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Fighting The 200 demon!

Discussion in 'Parents of Children with Type 1' started by danielsmom, Nov 13, 2011.

  1. danielsmom

    danielsmom Approved members

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    Is this what its like to get out of the honeymoon? Battling the highs for a few weeks until you get it all figured out again? Getting frustrated. We upped his dinner dose. From 1:30 to 1:20. He still went to bed with 215 and woke up 143. I upper his breakfast by 1/2 unit, and at lunch he was 280. The fact that he has been in the 200's does not seem to affect him, still feeling fine, soccer, the world as usual. His diet hasn't changed. His just dealing with allergy issues. We only hopes the levimir a half unit, so I'm thinking we need to up it one more half... Just frustrating.and feeling stupid that I can't fix it.
     
  2. Butterfly Betty

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    What time did he eat dinner and what time did he go to bed? What's your correction ratio?
     
  3. danielsmom

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    Bedtime correction at 250 and above,
    Lunch / dinner 200 and above .5 for 250 its 1 etc. But if he is barely over 200 and vorrected he goes low. So at lunch he had 73c, so we haven't changed 1:30 yet, but I gave him half unit more and corection. We will see how he does.
     
  4. jbmom1b2g

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    Shirley, I am right there with you. My DD has been running high for bit, we changed her dose of lantus to 5 units, this weekend she has been running high. Fri and Sat were more guesstimates due to 2 parties she went to but it is still frusterating all together. Good luck. our nurse told us she thinks Taylor is coimg out of her honeymoon
     
  5. Beach bum

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    What kind of meds is he on for allergies?

    Are you prebolusing him for his meals? If he's having high/carb/high fat meals (pizza, mac n cheese, chicken nuggets type stuff) are you breaking the shots up into two doses (1 for a portion about 15 minutes prior, then the remainder after)?

    All I have to say is to keep tracking everything so that you are armed with as much info as possible to give to your doctor so that changes can be made.
     
  6. Sarah Maddie's Mom

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    As much as I detest the word "control" with regard to D stuff I think, from reading your threads, that you have a "control" issue.

    Managing diabetes is not easy. If the endo led you to believe that you give a shot and can expect it to result in steady bgs then they have served you ill. You have to balance what is being eaten with the right dose at the right time(s). This may mean a change in diet, or a more aggressive use of pre-bolusing, or using multiple injections to cover a meal, but at least one, or better two of those factors have to be "controlled".

    I'd highly recommend, if you are seeing highs all the time, to do some basal testing. Then be open to experimenting with using two injections to cover high fat/high carb meals. Or try lower carb/lower fat meals and see if you can get your ratios right for simpler to bolus for foods. And as Wendy suggests, log everything so that the endo can help you make the necessary changes.

    Good luck!:cwds:

    Edited to add.
    And if you haven't already, I strongly encourage you to buy and read Ragnar Hanas' book, "Managing Type 1 Diabetes". You don't have to buy the latest and most expensive edition. It is a vital resource for understanding how insulin therapy works. I really cannot recommend the book highly enough.
     
    Last edited: Nov 13, 2011
  7. tabd22

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    I don't have any answers for you, but found out something interesting on Wednesday when my daughter started her trial with Omnipod. The rep used the rule of 1400 (or maybe 1500-can't remember) to find out how much her sugar will drop with 1 unit of Apidra. It was calculated that 1 unit will drop her 130 points. That really opened my eyes as a reminder to how important it is to carefully count carbs and correct when needed.

    We are still honeymooning too and seeing the same ups and downs.
     
  8. danielsmom

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    Well at dinner he was 225....so I corrected with .5 and gave him the 1:20 ratio(and mind you this was without his midafternoon snack of 15c)...he hada reasonable dinner...no high fat...well the slice of texas toast, but rest was good...so post dinner he was reasonable 175...so tonight I'm giving the 7 units of levimir instead of the 6 1/2 I think the manager told me this last friday to up it and with all these changes I"ve been doing, I forgot to do it during the weekend.. I'll do my 2am check and see how its going....I know that you can't "control" diabetes....but I want to manage it as best as possible..his highs have only come on these last two weeks..otherwise he was doing wonderful.. Thats why I asked AGAIN..my original question, if this is what you all saw when Honeymoon was ending with the numbers being wacky and trying to get them back into a reasonable range?
    Getting my son to eat food not so high in fat is a work in progress...for this I will be happy to be on the pump... for now I deal with one number at a time..
     
  9. rutgers1

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    I saw mention of a 15 gram snack. Is that something that your endo allows him to take uncovered? Early on, for some reason our endo was allowing unnecessary snacks or bigger snacks than needed to treat lows. A few months into it, we realized he could only eat an uncovered snack if he was exercising or low. With exercising, we had to tailor the snack to the length and intensity of exercise (a school recess was only 7 grams), not just the blanket "15 grams" our endo listed on our sheet. With lows, we also had to determine how much 1 carbs approximately raised him and treat each low with the right amount of carbs, not the standard 15 that the endo recommended for everything.

    Aside from that, I recommend a night without sleep. That might sound nuts, but I can never sleep when experimenting with insulin. I want to test every hour to see how it is affecting him. That is even more true now that Matt just started the pump, as I want to find the exact times that his blood sugar starts rising/falling so I can adjust the basal.

    Is he any less active over the past two weeks? If Matt stops sports, his insulin needs go up.

