have days like that. It's so frustrating - change pods, temp basal, etc. and nothing works! I always try to tell myself that tomorrow will be better!
     
  15. BittysMom

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    Swimming seems to have helped. 136 when she came out and 87 just now before dinner. Looking back, you're right: running the +10% was giving her the same amount. Duh.

    I wanted to use a different ISF but felt like I didn't have a basis to pick a number. I wound up correcting every 2 hours instead. I still can't believe it didnt work, just glad today is better.

    I'm going to try to do some basal testing tomorrow. Her basal is only just under 3 units a day. Crazy to think she was on 1.75 of Lantus just 3 weeks ago.

    Thanks for the cheer leading :)
     
  16. BittysMom

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    Yes, today is much better thanks :) What you said about growth spurts makes sense. Something was definitely going on in her.
     
  17. BittysMom

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    Yes, and today was better :). It's maddening though when you're in the midst of it.
     
  18. hawkeyegirl

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    Those times are hard. What we've figured out is that until you break through the insulin resistance, you can pour it in like water and not be able to get them down. During the worst of these episodes, we have to run a +100% temp and do double or triple corrections. It's crazy. Of course if you don't have a CGM, you have to also test like crazy, because you never know when the break will come, and you often then have to catch the plummet with carbs.

    It's enough to drive you (me) to drink.
     
  19. BittysMom

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    Yup, just when you need a clear mind too, figures! Now I know to be a lot less hesitant the next time this happens. Hoping that won't be for awhile.
     
  20. Lee

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    What she said - if you did everything - changed the insulin, gave an injections, dealt with ketones, etc and they are STILL high - the only answer is the simplest answer - more insulin. 10 units over 24 hours = .41 units an hour, so a temp basal of 10% only adds .05 of a unit - so not a lot of insulin being increased.

    I know doing that big TEMP basal is tough - but I always find reassurance in the fact that I can test in another hour (and hopefully she will sleep through it) and readjsust then.

    But you did a temp basal and you just started pumping that is a BIG DEAL! :D
     

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