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Help pls

Discussion in 'Parents of Children with Type 1' started by kledi, Aug 27, 2016.

  1. kledi

    kledi Approved members

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    Please help , i feel so confused. My son 4 year old has diabetes for 1 year . He is on MDI tresiba and novo rapid . We have 2 weeks that we fight lows every day every meal . I have redused basal as doctor adviced but im sure that is novo rapid acting strange bringing him very fast dawn . We have redused novo rapid a lot. Before we were using 1:20 but now we need a lot of carbs or no novo rapid at all with his meal. We see a rise 2-3 h after eating.we tested him for celiac and we get results monday. Do u have any clue what is happening . And he has been 2 times during this week going very low with 0.5 unit novo rapid we had to use glucagon as fast acting carbs didnt make a change from the drop .Thanks in advance
     
  2. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

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    All I can tel you is that it is not uncommon for kids to have "non-diabetes" days even years after dx. My kid continued to have them occasionally, usually 2-3 days in a row, up until her 5th year post dx. Just keep reducing insulin as needed. That's really all you can do. Best of luck, hope you can avoid more glucagon and let his liver replenish it's glucose supply.
     
  3. kledi

    kledi Approved members

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    Strange things today too, his correction factor is 1 unit brings 10mmol down his blood glucose.diner 1:30 , in the dinner time his blood glucose was 17 , eat 30 carbs and because of strange things lately i decided to give 0,5 novo rapid and watch carefuly his cgm. Small physical activity . No prebolusing, after 20 min his bg was coming fast dawn. And we needed 70 carbs to stop that drop. This is hapening with every meal . No drop from
    Basal insulin if i try to delay the meal 2-3 h no drop with happen . What do i sugest
     
  4. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Can you skip the meal bolus and see what happens? When I was first diagnosed I was in a strong honeymoon period where I took basal insulin but needed no fast acting for meals.
     
  5. Manuel

    Manuel Approved members

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    Hi! We have that kind of oscillations the first month after my son was diagnosed, he has 2 years old and his dosage is very similar to your daughter. After some reading and a lot of trial and error we managed stabilize him.

    Some tips that we learn and could be useful to you:

    - If the bolus if after the meal he will have a high peak followed by a very fast (two arrows) drop, that usually need to be stoped with 5 to 15 carbs. Very similar of whay you have described.
    - If the bouls is before meal (10 min) he will not have a peak at all, and he will not have a fast drop. After 2hs he will be stable in range.

    I don't know exactly why that happens, but it seems that the insulin is much more powerful when it has to cover JUST glucose in blood, but if has to cover the ongoing meal the effect is more "smooth". For example if my son has 17mmol (300 mg/DL) 0,5U of Novorapid will take him to 6mmol or less very fast (I have to stop the drop), but if he has 6mmol I put him 0,5U of novo rapid (10 min before meal) and he eat 30-40 carbs for meal he will not have a peak and he will not have a fast drop, usually came back slowly to 6mmol. So the timming of the bolus is very important, and there has to be some recent food in the body to make the drop more smooth.

    - Basal has peaks, and sometimes those peaks are at the same time of the meal so you will have a "double" effect. Understing the time of those peaks is crucial for the bolus. For example, my son use 3U Levemir + 1U Novo Rapid at morning (applied at the same moment), the levemir start acting after 1 hour and the Novo Rapid after 30 minutes (and goes on for 3 hours), so we was giving him 1,5U of novorapid but after 2 hours he use to have a very fast drop that we have to stop with carbs. We reduced the novorapid to 1, and always 15 min before breakfast and worked very well.

    - Are you considering that the CGM is slower on showing a change of direction after a low?. If she is going low, and you give her 10 carbs, wait 10/15 min and measure with the finger to be sure that she is out of the low (regardless of what CGM is saying). It usually take at least 20-25 minutes for the CGM to start showing the rebound. An other strategy is catch it way before she is low. For example she is at 180mg/DL (10mmol) going down very fast (two arrows down). Gave her 5 to 10 carbs and wait 15 min, if CGM does not change the speed (1 arrow instead of two), give her a little more of carbs.

    - Consider the glycemic index of the food. Fast acting food like cereals, bread, banana could have a hi impact on the speed of the drop. From our experience is better to combine some fats when he is eating a high glycemic index food. For example if he is going to eat white bread at breakfast, we put a slice of cheese. That avoid a hi peak followed by a fast drop. Without the cheese is a high and a very fast drop. I don't know why, but It just happens like that.

    - Try to understund each meal at a time. Morning sensitivity to insulin is usually different from the night or afternoon. If you focus in solving only one meal at a time, you will understand the diference in insulin sensitivity, peaks of the basal and the effect of the glycemic index of the meal.

    - Consider that the effect of the basal and the novo rapid will combine. So if her basal is high the effect of the novorapid will be stronger. If the dose of basal is correct, she should be steady/stable between meals for at least 2 hours (oscillating +- 1.6 mmol), if that is not happening your basal is high.


    Have you read "Think like a pancreas"?. It is a very practical book on this kind of small things of the diabetes, it helped me a lot.

    Hope it helps, regards.
     
  6. wilf

    wilf Approved members

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    How much Tresiba has he been getting per day?
     

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