    Finally, I may be new at it, but I recommend the pump ASAP.
     
  10. rutgers1

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    Whoops.....forgot to add that I think you are doing the right thing by upping the long lasting insulin. What frustrated me when we were on MDI was that he could go high on one dose and low with a half unit more.....or high at one time of the day and low in another.

    After a few great A1C results, they started getting worse because we had to accept him being high part of the day so he wouldn't go low the other part, etc. This is why I am loving the pump. His basal need is like 2x as much at night while sleeping, which is something that we couldn't address without the pump. On top of that, I can make micro corrections to bring him in range that I wouldn't have been able to do a month ago on MDI.
     
  11. Connor's Mom

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    Our honeymoon was unique. When he was first diagnosed he was only on insulin for a month before they had to take him off his Novolog and Lantus. When he started going above 200 (8 months later) we still thought it was easy because he adjusted very quickly. Then it started. When we thought we had it under "control" he really got out of the honeymoon phase and we started to learn what it's like to look for trends, test and correct. We had hime pretty stable and then he started to react differently to his insulin based on where the shots were given. If the shot went in his butt or belly he might as well not have had any. If it went in his arm it reacted quickly, his leg was slower than the arm but better than the belly or butt. We just started a pump and we have started a whole new set of challenges. I agree with rutgers1, I did the night or (100) without sleep finding the exact time when things start to change. It really helps to be OCD for a little bit to find the trend. To answer the question, YES the numbers do get wacky coming out of the honeymoon.

    Keep up the good work and trust your gut. You see him everyday the Endo doesn't. If their suggestion doesn't feel right talk to them about your concerns right away. Waiting only increases the frustration.
     
  12. jtolpin

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    Allergies? BTDT still doing it.

    Milk, egg, gluten et al.... yes.

    Gluten free works differently for Caitlin. Takes a while to absorb.

    Hugs!
     
  13. Melissata

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    Once the honeymoon is over, you will find that you will not be able to keep him in range nearly as easily. Life happens, and the sooner you realize that you can't perfect this, the better off you will be. I have all of the tools that you don't have, pump and CGM, and I still can't keep my daughter in range all of the time. Shoot for a % and don't work so hard trying to keep him in perfect range. I doubt that there is a parent posting here that can say that they keep their kid in range most of the time. We all start out thinking that we can, if we just work at it hard enough, but it just is not possible.
    Like someone else said, you need to look for trends, not just numbers for one day. When you see something that is happening consistently, you make the change then. Otherwise, diabetes is controlling you, you are not controlling it.
     
  14. saxmaniac

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    The first think is to look up your child's weight and current TDD (total daily dose), and get a feel for where it's going to land when he comes out. It's about 1u/kg, and you can assume 50% of that will be basal.

    So, if he's getting 5u basal with a TDD of 10 -- but the numbers say expect 15u and a TDD of 30, then you know you have a long way to go, and tiny adjustments will just be a drop in the bucket.

    When my son came out of the honeymoon, it was fairly abrupt. We had lots of trouble because we were adjusting the basal very slowly and very conservatively, based on honeymoon experience -- back then 1/4u or 1/2u made a big difference! But when it was over, we had to get very aggressive, and we just didn't have an idea where the TDD was going to wind up at.

    We went through over a month of horrible highs and ketones and things that we thought were pump failures.. but it turned out that we were simply not adjusting the basal quickly enough, and by enough of a mount to make difference.
     
  15. danielsmom

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    Well I hope to figure something out soon....Maybe I'm just not getting it...I do see now that when he has the high fat food for dinner(pizza/cheese)..he spikes about 7 hours later...which he did again, although he went to bed with 175, he spiked up at 2am with a 300(and the only high fat food he had was a slice of texas toast)...maybe the white rice too?...Okay..well reality check, guess I will keep working on it...and yes upping the Levimir didn't seem to make a difference today....it may need to be split..just have to brainstorm...I have changed the carb ratio 1:20 these last few days...
     
  16. danielsmom

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    Our endo won't give us the pump until we are 1 year into this.. I am thinking I may need to fight her on this...Daniel aggressively exercises 3 times a week...a little less with the P. E. Twice weekly..but yes he was snacking 15c(although he does the tube yogurt which is 13c)....at am at school...and sometime 11-15 at pm snack after school...All this "was" working fine.. Obviously it is not now.
     
  17. Beach bum

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    You can fight this. If he says no, then find a new doctor. Just because he was assigned to you doesn't mean you have to stay with him. We started pumping 8 months after diagnosis.

    If a pump is something you feel that you really want, then go for it. Do research, ask questions, then tell the doctor this is what you want to do.
    I never understood the theory of making people wait 1 year, or waiting until the kid is a certain age. I really think in your case the pump will help. It would help you better bolus for foods, adjust for sports etc.
     
  18. hawkeyegirl

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    You are your endo's boss, not the other way around. ;) Nicely, but firmly, inform your endo that you would like a prescription for the pump. If he/she will not do it, find another endo. There is no reason to wait a year if you want one now. We started pumping 5 months after diagnosis, and it was life-changing.
     
  19. Christopher

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    I agree, you should talk to the endo about spliting the Levemir. It worked very well for Danielle.
     
  20. danielsmom

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    I spoke to d manager and forgot to ask about splitting the levimir....she is calling me back in a bit, so I will ask...we are going to be more aggressive right now...no other way about it....
     

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