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Help - Still learning about insulin... not sure if I quite get this one

Discussion in 'Parents of Children with Type 1' started by ashtensmom, Sep 29, 2011.

  1. ashtensmom

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    DD felt low today about half hour pre-dinner (and also 2 hours past last injection). We treated her for the low and 30 mins later had dinner. Because her last injection was 2 hours ago, we figured she still had some insulin in her and also because she was slightly low (3.9 mmol/70 mg) we reduced her supper insulin by half (usually 1 u:40 but gave only 0.5 u for 40g). So, now 2 hours later we checked again and she is 17.9 mmol/322 mg :eek:

    Did we do this wrong? Should we have stuck with the 1u per 40 carbs as usual for dinner insulin?

    I think we are not quite getting the IOB (maybe it's because we are on NPH/humalog still). We didn't do the full 1u for 40 carbs because we thought that since it was only 2 hours since last humalog that there would still be insulin to bring her down. However, that previous shot was to correct a high at around 3:30 pm, which obviously worked because she went low (70mg).

    We only gave her 6 g to treat the low, which usually brings her up by 3 mmol/54 mg. So given that she was 70 mg plus the 54 ish mg she would have gone up with the treatment, she would have been around 125 ish (6.9 mmol) at supper. Were we wrong to cut her supper insulin by half and should we have given the usual 1u to cover dinner? I am guessing so since she's 17.9 (322) 2 hours later :confused:
     
  2. sneakermom

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    How low was she when you treated her? With severe lows, some people experience "rebound highs". This is because their body releases some glycogen from the liver to help get the blood sugar up. They can be stubborn to bring down.

    As for the insulin treatment, I am not very familiar with NPH peaks, etc. I am sure someone will chime in soon on that. Sometimes, D just does the unexplained to our kids. Just when you think you've got it figured out. A curveball comes your way. Hang in there.
     
  3. Mel

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    Our little guy experiences rebounds like this as well. If he was low before dinner, his insulin dose would depend on how low he was and what we used to treat it. Hang in there, Momma! *hugs*
     
  4. ashtensmom

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    She wasn't very low at all 70 mg (3.9 mmol) so it wouldn't have been a rebound. Her BG sure indicated that we goofed on cutting her supper insulin in half. We gave the reduced insulin because we didn't want another low.

    What do pumpers do? If you usually give 1 u for 40 carbs, but it was only 2 hours since last insulin, do you reduce current insulin?

    Actually I would like to hear from MDI users too in this situation.
     
  5. lisac

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    With a pump, if you're using the bolus calculators, it will subtract the actual insulin on board from what is needed to reduce the bg when you are giving carbs. I just reread that and it won't make sense if you don't "know" the pump. Ok, here's an example: Hadlee is 70, we give 15 carbs. It's been 2 hrs since we treated a high, it will show 30% of the insulin given to treat the high as IOB. Retest at supper, put in new bg, pump will still show the IOB, but still will give a full carb bolus (at least that's what Hadlee's Ping does.) If I'm concerned that she'll go low again, I will manually subtract a bit of insulin, but usually not very much because Hadlee is VERY carb sensitive and even a very few "uncovered" carbs will send her bg skyrocketing! The pump will only subtract the IOB if her bg is high, it won't let me double treat the high bg.
     
  6. ashtensmom

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    So let me see if I get this right... the pump would have given my DD the 1 u for the 40 carbs that she would normally get and not reduced it just because she received insulin 2 hours ago? Meaning, we should have given her the full dose of 1 u at supper rather than just half the dose, correct?

    My DD is very carb sensitive too. 10 carbs will bring her up 5-6 mmol (90 to 108 points).
     
  7. lisac

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    Yep, that's what Hadlee's Ping does...sometimes it makes me nervous, so I will subtract out a few tenths of a unit, but only if she's still in the lowish range (100 or below)
     
  8. kiwiliz

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    I don't think you did anything wrong at all. It always pays to be cautious when you are not using a cgms. However, I think you are right, treating the low worked - so next time you will know you don't have to reduce the dinner insulin so much. Do you know how long your insulins are active?

