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How long do you typically wait before making changes?

Discussion in 'Parents of Children with Type 1' started by JNBryant, Feb 15, 2013.

  1. JNBryant

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    For the past three days, my son's numbers have been on the low side. It started out with his morning numbers going from around 150 at bedtime to around 75 before breakfast. While 75 isn't necessarily a bad number, it was a little low for comfort so I went ahead and reduced his basal by 1u which seems to have fixed the problem. Unfortunately, his pre-meal numbers have also been extremely low (40-55). I really managed to nail down his I:C ratios and they've been working really well for the last three weeks or so, but then we saw this drastic drop in insulin needs, so I went ahead and called my endo team. The nurse I spoke to told me to keep my son on his normal I:C ratios for at least a week so we could gather numbers and have a better view on what's going on, and that if we needed to, we could just give him a snack to keep him from going too low...say what???:eek:

    I understand the need to spot patterns and such, but I was REALLY uncomfortable with keeping those lows going for an entire week just to gather information-especially since we're still in the process of getting the G4. I decided to go against the nurse's advice and start making changes to his I:C ratios to stop the hypo episodes he's been having. Breakfast has gone from 1:22 to 1:30, lunch is still at 1:25, and dinner went from being 1:25 to 1:35. If he had been experiencing mild highs, then I'd feel a little better about waiting to see what his numbers would do. The lows aren't good though, and some of them showed up after only three hours post meal. I thought she was off, but was the nurse right? Should I have waited a few more days?
     
  2. DavidN

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    No, I think you did the right thing. Persistent lows is not a good thing. We are having the same problem with highs. My son got sick and insulin had to be cut in half. As he was getting better we had to adjust upward, but we are slow to adjust for fear of triggering lows, particularly at night. Then we got to his pre-stomach bug levels and he was still high, so we had to keep going higher. Maybe a growth spurt? Not sure, but I think we've been too slow to react. It was easier to go slow, albeit probably still troublesome, because our son was high vs low. But I absolutely understand your desire to alleviate the persistent lows.
     
  3. mmgirls

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    no she was not right when you are talking about lows into the 40-55 range.

    If I saw this pattern I would be changing things too.

    We "feed the insulin", when a surprise low popps up mostly due to activity or unsure carb count but not consistant lows below 75. IMHO it is dangerous to not deal with consistant lows by lowering insulin.
     
  4. hawkeyegirl

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    I agree with you. But I've never been terribly patient about making changes where I think it is warranted.
     
  5. TheLegoRef

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    Not saying we always follow this, but I think we've been told that make changes to lows after three days of seeing a pattern, and I think a week of highs.

    We do kind of follow that, my DS was low two days in a row at the same time last week, but hasn't been low since then. I didn't make a change, because I thought maybe it was dinner or something. I don't make high changes too quickly just in case he was stressed about school, or was less active at school, etc.

    You take a guideline, and tailor it to each situation after adding in other factors. :)
     
  6. Sarah Maddie's Mom

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    I think that for a 3 year old I would be faster to make changes for lows than I am now. At 3 you are with them all the time, can note the impact of the change, can know for sure how food, exercise, schedule changes might be playing a role and too he's so newly dx'd and probably honeymooning so I'd probably be quicker to adjust things.
     
  7. JNBryant

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    Thanks for all the input. I tried to figure out what was causing the lows, and I just came up empty handed. I don't think he's honeymooning as we're almost a year into this whole D thing. Come to think of it, he never had much of a honeymoon after his dx. We never really saw any changes. I just chalked it up to some rogue islet cells putting out insulin. Pre-lunch number was at 101, so I must be doing something right!
     
  8. shannong

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    I think you know your child best, so I would listen to your instinct over what the nurse has to say. I think the safest course would be lowering the insulin. I am constantly changing my DS's I:C ratio, because it is so dependent on his activity level, among other things. If he is having dinner, but then going out skating after, his I:C ratio would look much different than if he was having dinner and then sitting on the couch. Anyway, I factor many variables in, sickness, how his numbers have been lately, activity, etc, so I:C is sort of an ever changing thing for us. I think only a parent, could really be able to factor all these things in. Basal changes however, are kept more constant and I am slower to make them, until I see a consistent pattern.
     
  9. steph

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    I have a 2 1/2 yo, and we make changes after 3 days. When increasing I test more often to look for lows. Especially when increasing basal. Sometimes insulin needs just seem to fluctuate for totally unknown reasons. When I disagree with the endo's advice, I do what I think is right, but I move doses in small increments. You know your child's needs better than the endo bc you have been watching their patterns every day. So for, every time I've made a gut call, it's been right.
     

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