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Didn't know what to do?

Discussion in 'Parents of Children with Type 1' started by MyTMax08, Nov 20, 2011.

  1. MyTMax08

    MyTMax08 Approved members

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    Our son Maxim was up to 400 this morning just before Church started...had him drink a cold bottle of water and it went down before services were over but geesh...what would I have done otherwise (if I didn't have access to that water bottle?) taken him to E.R. right away? He has been sick for over two weeks now and finally got a prescription for his cold on Thursday but he refuses to drink a lot of water...he hates it. What else can I offer? :eek:
     
  2. Butterfly Betty

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    Could you not have given a correction?
     
  3. Connor's Mom

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    That was my first thought. Are you on MDI's or a pump? When we were on MDI's I carried a baby bottle cooler pack in my purse where ever we went with Connor's insulin, syringes, alcohol swabs and emergency snack and water. Even if it was going to be a quick trip I always felt better having the insulin with me just incase something happened like the car breaking down or if our plans changed and we wanted to go have a treat. With the pump it is easier to be spontaneous but, we have had a rough time finding stability with his numbers.

    I am glad the water helped lower his BG. Any sugar free beverage would have helped too but, I have always found water works best.
     
  4. MyTMax08

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    Hi Lisa...thanks for responding. I have been so confused with corrections, only had to do it twice now and one time was awhile ago and the other my husband helped because I couldn't do it; it seems like I have a huge fear of doing something wrong with that. Endo gave 1:120 from BS -- 1:30 by grams of food -- and correction for super high 1:150 from BS. I guess in all nervousness (he hasn't been that high since he was diagnosed) I didn't know what to do other than relate it to his dehydration (his lips are so chapped and I told him it is bc he's not drinking enough...he hates water and I don't want to just off Diet Coke (which is rarely on hand). Idk, I was glad to be at Church...the Pastor took good care of our family, as always. I am still so confused as to what the correction does and when to offer it :confused:
     
  5. Butterfly Betty

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    Not sure I fully understand. What is your correction ratio? Like, ours is 1 unit for every 50 over 150. So, if Sophie had been 400, I'd have given her about 7 units, but it would have depended on when she'd eaten breakfast, too. We never correct that much if we are less than two hours after she's eaten, I'd have done about half that and rested in an hour and half or so. But that's just how we did it.
     
  6. Sarah Maddie's Mom

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    No, you don't need to go to the ER for a 400. If he came down on his own then I'd suspect a false reading on the 400. Water helps with the highs but it can't alone bring down a whomping number. Either the reading was wrong or he's strongly honeymooning and the insulin (he must have had insulin at breakfast, right?) plus his body producing his own insulin brought it down. Obviously when they are sick you can see odd highs, but I still think that the 400 may not have been accurate.

    Hope the cold goes away soon.:cwds:
     
  7. nanhsot

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    Do you happen to know his target range? The way you figure a correction is to subtract the target from the actual, so if his target is 150, then you are dealing with 400-150=250 points over range. If his correction is 1:120, that means you give 1 unit for every 120 OVER range, so in this case he needed 2 units, assuming what you posted above is what your endo told you.

    I have a much older child so don't want to steer you wrong; please verify with your MD what you target is and what your correction is (my son takes a unit for every 20 over 110, so clearly it varies widely!). I would call your CDE in the morning and get some more clear instructions on how to do corrections since it seems that you have not been well trained in this.

    This is not unusual or unexpected, to be 400, you just need to educate yourself now on how to handle it. Water is not enough for a high that high, insulin is needed...since it did come down I can only suspect he either still had a lot of insulin acting from a meal or he's strongly honeymooning. If he's still strongly honeymooning they usually give a pretty conservative correction factor to account for that.

    edited to add: you also need to remember that you ONLY correct on MDI 3 hours post any bolus shot, you don't want to correct when you still have active insulin acting from a food. Had he just eaten and taken insulin for the 400 or was he hours away from a meal and insulin? Always factor that in when figuring a correction. When we were on MDI we really only corrected 3+ hours after the last shot had been given.
     
    Last edited: Nov 20, 2011
  8. MyTMax08

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    Hi...thanks for your response. I do also carry a bag with me at all times...we have a JEEP mini backpack that works really well and I put snacks, etc in it when I know we are going to be gone awhile. All I know is that the Endo on call (the night I had to call a long time ago) said to take his blood sugar from 150 and divide it by his correction factor which is 1 to 30. I just freak when it looks like I'd have to give him 7 units; so it scares me! Does that make sense now? I am sorry, I just am still trying to understand all of this...
     
  9. MyTMax08

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    Hi...thanks for your response. I do also carry a bag with me at all times...we have a JEEP mini backpack that works really well and I put snacks, etc in it when I know we are going to be gone awhile. All I know is that the Endo on call (the night I had to call a long time ago) said to take his blood sugar from 150 and divide it by his correction factor which is 1 to 30. I just freak when it looks like I'd have to give him 7 units; so it scares me! Does that make sense now? I am sorry, I just am still trying to understand all of this...
     
  10. nanhsot

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    I think you need to talk to your endo and clarify, here you are saying 1:30 for correction but earlier you said 1:120 or 1:150 for super high (which is odd actually, we find when my son is super high he needs MORE, not less, insulin), that's a HUGE difference!! You also said that his carb ratio was 1:30, so I want to make sure you are not mixing those up.

