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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 Darryl has an overwhelming belief that rebounds are a figment of my imagination, but in reality, they happen to quite a few Type 1's. Heck, he even explained away the one I caught on a CGM a few years ago.

    You believe what you see - and as Sugarmonkey said, and I have said, and one of the teens here has said, and a handful or two of others have said, reducing the insulin, after all other causes have been addressed, sometimes works.

    However, I don't think rebounds is the case with your child since her numbers are good at night. Look at how much you have increased her daytime basals - do you make tiny increase or are you more aggressive? Does her daytime basal seem to be extremely high when compared with her nighttime basal? Are corrections bringing her down into range? Is it the bolus? Is she about 80 points higher 2 hours after she eats? Or is she way higher then that? These are all things that I would answer first before I even considered thinking it was a rebound issue.

    In my mind, the only way you can tell 100% for sure that it is not a rebound phenom occurring is to test, test, test.
     
  2. Darryl

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    We saw this beginning around age 8-9, then each year the episodes of increased insulin need became more frequent needing more and more. At that time we thought it was bad insulin, a bad pump, a bad site, etc., but we learned that changing those never made a difference in how much she needed on that particular day. The characteristics were the same at that age as now, happening randomly, but at a lower insulin need (I remember the first time we increased her 0.25 basal by 0.1, it seemed like a huge increase at the time!).

    This all continued and peaked around age 13 with 5u/hr temp basals being needed a few days each week for 4-6 hours at a time. Many weeks the 200u in her pod would run out before the end of day 3. Nowadays 1u/hr is typical with temporary increases to around 2 or 3u/hr a few days each week.

    ETA - also remember that growth hormone is secreted during all growth, not just during puberty. It is moreso during puberty, hence the more significant insulin need swings at that point. It has also been shown and was posted in an article here a few years back that growth hormone is not on any regular cycle, and is often near-zero inbetween larger episodes, again correlating to how insulin needs suddently vary in children of any age.
     
    Last edited: Sep 7, 2012
  3. Darryl

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    No, not at all... rebounds just seemed to be the presumed cause of the problem and I wanted to provide the other likely causes. I think we all concluded years ago that rebounds happen in some kids, not in others.
     
  4. wilf

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    No, TDD of all basal and all boluses/corrections.
     
  5. KaseyK

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    Well I can say SOMETHING happened similar to this just in the last 2 days. 300-400s for 12 days straight after increases to basals all day. At an Endo visit, they were speechless and stuck a blind CGMS on him for the week.

    After reading this (and really REALLY trying to comprehend the opposite effect) I lowered his basal and have had low after low after low for the last 24 hours. LOWS AFTER LESS INSULIN!

    Like theres anything that could make my head explode more :eek:

    Braden's on the normal TDD for his age/weight but his basal vs bolus is a little more even today then ever. Was it impeccable timing? Or the need for his body to settle in with all that insulin we were pumping in? Or rebounding?

    I dont know - but after 2 weeks of crazy high numbers, we are back to a normal amount of insulin and low or normal ranges today
     
  6. wilf

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    Thanks for sharing this. It's a classic low/rebound/insulin resistance scenario. Good thing you caught it! :)

    Have you seen the CGM readouts yet? They would be very valuable to share if available.
     
  7. Darryl

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    If there is some "constant state" of rebound that could cause persistent highs for 12 days, that would presumably mean that that excess insulin is causing some kind of repeated oscillation from extreme high to extreme low over and over again for 12 days, which would be evident on a CGM. It would be really interesting to see the iPro data as it would answer the question.
     
  8. Ali

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    Maybe if one is having a persistent low for two or three hours every day then you may have a persistent insulin resistance reaction going on. FWIW I have observed both a low and high reaction. I have seen low after low after an extended low period of time and also insulin resistance after a low session. I do not know if it is the level one drops to during a low session or the amount of time spent low or how much sugar your liver has to release or what, but I have seen both things happen. I tend to see:p that if I am low i.e. around 50 to 60 for two to three hours I tend to run low during the next 24 hours, if I have a major low into the 40s/30s several times in a few hours I will have highs 4 to 6 hours later for 4 to 6 hours. I have come to assume that my body has a hormone that produces an insulin resistance to a severe low if it goes on for any length of time, but when all those hormones kick in is a guess, but I also have had this disease for 40 years so how my body responds will be different from a kids. Also I assume my liver gets depleted of sugar to respond with if I am battling lows, the hormones to release sugar may get activated but there is nothing to release.:confused:(maybe) The insulin resistance may sometimes be compensated by sugar being released?? It is really hard to sort out, but at least for me, lows or highs tell my body to send out different hormones that counteract the high or low blood sugars. How well my body responds depends on how my numbers have been running for a bit before and how long in years I have the disease. :cwds:ali
     
