- advertisement -

Frustrated with highs

Discussion in 'Parents of Children with Type 1' started by MommaKat, Jan 22, 2012.

  1. MommaKat

    MommaKat Approved members

    Joined:
    Sep 2, 2011
    Messages:
    646
    We've only been at this for 11 months minus a week. I realized things would change, change some more, and continue changing. (I thought I did? :confused:) We've been okay with a day or few that seem off whack, and sort of back to a fairly stable window of swings, normally 65 - 180, some 50s overnight, and rarely up to 250s. It should probably bother me that dd is more comfortable with several mild lows than she is with a few highs... but based on how they affect the way she feels, she hates highs with a passion, is scared of severe lows, and handles mild to moderate lows without missing a beat (so far), ergo her preference.

    I understood that because she's been sick, we needed to and did expect higher numbers. Whooping cough is making it's rounds at school, and she missed three days of school on top of the entire three day weekend prior. (she is up to date on immunizations, pertussis infection still occurs in immunized individuals, just not as severely, and the region we live in has a high percentage of non immunized so it's a hot bed for pertussis.)

    My frustration is she's better now. Cough is almost nearly gone, she's got her energy back, is going to bball practice, eating her typical healthy / balanced diet. Her numbers? High 200s and it's as if we haven't given any insulin when we do her post meal check. Her avg bg for 7 days on her meter is 190. We've been giving corrections higher than ever before (even than when she was really ill), AND more insulin for carbs, and there's hardly a drop, no drop, or she even rises. We increased lantus, still no change.

    I plan on calling the center again (I emailed logs with a request for review Thursday, no call back, and called on Friday without a response.) But if I don't hear back, I find the 7 day average very upsetting and am wondering what people here might suggest. We did open a new insulin pen, the regular humalog pen in case we're having problems with the half unit pen. This what today looked like. (We were out all afternoon, brother's bball games, and she walked around with friends. Meals are mostly veggie and fruit, w/ 20% protein, 20% or less starchy carbs, and very little fat.)

    7am - 130 - not feeling well, wanted to sleep in so just gave 7u of lantus
    9am - 152 - changed I:C from 1:22 to 1:18 covered breakfast with 3.5 u
    12pm - 307 - she felt nauseous (usually does with highs) so delayed lunch
    12:45 pm - 297 - 3.5u for 70g carb, 3.5u for correction (ISF 1:40) total 7u
    3:15pm - 198 - asked to wait on snack
    4:00pm - 192 skipped the covered snack she wanted
    6:00pm - 131 (finally) 62g carb, 3u
    7:30pm - 6u lantus
    9:10pm - 222

    A week ago her I:C for meals was 1:20 bfast, and 1:25 - 30 lunch / dinner. She was on 6u of lantus in the morning and 5u (couple days at 4u) in the evening. We were still seeing a drop of more than 100 in her bg overnight. Now, not so much. The first couple days she was sick, she had a ton of lows and her I:C changed to 1:35. Obviously we decreased that (? or is it increased) fairly quickly, and the on-call doc I reached earlier in the week had already cautioned me that we'd probably go back up on lantus. When I look over the last three days, she's gotten nothing less than 6u at each meal, often 7 or 8u, until bfast and dinner today, but those look like she should have gotten more. With the highs, we did what they had us do last time she was sick, and changed her correction from 1:50 > 150 to 1:40 >150.

    Is this because she's still at the very tail end of being sick? Does it look more like the end of her honeymoon? Both? She is so frustrated, and I am scratching my head. How do you get 7u of insulin (from a new pen, no less) and not come down until 5 hours later? I guess I'm somewhat concerned because her post prandial numbers haven't been in range for awhile now (a month or so), but the clinic wouldn't change much because of the overnight lows. I worry about long term affect on her health, and insulin resistance. Now, we're not even seeing the prolonged time it takes to drop (like the one between lunch and dinner) very often - she just stays high. At the same time, I don't want to over react, increase basal too much, and end up with night time lows all over again.

    I think I'm starting to understand why people here say D was easier to manage during the honeymoon. A week and a half ago, we couldn't keep her out of the 60s!! It feels like we've been through such a weird series of swings, and now we're upside down. I hated the overnight lows, but I really wasn't asking for this. :eek:
     
  2. Connor's Mom

    Connor's Mom Approved members

    Joined:
    Nov 10, 2011
    Messages:
    564
    Things can change fast especially after an illness. It sounds to me like it is a combination of coming off the illness and needing more insulin because the honeymoon isn't as strong any more. I feel your pain though. My little guy just finishe da cold only to be slapped with another one less than a week later. He is home now feeling awful and swinging wacky BGs!

