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Honeymoon Microdosing Finding the Sweet Spot

Discussion in 'Parents of Children with Type 1' started by MMMMMMM, Mar 29, 2017.

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  1. MMMMMMM

    MMMMMMM Approved members

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    Our son is 7 and was diagnosed a month ago. He's apparently in the honeymoon stage.

    We keep needing to drop the lantus dose and are down to .5 units before bed but still see a drop in bg of about 150 over night. To combat this, we're giving him about 60g carbs for snack before bed (his usual meals are only about 30g).

    His bolus is .25u to about 30g carb and he usually has a small snack between meals.


    We've been in constant contact with the endo clinic but have started doing some adjustments on our own.

    One thing I'm considering is dropping it once again to .25u. Since he's on Spring break it's the perfect time to try it. I'm also wondering about dosing the lantus in the AM so it's not so effective overnight. Does anyone do this with their kiddo?

    I don't expect to find a perfect sweatspot, I know his needs will continue to change, but it would be nice to find a dose that will get rid of the bedtime carb cramming and middle of the night "snacks"... which he HATES.

    Last night I slept through his 2 am check and I feel terrible. I don't even understand how I could have. That's a scary thing... anything can happen at night. Thank God he was 112 this am. :(
     
  2. barbiduleny

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    Hi

    Have you considered getting a pump? I know it's a tad early, but that's what helped us solve the 'night issues' during honeymoon for our son. We kept on reducing the lantus, changing the timing of administration but he was still going low at night. With the pump, slow acting insulin is replaced by a basal rate of Novolog / fast acting that you can modulate as much as you want (you can drop it to 0 in the middle of the night). Generally we found that we've had to modulate the basal quite a bit during the day to achieve better control, with rates as high as .7u/hour or as low as .05u. Just a thought, I know how overwhelming these first few months are...
     
  3. MMMMMMM

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    We changed the lantus to AM yesterday and last night was a little more smooth, no major drops but it's still a gradual one. That's probably to be expected?

    I'm definitely already thinking about a cgm/pump but my understanding is that our insurance doesn't cover it for children under the age of 16. However, it can be overridden for special circumstances and with prior authorization. I'll certainly be talking to his dr at his appointment in 3 months.
     
  4. kim5798

    kim5798 Approved members

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    When we were on shots, AM lantus was very helpful in avoiding the nighttime lows. If you & your child are interested in the pump, ask at your visit. The folks who advocate for our kids to get pumps are skilled at what they do & they can help get the approval from your insurance.

    Good luck in the diabetes journey!
     
  5. MMMMMMM

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    thank you. :)
     
  6. MMMMMMM

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    Now Getting Lows all Day after switching to morning Lantus.

    Since we switched to AMs he's now getting lows all day. Most just between 60 and 80 but yesterday he had 2 in the low 40s. Nights are doing much better which is nice not to worry as much about but I got 3 calls from school today about his lows! The on call doctor says there's nothing more we can do other than increase his mealtime carbs intake and he is such a picky eater it's hard to get him over 30 carbs unless it's unhealthy stuff. He would gladly eat junk all day long.
     
  7. hawkeyegirl

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    Ah, that's pretty tough. The pump really would be ideal for you in this situation. In this day and age, I would be shocked if your insurance denied the claim, especially since your doctor will be able to write a letter of medical necessity. In the meantime, well, some "junk" is better than him having to fight lows all day at school.

    Best of luck to you!
     
  8. wilf

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    I missed this when you first posted.

    The switch to Lantus was a good decision. Giving Lantus in the morning is a great way to deal with dropping numbers overnight. :)

    While he is in the honeymoon, his body will naturally pull his blood sugars down to the 60-80 range. Don't make the mistake of fighting that with carbs, as he is producing enough insulin that he'll drop nonetheless. Just go with it and give some overnight checks to make sure he's not going below 60. His body will tend to pull him down to the zone it is comfortable with (as said, usually 60-80) but then will stop and he'll generally hold steady with great waking numbers. :cwds:
     
  9. MomofSweetOne

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    Several things:

    1) Learn to be your son's best advocate. Just because the policy on a pump might be "6 months" or whatever doesn't mean you can't fight it and win. From what you described, the microdosing a pump can do (.025 unit) would make a huge difference in your son's management. He'll feel better, have lower risks, and more.

    2) Switching Lantus to morning was a good move. We actually did the opposite as my daughter climbed during the night, but the endo initially recommended morning dosing until we learned what was happening.

    3) When my daughter had to eat all day to be stable at night, we switched to the pump. It was revolutionary. She didn't feel well on MDI. For us, it was puberty hitting full blast overnight.

    4) Most kids do become quite good at juice guzzling in their sleep.

    5) Sleeping through alarms is scary, even several years in.
     
  10. MMMMMMM

    MMMMMMM Approved members

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    I love this quote. I've had it in a frame on my work space for years. I don't feel like dancing in the rain right now and it's nearly impossible to believe the storm will pass.

    I'm wondering what MDI is, I'm still learning a lot of the terms.

    His next appt. was in three moths but I was able to move it up to the end of the month and discuss a pump/ cgm. My understanding is that dexcom isn't the same as a pump?
     
  11. MomofSweetOne

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    MDI is Multiple Daily Injections. Basically shots, but also distinguished from shots with older insulins that only required 2 shots per day but life was lived around diabetes, not diabetes around life.

    Dexcom is a Continuous Glucose Monitor (cgm). Medtronic makes one as well. We're very biased after interacting with both company's customer service. They are AWESOME...and sometimes I'd like to run the thing over with a car when I'm sleep-deprived and not feeling rational about just wanting it to be quiet and let me sleep. Every kid (or adult) should be sent home with a cgm at dx. They're that much of a game-changer. If you call Dexcom or look at their website, they will start the process of getting a script from your doctor, contacting insurance, etc. Let them do the work; you don't need more!

    You can also call pump companies yourself for trial/information sessions without waiting for a pump class. My daughter actually wore the Medtronic pump/cgm into our intro to pumping class with saline in it. It's important to TRIAL every pump before deciding. They have slight differences that may be a deal breaker for one user, but not another. I'd thought my daughter would choose Animas, but she could feel the boluses and said it hurt. We went with the Medtronic the first time, then later bought a Omnipod PDM through a program called "Cut-the-Cord" that allows her to have it as a back-up or option. She now wears the T-slim, which is her favorite by far. I wish it had a remote, but I'm very excited about the ability to remotely upgrade the pump software, especially as their low-glucose-predictive-suspend is due out in the next few months.

    A lot of AP systems will be coming out soon. The Medtronic is already out. I think about 4 more are due out in the next 18 months, followed by at least Omnipod in 2019. That's something to take into consideration, as what you buy will be what you're likely stuck with for the next four years until the warranty is up. For us, that probably means that the first AP my daughter will use will be the Type Zero integrated into her t-slim pump as her warranty won't be up for another two years. But for now, I'm just really excited at even the thought of the low glucose suspend!

    We're not feeling like we're dancing right now, either. It comes and goes. Diabetes has thrown lots of curveballs at us in the last couple of weeks: cold, infected site, etc. I turned up basal the night before the ACT as she'd been in the mid-200s all day despite correction doses, only to send her down into the 50s. We were up multiple times, and she went off for the test with four hours of sleep. Then the stress sent her into the 200s. Not what we strive for, by any means, but some days it happens. How sleep-deprived we are really affects how well we cope emotionally with diabetes.
     
  12. wilf

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    MDI is multiple daily injections. If you're not using a pump, then MDI is the standard of care. Basically it involves measuring blood sugar before each meal, and then blousing to cover carbs.

    A dexcom is one kind of continuous glucose monitoring (CGM) device. All CGMs are used for is measuring blood sugar - they give a continuous data feed.

    A pump is another way of delivering insulin - an alternative to injections.

    Sounds to me like you need to get your hands on a good reference text. Try Type 1 Diabetes by Ragnar Hanas. :cwds:
     

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