    What I really wanted draw to your attention was the root cause of this problem - the correction factor. That is probably off. It has been a year since diagnosis - if you notice other unpredictable numbers it might be that her insulin needs are changing. Worth keeping an eye on. :)
     
  9. danismom79

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    I think you basically overtreated - once for the low, and then with 20 additional uncovered carbs. The correction you gave was too strong, either in general or in conjunction with the NPH. It's kind of hard to tell.

    On MDI, what I would usually do for a correction that was too strong was cover the remaining insulin, plus whatever she needed for the low. At the 2-hour mark, I estimated that half of the insulin was still working. So if I gave 1u correction, and she was low 2 hours later, she'd get the carbs for the low, plus enough extra to cover the remaining 0.5u of insulin.
     
  10. Butterfly Betty

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    What I would have done if Sophie tested 70 that close to dinner is treat the low by giving her 15 grams uncovered, then of she ate her nromal 45 carbs at dinner, I would have just covered those and retested her two hours later to see where she was at. Tends to work okay for us.
     
  11. hawkeyegirl

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    I agree with this.
     
  12. MommaKat

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    I'm not giving advice as we're still SO new

    but I find this thread fascinating in terms of the different approaches. Our endo and RN absolutely do not want us correcting for highs unless it's been three hours since her last injection of humalog, and is at least three hours before her next meal humalog. Since Niko eats meals about 5.5 to 6 hours apart that's pretty much never - I'm afraid to correct a bed time high unless it's close to 250 since she dips towards morning anyway.

    Niko does go low close to meals, and what we typically do is treat the low (juice or glucose tab), followed by a 15 gram snack. If it's too close to the meal, we subtract the first 15g. Then we cover the meal as normal, but might give the injection half way through. We were told that humalog peaks at 3 hours and lasts up to about 4. I've actually read that it stays in the system closer to 6 hours (though a very low level by then), and we can tell that for our dd it peaks at around 4 hours.

    I don't know why we started doing this, but rather than adjusting how much insulin she gets at meals, we adjust the carb ratio. On a typical day she might be 1:30 at breakfast and lunch, and 1:25 at dinner. On swim practice days she gets 1:35 for dinner, and PE mornings we do the same thing. It's a conversation we have as we put finishing touches on each meal or make lunch and snacks for school. What's your bg, what activities are planned? What do you think, should we go for ....? Today she was 66 when she woke up. (Yikes!) We treated with juice, she was up to 83, ate eggs, turkey bacon and 15g of carb (rye toast and berries) - no insulin. She ate a 15 g snack during 6th grade lunch (10:25 am!!), and got 1:35 at her lunch just now. Her bgs have all been low 100s. I'm sure we'll bump up her after school snack to 26g (90 minute swim practice today), and stay at 1:35 for dinner. Tomorrow's a weekend, so we'll adjust for a late and lazy Saturday morning.

    I don't know if that's weird, but it works, and her A1c yesterday was 6.3 again. (though how much of that is attributed to her honeymoon, I have no idea)
     
  13. wilf

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    Good response here. :)

    My thoughts exactly. It was right to reduce the supper bolus - next time you'll know you don't need to reduce as much. And see about whether that correction factor needs changing.. :cwds:
     
  14. Rocky Mountain Mom

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    I don't really have an opinion on "right vs wrong" here. IMHO, diabetes doesn't play by the rules, anyway! What I wanted to add to this conversation is highlighting how beautifully we get feedback from this process -- feedback which helps us learn from what we do, and apply it next time. The maddening thing about trying to understand DM, especially in a growing child, is that what works one day often doesn't necessarily work the next day! There are so many variables.

    I hope to encourage you to be gentle with yourself. It sounds like you are really doing a great job paying attention to the details. Bless you.
     

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