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Can someone help me think this through

Discussion in 'Parents of Children with Type 1' started by samheis, Sep 9, 2011.

  1. samheis

    samheis Approved members

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    In short, my family is under high stress this week, since monday night. We are an evacuation zone for a wildfire in texas. We evacuated monday night, came home tuesday morning, evacuated tuesday night, came home wednesday morning. When they told us to leave again wednesday night, we decided to stay and use our common sense.-Part of the reason I am staying is I have somewhat lost control of BG's-we were eating on the go, losing track of time, etc.

    I've had very little sleep, and am not feeling confident, so looking for input on changes you make make. I'm attaching a spreadsheet of the log. It's missing info, etc, like I said, stressful week.
    Will someone please look at it and give me your advise. I will take anything said with a grain of salt, knowing my son best, but I could use a fresh perspective.

    He gets:
    11 units of lantus at 8 am and 2.5 units at 6 pm.
    Bkfst is 1:20
    Lunch 1:45
    Dinner 1:25

    He does get uncovered snacks at 3pm and at bedtime.

    I have one unexplained low thursday morning, which is messing with me. We think it may be a result of high activity/wrong snack wednesday night. But it's making it difficult to decide how much/if I should go up on the lantus, or if I should just focus on upping the carb ratios.

    Thank you and please forgive typing mistakes. Not my priority atm.

    The log I attached isn't right. I tried saving it to this link: C:\Users\Anita\Documents\SAM LOG.mht I'm probably still doing this wrong. Sorry.
     
    Last edited: Sep 9, 2011
  2. Lisa P.

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    I'm sorry for the evacuations. Stay safe, I know those things can move very, very fast.

    I'm no good with numbers but wanted to note that my 5 year old (38 pounds) uses 3 to 4 units of Lantus and her ratios are more like 1:20. Since Lantus is a 24 hour insulin (in theory, of course) you're getting 13.5 units of Lantus each day. When we had too much basal we would see highs at the two hour mark and lows at the 4 hour mark that we would have to feed. I'm guessing that's why your lunch ratio is so different, you have a Lantus peak from the 11 units in the a.m.

    If it works for you, then it's the right way, but just thought I'd note that is way out of our zone!

    Good luck getting great answers.
     
  3. samheis

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    Lisa-I'm totally noting what you are saying.

    He was getting an even split before our last endo appt-7 units in the am, 7 at night. Our endo decided to try this drastic uneven split as we were having wide swings up and down. It was an adjustment at first, but It's been working well, but I'm still unconfident about where to make my lantus changes now. My thought is upping the am lantus, but GAH my brain is frozen on peaks and such.
    His lantus needs increased drastically last spring. He's 8 now, about 50 lbs.
     
  4. Lisa P.

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    Oops! I thought 6! Time flies!
    Of course, I think especially with little kids there's such a wide difference in basal needs.
    Is he getting about 2/3 of his insulin as basal, though? Why are you thinking of increasing the basal instead of bolus insulin, out of curiosity?
    When Selah's numbers get higher and higher I tend to increase the basal just because it seems the right thing to do (I did it just this morning, oops!) but I often find what she needs is actually less basal and more bolus, and when I go that direction I get fewer highs and lows and more even numbers overall.
    But, that's just us! And she's not 8 going into a growth spurt!

    Can't believe you have to evacuate like that, I hope you have good places to go. Do you have animals? It's so hard to figure out how to judge the danger, I don't think anyone really knows how those things are going to behave. I hope it passes by and you get some relief soon.
     
  5. hawkeyegirl

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    I'm not very good with MDI adjustments, but I'll echo Lisa's sentiment that that is a LOT of basal for his weight. Jack is 7, weighs 80 pounds (so 30 pounds more than your son), and his basal is in the neighborhood of 13.5 units a day. And he uses a lot of insulin for his age/weight.

    They need what they need, but 13.5 units of Lantus is a TON for a 50 lb. child.

    ETA: For reference, Jack's ratios are 1:11 breakfast, 1:13 lunch, and 1:12 supper. His basal/bolus split is about 40/60.
     
  6. Lisa P.

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    Tried to read the log but I'm afraid those things are kind of Greek to me. Imagine you have a better handle on this stuff than I do anyway, you've been at it longer!
    I will say that 25 uncovered carbs would only be the treatment for a drastic low for us, an emergency type of situation that we'd have to address later of she'll go high.
    So if I'm reading your numbers right it does look to me like you are using basal insulin to cover carbohydrates, which is what we sometimes do on purpose but if you don't want to do that you might revisit it. When our basal is too high what happens is that she eats, the bolus doesn't cover the carbs so she goes too high at 2 hours, but by 4 hours she's going low because the basal insulin is dragging her down. So we don't dare give more bolus insulin because we're afraid of a low 4 hours after the meal. But if we reduce the basal, then we can increase the bolus to match the carbohydrates better. The spike isn't as high and the low at 4 hours doesn't happen.
    If that makes sense.
    But I'm not sure that matches what you've got on the log.
     
  7. Becky Stevens mom

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    Anita, Im so sorry about having to be evacuated! Ive been worried sick about all of our CWD members in Texas and for everyone down there:( So Sam has been getting the same amount of Lantus for awhile do you say? Steven was getting between 13-15 units until about 4 months ago. He's now getting 19. He is 10 and weighs 95 LBs. Sam is on thyroid hormones is that correct? I know being hypothyroid can mess with blood sugars. Im also sure that he's stressed along with everyone else which may be causing high BGs. Are his wake up #s also high? I think if they are ok then leave the lantus for now until you guys are out of this crisis and then start making some adjustments to his basal. For now you can always lower his I:C ratios if it seems that he's high alot during the day.

