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Base bolus on pre-meal low number or correction?

Discussion in 'Parents of Children with Type 1' started by BozziesMom, Jul 22, 2008.

  1. BozziesMom

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    Well we had a pre-lunch 70, which I corrected to 146. I called the emergency number for my peds diabetes team - was on hold 10 minutes. The operator kept coming back reintroducing herself. Needed to know which number to use to calculate his novolog. They told me the corrected number. Wondering if that's pretty much the standard.

    oh my gosh. 10 minutes on hold for the urgent calls... I really feel like I need more support from my team. I'm sure once I learn more, I won't be so frantic. grrrr...
     
  2. Aidan'sMom

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    If Aidan is in the 70's before a meal I usually just let him eat and dose him for carbs eaten. Aidan's range is 80 - 200. I only treat before a meal if BG is under 70. Which for Aidan lately lows have been RARE!! This works for Aidan and I am by no means telling you to do this. I would just do as your medical team says and go with the 146.
     
  3. BozziesMom

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    I've noticed with Bozzie, if he's under 80, he's shaking very badly... I do that myself when I don't eat (and break into a clammy sweat). :) But that's another story.

    I didn't want to give him lunch right at that moment because that would have been too close to last meal shot. So I corrected him - which is what they told me I should do in that case before feeding him anyway.

    It's all so confusing. Especially since it happened at such a time that it's unclear which insulin might be the culprit.
     
  4. tiffanie1717

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    This is what I do. If I treat the low, then I use the corrected number for the novolog. There has been some contradiction about whether or not to cover a high, if the corrected number is high (i.e. you overcorrected). My CDE said not to, but I've read other sources that say to correct it. As of now, I have not corrected if the high is from an overcorrected low. My CDE said it could cause another rebound low if I corrected it.

    If it's a meal, I will feed Kylie (without correcting the low) and then subtract one unit from her basal dose. This is, of course, if she is just in the 70's and not an extreme low.

    That's what I do. I know others have suggested to always correct the low first and then feed the meal. YDMV.
     
  5. hawkeyegirl

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    I think, given your newness, that you did the right thing. :)

    By that, I mean that it's always safest to treat a low, retest, and then if it's a mealtime, dose according to the BG number after you treated.

    Now that we've been doing it a while, unless he's LOW low, I might just not count a few of the carbs that he eats, and otherwise dose him normally. But I think you made the right call - it takes a while to get comfortable enough to make those sorts of decisions.
     
  6. Aidan'sMom

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    Perfect answer.
     
  7. frizzyrazzy

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    I agree with hawkeygirl. You did the right thing given that he's recently dx.

    later on you'll handle things differently. We don't normally call 70 low if it's at meal time. Ian just gets a regular insulin dose and we subtract for that blood sugar. I know it's scary at the time. I look back at the frantic call I made to our endo team after hours because Ian was having his first low - 73. LOL. I felt just like you when I didn't get a call back RIGHT AWAY. Like me, you waited for an answer because it truly wasn't an emergency. :) I'm sure your endo team is just fine.

    Also, the reason why he FEELS bad at 70 is that his body is probably used to being so much higher. Eventually he won't feel shaky and bad at 70. :)
     
  8. Flutterby

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    I think you definitely did the right thing, now the being on hold for 10minutes shouldnt have happened, they should have gotton to you a bit faster than that!

    like others have said, in the beginning, most definitely treat a low, then feed the regular meal, and dose for the meal.. as you get further into this you'll learn how your child specifically reacts to these types of situation.. I would have subtracted some of the carbs Kaylee ate for lunch and just normally.. BUT you said it wasn't time for lunch either.. so I would have definitely given her something for the low..
     
  9. BozziesMom

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    Thanks all. I'm so glad I found you. :)
     
  10. tuckerk

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    I have noticed with Caitlin, that even when she is low (below 70s), especially in the morning, I will give her regular insulin dose and recheck BS in 2 hours. She seems to have a high insulin resistence in the morning. We are new to the pump and it has been a challenge to regulate her BS being that the Insulin Pump Team doesn't want us to adjust the pump setting without their approval.

    Which I totally understand!!!! Feels like some days, I have lost a sense of control. So much to learn with the pump.
     
  11. Denise

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    For us (you know the...YDMV stuff) our endo told us not to correct a bg at meals if we had recently treated for a low if it the treating of the low was within 90 mins of meals. We've had good luck w/ this method but again, go with what your endo says.
     
  12. Momof4gr8kids

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    If we treat the low before the meal and have a second reading we use the second reading. Other times we bolus for all of the carbs and use the low number as the correction. It really just depends on the day.

    However, if you correct a low with carbs, then feed and use that low number, you wont have enough insulin to be where you want to be.
     
  13. mph

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    You're doing great!:) Your Mom Alert tells you that his shakiness at 70 is bad. Hold on to that.;) He could be 70 and plunging lower. Feed him free carbs and THEN call. Being on hold stinks!!!

    Nick will be 70 and feel fine and then I know he is stable. I will give him his lunch and just bolus "after" he eats (instead of before). Another day, he can be 90 and shaky and I know he is plunging fast........so I feed him NOW, retest in 15 minutes and if OK, I bolus at that point and give him his meal. On mdi I might give a good 10 grams free in this case, but YDMV.:)

    Keep the Mom Alert running.;)

    Oh.......btw, you will want to start some testing to figure out "why" he is 70 and shaky at lunch. You do not want daily repeats! Maybe the basal is a tad high or the morning I:C ratio is a bit off. Best wishes!!!
     
    Last edited: Jul 23, 2008
  14. robinseggs

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    We don't correct lows before meal either. We just take it into account with carbs eaten then dose w/ that in mind. Don't worry, someday you be confident in knowing what to do and calling will be the last thing on your mind! Good luck! Robin
     

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