    If you are looking at the numbers and you can spot a solid trend, make the change. If it were me, I would make the change. I would be cautious and make it small. If it showed promise then I would tweak it some more. Trust you mommy instincts they are good.:cwds: no one asks for the swings but, we all go through them. They suck and aren't fair and make us lose sleep and they are part of the job of D care. Hang in there!
     
  3. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    What I've heard about pertussis is that it can stay in the body for a long time -- did I hear six weeks or six months?

    What I know about sickness and diabetes is that even when Selah isn't showing any symptoms at all, she has higher bg when she's fighting a virus. Which makes sense, her body is putting out stored energy to fight the infection, right? Selah happens to thankfully have a strong immune system (too strong in some areas, eh? :rolleyes:) so she often gets only a few sniffles or no symptoms when her sisters get sick, so I've been able to observe through bg when she is fighting a virus but not showing it with symptoms. So I'd suspect that's what you've got going.

    (A note about pertussis, too, the first outbreak I ran into the problem was not folks opting out of vaccines, it was that the vaccine loses efficacy and people were not thinking to vaccinate middle school, high school, and adults -- that's the population it was running in. I think they're tackling that now. Also, I understand there are new strains.)

    Also, I find that where you start really affects how you wind up with bg. When things are going well, she can be evenly 200s all day and night or evenly 150s all day and night, depending on where she starts. You got to get her down to a good starting place or she's never going to level out at a good place. BUT when you have been on the high side for a long time you get insulin resistance, so you need jump start corrections but those WILL drive her down. E.g. Selah is in the 200s and 300s, stuck, so I give her say 1 1/2 correction. It unsticks her, she winds up coming down into range, but now she's got far too much insulin on board for her bg number and has to eat something to keep from going low. If she eats too much (or too late in the drop, so you have to overtreat to head off the low) then she's back up high again. If she goes low and rebounds, back up high again. It's a bear to get back to a good place, you kind of need to set aside some time and energy to work it back down and then it gets easier again.

    Keep in mind also that what might look like overall insulin increase needs might be a matter of too much basal and too little bolus. We have often found that highs are combated by lowering the Lantus, not raising it, paradoxically.

    Good luck and yes, this is life with diabetes. Always a party!

    (Just realized we're coming up on four years in February!)
     
  4. Amy C.

    Amy C. Approved members

    Joined:
    Oct 22, 2005
    Messages:
    5,560
    The test I use for making changes is if my son is not in range 3 hours after a meal that he needs more insulin at that meal.

    If out of range 5 hours after a bolus during the middle of the night, the Lantus needs to be changed.

    Your child needs more insulin. Please don't be afraid to give her what she needs. This happens to every child -- the insulin needs go up as they grow. There is no need for mourning that changes need to be done. That is part of the nature of dealing with diabetes.

    I was reluctant to give my son more insulin when he was about 9 or 10. More insulin is not bad.
     
  5. MommaKat

    MommaKat Approved members

    Joined:
    Sep 2, 2011
    Messages:
    646
    Thanks for the feedback. I decided not to correct the 9pm even though she was bumping 200, and now I'm glad I didn't as she dropped to 52 last night. Grrr.

    We treated with 20g fast acting carb, waited 15minutes, she only came up to 60. Treated with 5g more, waited 15 minutes, back to 95 (and sleep!)

    2 1/2 hours later - 165, rebound but not as bad as we've seen. We covered breakfast at her lower I:C (1:18) and corrected the 165. She just called, it's been 3 hours, and her bg is 170. :confused:

    I am so confused. I don't correct, she goes low. I do correct, she bumps up. I have to say, though, that I really wasn't all for her breakfast choice, cheerios and banana, as that does tend to spike her. So, maybe we actually didn't do so badly?

    Anyway, we've covered for lunch at the lower I:C, again, and corrected for the 175. (She calls from school everyday still. We found out the aide isn't even looking at or recording carb amounts, and dd wants someone to check her math and thinking when it comes to carbs + correction.)

    You must be right, Lisa, that she's still fighting pertussis enough for it to affect her bg. Maybe I can be more aggressive at breakfast and lunch, but careful with dinner and night time. I can't believe we're back to that huge drop at night again. Would it make sense to drop the pm lantus to 5 and increase morning to 8? Or, should I drop the night time, and keep am at 7u? I hate night time lows. What if I'd corrected the 198 last night?!

    ETA: I just re-read your reply, Lisa, and this part is what I was thinking, thanks to some useful advice from Wilf, right before she started getting sick and got hit with a string of lows. (Two days in the 60s)

    So, maybe we're heading back to that scenario as she gets better, and I need to drop lantus but increase all of her I:C ratios?
     
    Last edited: Jan 23, 2012
  6. Amy C.