    Praying for you guys and everyone affected by the wildfires:(
     
  8. TheFormerLantusFiend

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    I had a lot of trouble opening the link and then it's not formatted in a way that I can easily make sense of- it's a list of words that I think must have been originally as a chart.

    If I'm reading it right:
    On Sept 5, At breakfast his blood sugar was 137 and he took 11units Lanuts and 2.5 units Humalog. At lunch his blood sugar was 136. At suppertime his blood sugar was 299 and he took 4 units Humalog and 2.5 units Lantus.

    Overnight his bg was 101.

    On Sept 6, at breakfast his blood sugar was 169, and he took 11 units Lantus and 3 units Humalog . At lunch his blood sugar was 404. At suppertime his blood sugar was 183 and he got 2.5 units Lantus and 2 units Humalog.

    Overnight his bg was 400.

    On Sept 7, at breakfast his blood sugar was 189. He took 11 units Lantus and 2.5 units Humalog. At lunchtime his bg was 271. At suppertime his blood sugar was 147 and he got 2.5 units Lantus and 1.5 units Humalog.

    His overnight bg was 187.

    On Sept 8, at breakfast his blood sugar was 51. He took 11 units Lantus and 2 units Humalog. At lunchtime his bg was 408. At suppertime his bg was 283 and he took 2.5 units Lantus and 2.5 units Humalog.

    His overnight bg was 126.

    On September 9, at breakfast his blood sugar was 262, and he took 11 units of Lantus and 2 units of Humalog.


    If I'm reading this right, my overwhelming thought is that he is not getting enough Humalog. Also, more bg checks are needed to prevent blood sugars of 400. I suggest a bg check at 3pm and only giving the snack if his blood sugar is not high at that time. Since he wakes up in range or low on all of the mornings, it doesn't seem likely that he could skip the bedtime snack if the Lantus dose stays the same. Which likely means that the Lantus dose is high, but there have been times when a snack and a high Lantus dose was the only way I could get my evenings to work.
    What is his correction factor? Are you giving more insulin for high blood sugars?

    P.S. Travel always messes up my blood sugars so I'm not sure, if I were you, that I'd make big changes for at home based on travel numbers.
     
  9. samheis

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    Perfect, you guys are giving me exactly what I need, and I'm working through it mentally now. thanks-

    I agree on the high lantus, I've actually tried lowering it and decreasing ratios so he's getting more humalog, but honestly the numbers start going low to high. On this current lantus dosage/split, we've had the best numbers we've had since last year-so I've been going with it until I can meet with the endo again in Oct. to discuss why they feel Sam needs so much lantus, and if this is really working.

    I usually do more checks. Our stockpile of supplies/insulin are currently in a seperate location(taken during first evacuation) -and of course, I thought I'd put aside an extra box of strips, but can't find it. Husband is currently going through bags, I am positive they are here, just a matter of finding them.
    House is slightly chaotic from packing, etc.

    SOrry Lantusfiend, couldn't for the life of me figure out how to attach spreadsheet, it wouldn't let me upload it.

    Um...I'm going to sit and reflect on the ratios and make adjustments there. You guys are right to suggest starting with this. Thanks again.
     
  10. Lisa P.

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    Well, if you are getting one very high number each day but the rest of the day in the 100s I'd be inclined to not be eager to change too much. I think most of us face a high number most days.

    I'm guessing you're certain there's no rebound overnight, right, since you've been on 14 units for along time?

    The problem I have with figuring this stuff is that we correct highs, so I can't look at a log and tell automatically what's going on because logs for me don't properly take corrections into account. For example, we've had times where the CDE or endo can look and say "Hey, you're low here every day almost, adjust for less insulin" but we're low because we'd been high earlier every day and corrected, so we had to track back.

    It's really tough to parse out, for me.

    Gosh I've done the test strip dig! And then I come up with four half-filled vials and don't know if they've been in the heat, etc. I had a meter guy that I called for troubleshooting ask me which lot # my test strips were from on the last 10 or whatever tests. I actually laughed. Well, let me gather my vials from all over the house and the bag and I can give you the possibilities. :p

    I think until things settled down if it were me I'd deal with the highs as they come and not worry about adjustment (unless you somehow think he's rebounding, then I'd check for that ASAP, but that seems very unlikely).
     
  11. momandwifeoftype1s

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    My initial thought echoed the same as previous posters. That is a perhaps too much Lantus IMO. Connor is 9 (almost 10), and he weighs 48 pounds. He gets a split Lantus dosage of 4 units in the AM, and 6 units in the PM (10 units total). His breakfast ratio is 1:10; 1:15 for lunch, 1:13 for dinner and evening snacks. Just something to think about for comparison. If anything, I'd lower the Lantus and up the Novolog. Can your endo help with this? I am so sorry that you are exhausted from the fire evacuations. I cannot even fathom what you are going through.
     
  12. wilf

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    How much does he weigh?
     
  13. Lisa P.

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    She said about 50 pounds?
     
  14. wilf

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    Thanks - missed that.

    So he is 22 kg, and if Lantusfiend translated the attachment right then it looks like he's getting 18-19 units or so of insulin per day. That seems on the high side, unless his diet is real heavy in carbs or he is not getting much exercise.

    I would be worried about lows/rebounds, and would be testing between meals. I'd also like others who have posted look at slightly reducing the morning Lantus..
     

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