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445 an hour after humalog

Discussion in 'Parents of Children with Type 1' started by Andy'sMom, Jan 14, 2009.

  1. Andy'sMom

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    I know YDMV but I was shocked to get a 445 this morning one-hour after Andy's shot of Novolog. We usually don't test then, but rather, test at the 2-hour mark because that's when his class eats a morning snack. Today, when I dropped him at preschool, he was very weepy and clingy and when I asked if he felt okay, he said "no" and I asked if he was low and he said "no" - so of course, I tested him before I left. Not sure what to make of the 445. Our 2 hour post numbers range from 250-325 but at 4-hour post, he's usually 130-160 (and that's with a 20 carb snack at the 2-hour time period). Should we assume he is spiking to the 450 range EVERY morning (I think I'll need to add a test there for a few days to see if this is a trend)??? And if that's the case, does it mean we need a lower I:C ratio for breakfast? But if we increase the insulin ratio, will we then have lows at the 4-hour post mark??

    We use NPH in the morning, so that always provides for a bit of unpredictability, but the NPH isn't working yet at 1-hour post and I did not think he would go to 445 with the Novolog in him (7:00 am number was 108 - beautiful!). Part of our problem is that for now (hope to change soon) we give the breakfast shot either after he finishes eating or a few mintues before he finishes (dealing with food battles so we give Novolog AFTER the meal so we aren't stuck harrassing him to death to finish all his food). This is clearly not ideal for his numbers.

    In case it helps to know, Andy currently gets 3.5u NPH at 7:00am, then we use a 1:12 ratio for the Humalog to cover breakfast (shot consistent at 8:00am), the NPH covers AM snack of around 20 carbs, Lunch of 16 carbs, PM snack of 7 carbs - then he gets 4 units of Regular to cover dinner 45 carbs, he is almost always in range (80-180) 2 hours post dinner shot and if so, gets a bedtime snack of about 30 carbs, then 1 unit of Levemir at 8:30pm.

    Sorry this is so long - my main reason to post was to find out if anyone else knows what could be up with that kind of spike 1 hour after shot of Novolog. Is that "normal"?? I worry about his little body and that's a big swing.

    If you made it this far, thanks for reading!
     
  2. hawkeyegirl

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    What did he eat for breakfast?

    I guess with normal 2 hour numbers typically in the high 200s to low 300s, a 1 hour number in the 400s isn't completely surprising, especially since you can't prebolus. It could be too that that is a time when his BG is naturally higher (my son needs a lot more basal in the morning) and that is adding to the problem.

    But it could be a fluke, too. I'd test again at that time and see if you can tell if it's an everyday occurrance or not.
     
  3. Andy'sMom

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    he ate a z-bar, some strawberries and milk - a very common breakfast for him. I'll definitely test at that time for a few days to see if it always happens or was a fluke.
     
  4. 2ladybugs

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    I would definitely test for the next few days to see if this is routine or not. Isabella has the same breakfast every day during the week and it's Cocoa Puffs ~ or as she calls them Cocoa Pops! ;) Anyhow, she typically spikes way high about 1 hour post so I have had to adjust her basal AND some of her bolus to cover this. Bolus alone was too much because of the tail. At the 2 1/2 to 3 hour mark she would practically crash if I didn't make that basal adjustment.

    If it is the breakfast, then maybe cut some of the NPH back and increase the Humalog a little. I'm assuming the NPH is for the lunch number since the H should be gone by then. If you give more H it will lower him about the time the NPH kicks in. I hope this makes sense. Isabella was on NPH for maybe a couple of weeks at most right after dx. We didn't like it at all! She was almost 2 and it was difficult feeding the insulin and because she was unaware of how communicate to us how she was feeling. She was much more stable with H/Lantus.
     
  5. danismom79

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    How long is it taking him to eat breakfast? Maybe there's too much time between the start of the meal and the shot. Could this be a bad vial of Novolog?
     
  6. Becky Stevens mom

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    That was happening to Steven for awhile also. Steven was on NPH and Humolog for the first 4 years after diagnosis. He would have morning highs especially if he ate certain cereals like cocoa puffs are really awful or even honey nut cheerios. He may need a bit more humolog to cover the breakfast and that should be almost all gone by the time the NPH kicks in to cover snack and lunch. Humolog is supposed to peak at one hour and be nearly gone by 2 hours.
     
  7. hawkeyegirl

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    Humalog lasts 3-4 hours in most kids.
     
  8. 2ladybugs

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    Exactly. This is what I meant by the tail coming and kicking in. Bella had a horrible time with this when we were MDI.
     
  9. wilf

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    I would suggest you start developing strategies to allow you to give him the insulin before the meal. I expect he is spiking high every morning and that is not what you want.

    Remember even if he won't finish his breakfast, all the insulin doesn't work at once. You have some time to get some more food into him (maybe a little snack on the way to pre-school if he doesn't finish breakfast..?) before he'll actually be at risk of going low.
     
  10. Andy'sMom

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    Thanks for all the advice! I do suspect that the big contributer is giving the shot after the meal (typically 30 mintues after start...then we count carbs on what he's eaten, pick-up the rest, and give the shot). We switched to this because he was taking over an hour to eat (just stalling, getting distracted .... very frustrating for us because per our discussion with our endo, he really needs to finish his meal in about 30 minutes). Anyway, so this morning I decided to go back to pre-bolus and with a lot of prodding from me, he did finish in 30 minutes. Pre-breakfast number was 160, one hour post shot was 254 (much better!), and 2-hour post shot was 202. I think that's much, much better. I'll keep testing at the one hour post mark for a week or so to see if it's fairly constant. Thanks again everyone!
     

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