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? about running high due to too much insulin

Discussion in 'Parents of Children with Type 1' started by Lee, Dec 3, 2011.

  1. Lee

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    I know a couple of you have explained this before, but for some reason I can't find the posts. Coco switched to Lantus last week due to extended disconnects for Basketball. We started her on 37 units and she hit the high 300 and 400's everyday - multiple times. She says she never felt low. She started dropping overnight, so I lowered her Lantus - now her BS is in range...

    I hate to think of her being in a constant state of rebound for week and I remember another explanation for it...just wondering what that other explanation was.
     
  2. Lisa P.

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    How about this one? :p

    Since Lantus is 24 hours but basal varies, for us nights are far different from days, and as I recall that was so for you guys too, right?

    So here's the deal, if you are getting the right amount of Lantus for nighttime, it might be far too much for daytime.

    When you have too much basal during the day, you can get huge spikes. Here's why, a la Saxmaniac two years ago for me! You give food, and bolus. It's not actually enough insulin to cover the carbs, so she goes high. BUT the Lantus being too high means her bg gets dragged back down into range or lower by hour 4. So you see she makes it back into range every time, it looks like you can't give more insulin for the meals or she'll go low. So you get the high spikes.

    Once the basal is right, you don't get the high spikes because you wind up using more bolus insulin. Now, this only seems to logically hold true if you also up the ratios. However, we have seen this not to be strictly true. I think it's because we tend in our heads to account subconsciously when carb counting. If I notice that Selah is running low at hour 4, I'm inclined when counting bread to count it as a little less than it really is. If I think she's been running high overall, I'll be more inclined to err on the side of giving just a little more insulin. Also, if you're moving back and forth from MDI and pumping then you are feeling out the new bolus insulin ratios, too, so you may be doing a lot of adjusting of ratios, etc. and that gets lost.

    Hey, it's my best shot!

    I have also read, from LF I think, that Type 1 diabetics have an inclination to natural alpha cell activity for no particularly good reason -- they kick out glucose reserves not necessarily in response to a low. I would not be surprised if a sudden glut of insulin somehow created a reaction that kicked extra glucose into the bloodstream. I'm not sure we entirely undestand that whole process.

    In any case, we have also seen the counterintuitive trend that when we reduce insulin we wind up reducing highs.
     
  3. TheFormerLantusFiend

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    I think the answer to why she had highs caused by too much insulin is that she had some overnight lows that caused insulin resistance all the time. It's also possible that when her insulin needs just happened to go down, her body could absorb the full Lantus dose appropriately. Sometimes the body can't absorb large volumes efficiently. I don't think that is the issue at a Lantus dose of 37 units but it's a possibility.

    It is true that most type 1s have high glucagon levels, because alpha cells (which make insulin) take lowered insulin production in the beta cells as their cue to make more glucagon. We do not have appropriate glucagon responses to any sort of situation- we don't make more glucagon in response to lows or less in response to highs.
    Some type 1 diabetics have enough damage to the alpha cells or enough function of beta cells that their glucagon production is normal or low.
     
  4. Lee

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    Thanks Lisa and Jonah.

    I think it must be some type of rebound thing. I know it wasn't at night since I was up at 12, 2, 4 and 6 to check all week long (where is the dead tired smiley?) treating her.

    We have since lowered from 37 units down to 30 in a 10 day period. I forgot ho much I hated Lantus sometimes. I miss temp basals.
     
  5. MamaLibby

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    Hope you're seeing better numbers now! I agree, we need a dead tired smiley! :cwds:
     
  6. MarkM

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    Have you considered using the pump with the "untethered regimen"? You would inject Lantus for 50% of the basal and use the pump for everything else. That way frequent and extended disconnects shouldn't be a problem.
     
  7. wilf

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    I think it was insulin resistance, from undetected lows. It's very tricky, standing in for a pancreas. I've seen this happen at our end too.

    Any time numbers are stuck in the teens, and I drop the TDD, and then the numbers come down I conclude insulin resistance from undetected lows. What else could it be?
     