  9. KaseyK

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    He still has the CGM iPro on until next week (7 days total) but Ill be sure to share when I get the results. Only bad aspect is that as of now, we only have about 14 hours of crazy numbers on the CGM before I lowered the basal and started seeing lower numbers. He was 359 when we put it on.

    Im not so sure "rebounding" was the cause of the highs, but more like insulin resistance to the dramatic increase in need for insulin? Like, his body paniced with in influx of insulin? Dunno. Thats my laymens terms theory.

    All I know is his numbers are much MUCH lower after much lower insulin
     
  10. Lee

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    We JUST saw this again. She was at her dad's and her BS was pretty high, so they raised the insulin, and raised the insulin, and raised the insulin. She was waking up in the 400's for 5 days on a row, even after going to bed at a decent #.

    She comes to my house on Saturday and I test at 3am and she is in the 400's, so I correct and she wakes up in the 400's. Last night, I tested at midnight and she was 120. I stayed up working for another hour and decided on a whim to test her at 1am. She was 48. I tested every hour and she had well over 100 carbs last night and woke up at 62. I think catching the initial low at 1am stopped the rebound process.

    I think this type of information would make a fascinating study...
     
  11. MomofSweetOne

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    Have you ever trialed CGM? It would be fascinating to see her data.
     
  12. Lee

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    We have and I posted a chart here a few years ago that captured a rebound. Unfortunately, due to her metal allergies, the CGM is just flat out painful for her.
     
  13. MomofSweetOne

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    Ugh. I've met an older Type 1 that told me she gets glucose dumps like that. I've never seen one in my daughter, but we don't see many lows below 60s with the CGM. I hope she doesn't develop an allergy to it.
     
  14. sugarmonkey

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    We have holidays in a few weeks, and I plan to do more tests to see if I can catch any lows. Phillip has exams for the next couple of weeks, and wakes up when I test him, otherwise I'd do it now. He's still waking up high, but his numbers earlier in the night are better.
     
  15. joan

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    Hi Lee, were there ever ketones?
     
  16. Darryl

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    Just curious, does this happen when she's with you...? I can understand a rebound as a single event epinepherine reaction, but to presume a rebound could last 5 days in the 400's with high insullin the whole time, that's really hard to understand. It's as if the liver would have thousands of carbs that it outputs over 5 days with BG never dropping below 400. What really is a rebound from a BG of 400? What you describe sounds to me like she didn't take enough insulin for 5 days.
     
  17. Lee

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    Honestly - I am not really sure if it is rebound or some form of insulin resistance. But no, it happens at both my house and her dad's. Even after reducing her Lantus by 4 units, she was still in the 50's at midnight last night. But she forgot to test this afternoon and she went from 80 with a salad at lunch to Hi with no food for 4 hours. I suspect that we have to cut her Lantus even more.

    I do know that she rebounds pretty easily about 75% of the time, and then, she will drop down to the 20's with no rebound at all.

    This is diabetes, if we knew what the right answer was, we would be dealing with Type 1.
     
  18. Darryl

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    Just curious, when she was high during those 5 days, was the insulin increase you mentioned a daily adjustment to the lantus or was it correction boluses during each day?
     
  19. Lee

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    It was correction and her dad did a 10% increase every 2 days.
     
  20. wilf

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    What tends to set up is a scenario that starts with a hard low. The low triggers a rebound in blood sugars caused by hormones which force a release of glucose from the liver, as well as increased insulin resistance which will last for a half day or so. Through that period, you can give massive amounts of insulin but barely budge blood sugars.

    The danger is that the insulin resistance ends suddenly and with no outward signs. All of sudden, your child is as sensitive to insulin as they were before the low/rebound/resistant period. If you have a massive correction going at that time or have significantly raised basals, then if you don't catch it the increased insulin can lead quickly to another hard low and the cycle starts all over.
     

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