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Does this look like Somogyi?

Discussion in 'Parents of Children with Type 1' started by Theo's dad Joe, Jan 21, 2016.

  1. Theo's dad Joe

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    Type IIs don't have enough effect from their insulin due to resistance or eventual beta cell destruction to get their fasting blood sugar down to a good level. They DO have the ability to manage the fasting margin, so if they can get help from basal to bring the baseline down they can regulate up or down within that margin. In other words, a type II with appropriate basal who is at 170 will eventually come down to their set point, wherever it was titrated to.

    Are you saying that insulin resistance is not a lack of insulin sensitivity? Ex. Losing fat weight increases insulin sensitivity, and gaining it lowers sensitivity. Exposure to large amounts of insulin causes a decrease in insulin sensitivity ie insulin resistance. I may be using that term in more of a sports medicine context, but insulin resistance is basically equivalent to a lack of insulin sensitivity in that context.
     
    Last edited: Jan 21, 2016
  2. Theo's dad Joe

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    A type II will take enough lantus until they typically wake up at under 100, or will be under 100 under fasting conditions. Their own insulin though is helping. It still will tend to stop helping if blood sugar goes too low and it still will tend to help more if blood sugar goes up. That is the margin.

    What I am saying about my son is that he can still go to bed at 160 and wake up at 95 (with Lantus helping out), or fix a small growth hormone release, but eventually he will run more or less flat at 160 and something will have to be done if we want to start the morning at a good number.
     
    Last edited: Jan 21, 2016
  3. Theo's dad Joe

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    By the way, my son's honeymoon insulin doesn't always help any more (probably because we are using a lot more injected). For example, I can give him carbs if we are going swimming after dinner, but sometime his pancreas will just say OK lets clear that off for you, or sometimes it will correct a high while a correction is starting to work.

    I am pretty tired right now and I need to take a short rest while I have the chance today.

    Can anyone tell me about my question regarding having a breakfast peak so late at about 2.5 hours when so much T1D literature basically implies that the meal curve is more or less a two hour thing? Is it kids taking longer to digest their meals because their stomach is smaller?
     
  4. mmgirls

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    Of course he does not have a flat basal because he is honeymooning. But also just because you are currently giving him 5 units of basal and he trends down and does not go low does not mean that if you where to increase basal that he will go low. If you believe that he still has the shut off" control.

    I think you confuse things when bringing up Type 2 Diabetes, while I understand how you can draw comparisons between a honeymooing kiddo it is different.
     
  5. mmgirls

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    I think I understand what you are saying, but in the Type 1 world insulin sensitivity is a ratio, the correction factor or ISF, how much 1 unit of insulin will lower BG. It is not used inter chain ably with insulin resistance.
     
  6. mmgirls

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    It could be the amout of fat and protein in the meal that is delaying digestion, or a lack of basal for that time of day, a delay in digest due to activety/exercise. It could be a lot of things, but maybe someone can lead you to more specific info.
     
  7. Theo's dad Joe

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    Can you tell me though, do you usually see breakfast spikes earlier than that, like in the first 90 minutes? If I am getting a breakfast peak 2.5 hours after breakfast but it is only at 165 is there anything wrong with that? It makes it hard to manage activities, especially after dinner because my son may not go over 100 for 2.5 hours, but he ends up rising in the 4th hour, so if we go on a bike ride I sometimes have to give him carbs, but they tend to show up at the late peak for some reason. Though not always.
     
  8. forHisglory

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    We are still in a honeymoon. If he preboluses (according to the chart in Scheiner based on premeal BG, etc.) then we don't see a spike until 90 minutes. If he does not prebolus, the spike occurs in the first hour. We don't see rises that late unless its a high fat meal. With an increased basal temp when the spike hits, we rarely go above 200, but if we let it occur naturally with no temp bolus added in we rise to 225 by 90 minutes and then are back in range at 2.5 hour and then usually at pre-meal level by 3 hours and then headed into the 70's at hour 4. This is with the same exact breakfast every morning (Greek yogurt 20 grams, 1 serving of oatmeal at 39 g) Before activity, we make sure he's at 130 since activity still drops him on a bike or scooter ride. If he's lower than we like, we adjust basal 30 minutes before bike ride to get him up to desired BG. Or, feed uncovered carbs and cover them later when we return if it makes him go high (with a temp basal though vs. actual I:C for the carbs as he usually comes down fast).

    The late peak in your son is interesting for sure!
     
  9. rgcainmd

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    Insulin sensitivity factor refers to the number of points 1 unit of rapid acting insulin lowers your blood glucose. The goal of your insulin sensitivity factor, ISF, is to bring your blood glucose level into target if it is elevated.

    Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose from the bloodstream into muscle and other tissues.
     
  10. Theo's dad Joe

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    I know what ISF is. Insulin sensitivity however is simply a term used in medicine and human performance to describe a persons metabolic state regarding insuln. Someone who is less insulin sensitive is more insulin resistant. http://www.diabetes.co.uk/insulin/insulin-sensitivity.html

    "People with low insulin sensitivity, also referred to as insulin resistance, will require larger amounts of insulin either from their own pancreas or from injections in order to keep blood glucose stable."

    ISF however is different because it involves factors such as what percentage of insulin is disposed of by the liver before having a chance to act. So ISF can be higher for someone for causes other than relative insulin resistance.
     