  8. sugarmonkey

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    I've bought this thread up again because we had this happen to Phillip, and someone else may have the same situation and find this helpful.

    He kept going high. I thought it was growth spurt, as he seems to be literally getting taller overnight. Kept putting his insulin up, but it wasn't making any difference. Then I remembered this thread. Halved his insulin, and that night we had in range numbers for the first time in months. I was hoping it would work, but didn't expect it that quickly or dramatically. So thanks Lee for starting this thread in the first place, or we'd still be going up with insulin and blood sugars.

    ETA: I had been testing 2 hourly everynight for ages, without catching lows, but maybe I was missing them in between still.
     
  9. Deal

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    undetected snacks :) (depending on the kid)

    We had a period of highs due to ds developing a bump in his lantus injection spot. That spot seemed not to allow the insulin to absorb.

    He stopped rotating spots and we didn't catch on until we noticed the highs and then the bump.
     
  10. BittysMom

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    Oh yes, we've had some undetected snacks. Those can really do a number on your number.
     
  11. Lee

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    Wow - hard to believe it has been 9 months since I posted this - and since she has been untethered!

    We have seen this two other times and now, after I up Lantus two time, I automatically lower it if she is still not coming into range. It works for us. I do believe it is insulin resistance combined with rebounds that cause this for her. She is still not on 37 units of Lantus though - her highest now is 26 units Lantus, so we had a definite dosage problem.
     
  12. sugarmonkey

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    To those who suggested undetected snacks - the highs were between 12am and 6am and I know for certain he wasn't eating then. So that was quickly ruled out. We have had this issue at other times of the day.

    His numbers have been so much better since I reduced basal. It's great.
     
  13. wilf

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    It happens for sure. I have seen it happening with at least a half dozen kids on here.

    Good that you have it figured out..
     
  14. sugarmonkey

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    This site is great, and this thread is just one reason. If it hadn't been for this I'd still be putting Phillip's insulin up and seeing numbers in the 20s (360) instead of the great numbers under 8 (144) that we've had all week.
     
  15. Nobby1

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    Guys sorry to sound real stupid but I don?t understand this at all. I have also been having issues with my dd numbers going from very good waking up numbers (after an all night battle) to skyrocketing into the 300?s and 400?s at school and anytime thereafter. The only thing bringing her remotely into range was running a temp basal of 180% basically the entire day. Are you suggesting that it would work if I halved the original basal, so basically running her on 50% basal? We do not cgms but at this stage we are testing like crazy up to 18 x a day to try and make some sense.
     
  16. wilf

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    One way to evaluate whether lows/rebounds are happening is to look at the ratio of your child's TDD to weight in kg). Outside of puberty this would normally be in the 0.5 to 1 range - if it's up significantly over 1 that is a warning sign that this may be occurring.
     
  17. Darryl

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    The rebounds described here are present only in a small number of children and attempts to document them using a continuous monitor have not been successful to my knowlege. In most cases, highs (other than those caused by eating without bolusing) represent normal response to growth hormone in children. Growth hormone is secreted in phases, and causes insulin resistance along with release of glucose from the liver, which explains sustained high BG's. In nondiabetics this is met with large increases in insulin secretion to control the BG, but also because the body needs the additional insulin as part of the growth hormone process. As you mention 180% temp basal might be needed - in our case, we often need to increase from the usual 1u/hour up to as high as 5u/hr.

    Also, I am not sure about insulin resistance caused by undetected lows. In our experiene of watching BG on a CGM for 5 years, it is exactly the opposite - lows never come up without carbs, and when low, even the tiniest amount of insulin drives BG lower, and when high, much more insulin is needed for the same BG change. All of the articles I've read since my dd's dx state that insulin resistance is caused by high BG, and that has always been our experience. But all children are different and I may have missed some of the articles to the contrary.
     
  18. Nobby1

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    Thanks for replying. Is this TDD of basal?
     
  19. Darryl

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    Last edited: Sep 7, 2012
  20. Nobby1

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    Thanks so much Darryl for the threads, my dd is only 8 so I am wondering whether puberty could play a part as yet but certainly interesting to consider hormones.
     

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