    Since he came down on his own I'd suspect he still had insulin acting or the meter reading was wrong. Don't forget that a bit of sugar on the fingers can mess up the reading, so sometimes I have my son wash his hands and try again to verify the number when it's unexpectedly high like that.
     
  11. Butterfly Betty

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    Okay, now I see. So for every 30 points over 150 he was, you'd give him one unit to correct. However, I tend to agree with Sarah about it possibly being a little off. That's a pretty big drop on just water alone.
     
  12. MyTMax08

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    Hi Sarah...it was accurate, he checked about 30 min later and it went down to 340 and another 30 min later he went down to 302. I did not want to give him a correction factor when I knew that we'd be eating shortly (we had a Thanksgiving dinner with our church family) and wanted to be sure that he was able to eat too. Would that have mattered though? I understand that water isnt the only avenue, I do...but please understand that he gets very dehydrated because we cannot get him to drink water. Water is necessary in his diet and the Endo told him that this will happen if he doesn't fluidate himself like Mom asks him to...this proves the Dr. appointment we had on Thursday that Max was skeptical about (he's so smart). Water, Diet and exercise...key to staying level. Yes, he did have insulin at breakfast which was two and a half hrs prior at the time we checked him in Church). He has been honeymooning...we have had to adjust almost every other week now because of his lows. It honestly (in the time of panic) gets overwhelming.
     
  13. MyTMax08

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    He was 121 at breakfast (roughly 8:50 a.m.)
     
  14. Amy C.

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    For a Type 1 who is no longer in the honeymoon stage, the effective treatment for high blood sugar is insulin. Water does not bring down the blood sugar, only insulin does this (or intense activity).

    I would say the timing between the insulin and the food was off, or that your son's pancreas kicked in some insulin to help out.

    Once you are dx'd with diabetes, you don't need to go to the ER for a single high blood sugar, with no other symptoms -- it isn't a live threatening situation.

    It looks like giving water helped make you son comfortable while the sugar came down. You did the right thing! Perhaps the correction factor you have been given needs to be clarified with this information. He most likely would have gone low if you corrected him.
     
  15. BittysMom

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    I just want to add that the correction factor you have, that seems to have been given at diagnosis and not used in a while, may not be still "accurate" if his insulin needs have changed at all.

    My daughter was diagnosed in August and her correction factor was 1:200. It's 1:400 now. So I would definitely call them before you do a correction, even if you have to call their emergency number and ask. I've done it!
     
  16. MyTMax08

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    Hi Amy...when we feed him we have all the ingredients calculated before giving his shot, this morning he did the calculations himself and I didn't check it and when I got home I checked what he had done and it was correct, so idk. I def would have taken him to the ER, for sure, knowing that he is dehydrated and not willing to drink would be enough for me to get him there and get an iv of fluid in him...had to do it last month (his lips since last night are very dry, cracked and bleeding--even when I have put chapstick on). I think that I will have to get some sugar free drop-ins and make his water that way for him to drink it. We tried it before and I just don't think he liked the flavor we bought. I will call the Endo's office tomorrow and talk to our nurse we work with, I trust that we did what is right this a.m. I just don't think that I have the confidence (which is important to have) that I know what I am doing? Something I am going to have to get over and learn more.;)
     
  17. Brenda

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    A BG of 400 mg/dl alone is not enough to warrant a trip to the ER, but if you have ketones or know he is dehydrated, you might need to go. Be sure to check with your endo on when and how (preferably blood ketones, esp. since he does not drink much water and is unlikely to urinate on a urine ketone strip for you). Most endos recommend testing ketones when BG's are over 240 or 260 (depends on the doc). Should he have more than trace ketones, you need to give more insulin and push water. Also, try to learn how to know when he is really considered dehydrated. Personally, I am not familiar with all the symptoms.

    Since he won't drink much water, you need to try various SF flavored waters until you find one he will drink. Diet Coke or such is not a good substitute, in my opinion. Again, ask the endo for advice on what to do.

    It often takes months or years to know all the ins and out of diabetes, then it can still throw you for a loop and you have to troubleshoot again.
     
  18. wilf

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    So what is up with him refusing to drink? That is the real problem here, not the 400 blood sugar..

    Is he refusing any liquids, or just water? If it's just water, then get something else that he'll down. Milk, juice, flavoured water, whatever.

    But if he's refusing all liquids then there is a major problem, likely psychological, that needs to be dealt with.
     
  19. Connor's Mom

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    I use a carb count sheet for the school nurse and for babysitters to make sure Connor's dose is calculated correctly.

    Food Dose= #carbs/_____. (______/_____= _______)

    Corrective dose= BG - ______/ _____. (______ - _____/_____=_____)

    Total dose = food dose + corrective dose. (we always take the digits out to 3 decimal places). (______+ ______= _______)

    I have our rounding scale listed under this so, if I ever question which way to round it is right there.

    I leave blanks so that I can change the values as needed.

    At the top of the page there is space for each food item to be written down with the carbs next to it. That way it can be tallied easily.

    When I am away from home I ask for a sheet to be filled out so that I can
    check it if his blood sugars seem way out of whack.

    Maybe a sheet similar to this would help you feel more comfortable when you are doing the calculations.
     
  20. wilf

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    Using the 1800 Rule, a 1:30 correction factor would be expected if he was getting 60 insulin units a day.. :eek:

    I'm sure he's getting nowhere near that - and agree with others there is a problem with this correction factor.
     

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