  11. Theo's dad Joe

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    I am pretty sure that the 7:30 pm thing is a hormone spike that occurs sometimes, but in our case it happens in the third hour after dinner, and I probably have a built in bolus for it so it goes up to about 130-160 when it happens and when it doesn't he may be 70-100 and get a small snack. Also at least in the honeymoon he clears out that late dinner bump on his own which makes it tricky because it activates his own pancreas' insulin production and he may end up being lower an hour after going to bed. I've also tried to correct it and had it drop fast, like from 180 to 100 in an hour. I think that basically you kids before puberty may get this spike (yes my endo mentioned an evening spike before puberty and an early morning spike after puberty) but the spike uses up some of the growth hormone that would have counterregulated your basal insulin later in the night, so it ends up smoothing out on its own. This may be similar to why dawn cortisol and adrenaline make breakfast spike, but you pull basal from the next 4 hours to beat the spike and can end up even 3-4 hours later, because the reserves of cortisol, gh and adrenaline, and glucagon are now lower after the dawn period.

    I also think one of the reason for our milder breakfast spike is moderate carb dinner (30-45 grams) 4 full hours before bed, and almost 14 hours before breakfast, so liver glycogen is empty and there is lots of room to put the breakfast carbs, and not a lot of glycogen to release. If we ate a real starchy dinner and went to bed, glycogen is going to be pretty high in the morning still and will get released when someone eats breakfast. It works though. My kids want to eat before 5:00 and they go to bed around 8:30 and wake up at around 7:00. Anyway I don't know for sure as we have done things that way for a long time and I'm sure the two younger ones will eventually want to eat something later, and stay up later, but we could be maybe 900 days for a BP and my son is going to learn a thing or two on his own too as he grows up. I've got a few years.

    Edit: dinner tonight was FLAT, closing in on 4 hours, I think we went up to 125, down to 85, back up to 110 flat for the last hour. We did go a little lower saturated and more PUFA and MUFA tonight, but also higher than usual protein (about 28 grams, usually only about 15).
     
  12. mmgirls

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    so your kiddo is fasting for 14 hours? I find that amaizing for a 10 year old. or even a good 4 hour span than is not forced between meals if not doing high protein/fat meals to sustain with additional glucose absorption past 3/4 houra.

    you preplex me.
     
  13. rgcainmd

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    Now I'm really confused. The last thing anyone needs after eating breakfast is something to jack up BG further. So why are you saying that glycogen "will get released when someone eats breakfast"? Glycogen is broken down by the liver to release glucose when energy needs are not being met. So I don't think that "glycogen gets released" when someone's BG level is rising after eating breakfast...
     
  14. Theo's dad Joe

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    Glycogen in the liver is going to be high in the morning if you eat a starchy dinner because the liver will have been filled up at dinner. When you eat breakfast then, there is not room in the liver to take on glucose from breakfast, and the large stores of glycogen in the liver will be broken down into glucose and released into the blood stream stimulated by glucagon that is triggered by eating. If liver glycogen is not as full, such as when less carbs are eaten the night before, or when the liver has had time to use up stores of glycogen for metabolic demands) the liver will not have as large a glycogen reserve and so it is inhibited to break down its glycogen and let it go into the bloodstream. (low liver glycogen inhibits glycogenolysis, high liver glycogen promotes glycogenolysis).
     
  15. mmgirls

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    the liver is not last in, first out type of inventory system. But, I will stop their because I can' nt argue with you because I do not know enough.
     
  16. Theo's dad Joe

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    If a kid goes to sleep at 8:30 and wakes up at 7:15 they are going to be fasting for at least 11 hours and that is if they eat and jump in bed. I don't know where you are coming from. The body burns over 90% fat at night anyway and any carbs you eat close to bed are going to get turned into body fat, (using insulin in the process) and then released as fat overnight for fuel. The body only uses about 3 grams of carbs an hour at night from liver glycogen and all of the rest of carbs on board when you go to bed are going to get turned into fat for later. My son eats 1600 calories a day at 54 pounds in three meals evenly spaced. I am not going to argue about nutrition except to say that my wife is an MD and I worked in sports nutrition for over a decade and he eats appropriately.
     
  17. Theo's dad Joe

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    It IS. the liver spills more glucose the fuller it gets! If it gets too empty it will start to make glucose from protein though. It takes about 25-30% carbs to keep the liver full enough to not turn on gluconeogenesis and not so full that it activates glycogenolysis. (under normal activity levels)/
     
  18. Theo's dad Joe

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    How do we know that though. Has someone tested people with blood sugar of 70 and 170 at the same time of the day and shown that they remain flat with the same basal at both points? The liver will dispose of insulin faster if blood sugar is lower, and slower if it is higher. Anyway I have talked to two endo researchers who believe that flat basal was made up and that there are other factors that will slowly move people somewhat predictably into a tigher range of about 90-140 given enough time.
     
  19. rgcainmd

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    I think you got this wrong: "glucagon that is triggered by eating."

    Glucagon release is stimulated by hypoglycemia and inhibited by hyperglycemia, insulin, and somatostatin.
     
  20. mmgirls

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    Have you tested ketones in the am? Do you know why I am asking?
     

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