    Amy C. Approved members

    Joined:
    Oct 22, 2005
    Messages:
    5,560
    this is an over correction, not a rebound. Sometimes it takes a while for the sugar to rise.
     
  7. MommaKat

    MommaKat Approved members

    Joined:
    Sep 2, 2011
    Messages:
    646
    If it's an over correction, how long do you usually wait to retest after giving juice or glucose tabs for a low? We waited 15 minutes both times, and the endo chewed me out for waiting more than 10. I was honestly positive that the juice alone (13g) would not bring her back up to 70, but with smarties (18g total) would. After 15 minutes, she was at 65 and shaking. Had she not been shaking, I probably would have waited another 5m, but since she was we decided to be safe but conservative. Instead of the full 15 we're supposed to give, I gave her 5g more. At ten minutes she still wasn't up to 70, but felt better. At 15 minutes she was up at 95.

    I guess over correction is confusing to me because we treated symptoms - shaking, confusion, cold sweat, nausea, etc. and it wasn't enough after 15 minutes to reverse all those. Given that the next 5g still didn't bring her back to 70 in ten minutes, would it have been unsafe not to treat with the last 5g?
    (I really am asking here. I have a logical understanding of what lows do to our kids brains, and because of my medical background, I feel more worried about the consequences of lows in the right now. That said, I'm acutely aware of the consequences of highs over time, and don't want to routinely over treat either.)
     
  8. Amy C.

    Amy C. Approved members

    Joined:
    Oct 22, 2005
    Messages:
    5,560
    I really meant to say that 165 was not a rebound. I shouldn't have called it an over correction. It wasn't particularly out of range and the important thing was your daughter was no longer low nor did she feel low.

    Different kids come up at different rates.
     
  9. MommaKat

    MommaKat Approved members

    Joined:
    Sep 2, 2011
    Messages:
    646
    Amy, I appreciate your answers, and I so don't mind being told that I'm over correcting if that's the case. We've pretty much flown through the first year without support from our endo. (Twice recently I've had great conversations with people on call, but I can't really wait for them to be on call again, lol.) So I'm feeling a little lost on how to meet the changes she's going through with rational decisions. It used to be 10m was the longest we could wait to recheck. Now I'm wondering how long most kiddos wait to recheck after treating a low.

    I can tell that some things changed in really big ways. Before mid December if Niko went low, we had to treat and give a snack. Not even close to true anymore! I feel like she's very, very carb sensitive, and not so insulin sensitive as soon as she's over 175. We almost never saw anything over 225, and when we did it was too easy to correct. Not so much now, obviously.

    It's interesting though, her post lunch was 111 and then she went low right before basketball. I think my biggest struggle is that once we think we have a plan, things change before we implement or see it through. Having her back in school finally has helped restore some willingness to breathe and go with the flow. I know I can count on some good advice here, and that in the scheme of things we'll get the hang of this too. Thanks!!
     
  10. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    That is one of the bears about diabetes, and one of the reasons a CGM and the ability to catch a low before it's a low is handy.

    Once Selah is 55, we have to overcorrect, or whatever you want to call it! :p Because she will need to come up 100 points or so, fast. That's 10 grams. But it's 10 DIGESTED grams. No getting around it that I may have to give her 50 grams to get 10 digested in time, because a 55 isn't stable, it's going down. After the panic is over, I have to deal with the extra 40 carbs she got. No getting around it. Just life.

    A rebound is only clearly seen when there is no food given, like if you don't catch a low in the middle of the night but the CGM does. If you see 100 turn to 45 turn to low and then within half an hour it's 300, quacks like rebound.

    You can get rebound and "over" treating at the same time, you and her liver will both be panicking at 50. I believe Selah's body kicks out some glucose when she is that low, even if we don't get a full rebound to 300.
     
  11. Style mom

    Style mom Approved members

    Joined:
    Dec 3, 2011
    Messages:
    174
    We recheck at 20 minutes, but I know from experience that not even tabs will be fully digested by then.
     
  12. MommaKat

    MommaKat Approved members

    Joined:
    Sep 2, 2011
    Messages:
    646
    Thanks, that actually helps a ton. It sounds like we were right that the first twenty would bring her back up, just not fast enough to outrun the fall in the opposite direction. I do find that we can treat lows in the 60s conservatively with a lot more success, but once she's in the 50s or lower, not a fat chance!

    She's had two more lows today, and the one before dinner I was able to deal with better after reading all this. So, we're going to try moving down to 5u tonight, and hope that tomorrow she isn't too high during the day. I doubt it with the way today's been, but I know where that's gotten me before.
     
  13. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    I think that part of the issue may be undetected lows, which are causing rebounds and insulin resistance. I would continue to urge you to shift the Lantus to mornings.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice