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how do I get rid of her after dinner crash?

Discussion in 'Parents of Children with Type 1' started by gjank617, Sep 18, 2008.

  1. gjank617

    gjank617 Approved members

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    Hello all!

    Im quite new here but you ladies have been so warm and welcoming its so nice to know I can ask my questions and get great responses. Lane was DX about 3wks ago, and we are doing ok on trying to adjuse, (yes a bit easier since Im an RN) but we still cant figure out how to avoid her before bed BS of 35-46 (it ranges). she doesnt act hypo at all like she does when she gets a low when she wakes up, but i have tried every kind of bedtime snack and dinner plan to avoid this and nothing is working....UGHHHHH:mad:. Its also frustrating since she is 2 yrs old, and we all know they are total grazer's, its so hard to get her to finish her meal, i feel like all im doing is feeding her all day when i know that is not the case.

    so frustrated :(
     
  2. BozziesMom

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    How long after dinner is she crashing?

    You could either give less of the bolus, or give a snack with some carbs at the 2 hour mark - bedtime snack.

    Are you carb counting and using IC ratios or are you on a sliding scale at this point?
     
  3. cassie

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    Our Endo and nurse practitioner has us give Megan insulin AFTER meals because as you said, you never know how much they are going to eat.

    Another thing are you giving liquid carbs to her? We don't do any liquid carbs except for milk because if we do she goes way up and then crashes no matter how much or little insulin we give her.
     
  4. wilf

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    You haven't posted any details of her insulin regimen.

    But if she is at 35-46 before bedtime, then likely she's getting too big a supper bolus. If it were my daughter, I'd reduce the supper bolus by 1/4 unit every day until she was about 130-150 at bedtime.
     
  5. Lee

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    Yep - we need to know what type of regimen she is on. Also - have you talked to your endo? And more importantly, welcome!
     
  6. Aidan'sMom

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    Yeah, give us some more info and I am sure you will get lots of suggestions. Also, welcome, sorry you are here, but welcome.
     
  7. frizzyrazzy

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    In addition to what everyone else has said (including needing more info) I'd add to that - what is she eating? many foods process slowly. With things like pasta or pizza you have a very typical low right after eating and then highs later on, hours and hours later.

    So unfortunately, we need more info before we can help. But rule of thumb - lows mean too much insulin or insulin at the wrong time for the type of food. :)
     
  8. TripleThreat

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    It sounds like her ratio is off at night, Insulin to Carb ratio at supper

    also what is she eating at these meals?

    What kind of Insulins and times are they taken?

    Activity different during these days?

    Also she is still honeymooning, so she could be kicking in insulin at night causing the lows.

    unfortunately as a friend of mine child says "diabetes stinks" but we al become great problem solvers because of it.


    i would suggest lowering bolus
     
  9. gjank617

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    omg i am so sorry - such a dummy- i should have said what regimen we are on, welllll:
    she is on a 30 carb meal plan and 3 (20) carb snacks. In the morning after i take her BG, she gets Lantus 9 units and 1 unit of Novolog. She is on a sliding scale but she has been so low around meal time its only been 1 unit of Novolog at breakfast, lunch, and dinner. We count carbs which stinks but not many choices. Dinner is tough because its hard to get all 30 in her and since I have already given her the insulin. I moved her down to 8 units of Lantus this morning when she woke up at 50!!!! and 0.5 units of Novolog with her meals. Her BG was 77 before lunch so i had her eat before the insulin and then gave her 0.5 units. I checked her around 1:30pm (which was about an hour later) and she was 94. She is a picky eater but loves her chicken nuggetts and she likes milk so at dinner she eats chicken, sometimes with half of a banana and yougurt or she likes whole grain bread, I am running out of options for her since she wont eat what we eat (of course being a stubborn 2yr old doesnt help)

    TIA!!

    gail
     
  10. BozziesMom

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    How are her overnight numbers? Like 2 am or whatever time you do those? Plus, bedtime number and wakeup.

    Do you check her BG before snacks? I gather the snacks are being covered either by the meal boluses or the Lantus?

    Do you happen to have all the BG numbers for the day along with timing on meals and snacks and insulin dosages? In list form would be great. :)
     
  11. frizzyrazzy

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    First off it sounds like she's starting to honeymoon and you're going to probably see her insulin needs go to half of what she's taking now. If I saw a 50 at wake up when we were on MDI I'd have cut the lantus by lots more than just 1 unit. Defininate run those numbers by your endo because I'm certain that big changes need to happen. It sounds like across the board she's getting too much insulin. Period.

    Then there's no reason why you have to be on a set number of carbs that you're on. so my other suggestion would be to call the endo and tell them that you want an Insulin to Carb ratio and a Correction Factor. Insulin to carb ratio basically says that for every X number of carbs eaten you give 1u of novolog. what they have you doing is pretty much 1 unit for 30 carbs (give or take) and Correction factors are 1 unit of insulin drops her blood sugar by XXX number of points. Both of those two items are rolled into your "sliding scale" so the doctor will break them out for you. But the beauty is this. Say your 2 year old only wants to eat a handful of cheerios (which is frankly pretty normal) you can then know precicely that for 15g of carbs you only need to give her 1/2u of insulin. Or say she's extra hungry and wants to eat 45g of carbs. Then you also know how much insulin to give her 45/30= 1.5u. For the correction factor you simply take BG-Target BG and divide by the correction factor (for my son it's 120 for target and 150 for correction so if his BG were 200 then I'd do 200-120=80 80/150=.5 and I'd give him 1/2u of insulin. Don't want to get hung up on the math part of it really but it's very basic once you start using it.

    there's NO reason to have to force feed a child a certain number of carbs. No reason at all. 2 year old children are wildly unpredictable in their eating and there are ways to handle that with novolog and lantus. Just talk to your dr and explain the troubles and ask to do it the other way.
     
  12. Lee

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    8 units of Lantus for a 2 year old seems like alot - but then again, I am not an Endo.

    I wold specifically ask your endo if you can have an Insulin to Carb Ratio and a Correction Factor like FrizzyFrazzy mentioned. Also, I agree that she is probably going into honeymoon. What has your endo said about those drops?
     
  13. Abby-Dabby-Doo

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    The very first thing I would do is get a 2 year old off a meal plan. I don't mean to come off strong or rude, so I apologize.
    It would help if you would put her insulin regimen in your signature- because the question will come up often. Adorable photos of your kids by the way.

    If you haven't heard of the honeymoon yet, I'd read up on it- your daughter is in one, and adjustments are going to be needed on a regular basis.

    Her insulin needs to be adjusted. Many figure their Lantus by the middle of the night check and waking number. Also it sounds like your meal doses- need to be lowered. We'd need more numbers and what time you tested.
     
  14. Aidan'sMom

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    I was thinking the exact same thing. 8 units?? But like you stated, I am no endo either.
     
  15. BozziesMom

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    Me too, but we do have one other little girl on here taking a honking dose of Levimir.
     
  16. etringali

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    First, welcome, sorry you have to be here. 2nd, what every one s=else has said.

    Lantus amount seems awfully large for a 2 yr old. Alex was Dx at 4 yrs and started on 4u Lantus and sliding scale. Personally, i think sliding scales are evil. You're forced to feed the insulin and toddlers hate being told to eat. Highly suggest Insulin to Carb (I:C) ratio for the novolog. You'll get comfy with carb counting pretty quick. And it's so much easier on you and child when they can eat what appeals to them rather than a set amount of carbs.

    Thirdly, (never thought I'd say this) consider a pump when you're more secure with new world you've hit. Many young ones start right off with insulin pumps since, depending on the model, the insulin amounts given can be so small.

    Read lots, write down questions, post often and be a pain in the Endo's proverbial backside :)
     
  17. aishlingt

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    Hi
    and like the other mother said "welcome" but its sad that you are here too:)
    I was thinking what everyone else has said - 8 units is alot. My nine year old is on that amount (well we upped it yesterday to nine) and going by her and my dad (also T1) it does seem alot for a little girl.
    I wish you well. xxx
     
  18. Nate'sdad

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    Gail,

    I would not bolus until after the meal when you know how much Lane has eaten. 35-40 is not where you want to be but you already know that. I would work her bg down slowly. Highs right now are not good but hypo is dangerous. You will reel this in over time. We have been at this almost a year and still get the "strange number". You can only manage 3 hours at a time. Keep the fiath and make the best decsion when you need to make it.

    Jeff
     

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