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I think we're getting somewhere

Discussion in 'Parents of Children with Type 1' started by HelenaHandBasket, Jun 26, 2011.

  1. HelenaHandBasket

    HelenaHandBasket Approved members

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    Ok, so I *made* pork chops with peppers and onions with potatoes with a glass of milk. He ate the meat and decided he didn't want anything else. :eek: I gave him a 40 carb bagel and peanut butter at his request. So 40 + the 12 from the milk is 52gms. Dinner parameters for carbs is 50-65gms.

    I have his plate ready. We check his sugar, I give him his bolus and he sits down to eat.
     
  2. emm142

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    I've never bolused for a meal with meat in, but my sources would indicate that it slows digestion. Prebolusing for a meal with meat would seem to cohere with the drop followed by a gentle rise?
     
  3. wilf

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    I see what you mean. Well, the variable Lantus dosages will drop out of the equation the day after tomorrow - so this is the way to eliminate the low/rebound hypothesis then.. :)
     
  4. HelenaHandBasket

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    Alright..so I'm totally lost on the meaning of these numbers. So assuming digestion was done at the 1.5 hour mark, his BG was 147. How does this explain the rise to 201 in 1/2 hour? How do we get "2u on board" when I gave him 4u at dinner? :confused:
     
  5. Heather(CA)

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    OK so after reading all that went on today while I was at work. I feel good that he did not rebound, at least not today.

    I would first give the Lantus in the bootie, then it probably does need to be more. I would wait until it had been given in the bootie.

    I would not be surprised if the fastacting needed to be lowered after the Lantus is raised. It might not need to to be lowered though because you are per-bolusing and I don''t.:cwds:

    The high with the izza could have been a fat spke. Next time for pizza give the shot AFTER he eats. It works better that way :)
     
    Last edited: Jun 28, 2011
  6. danismom79

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    Even if digestion was done, the insulin was still working probably another 1.5-2 hours. The 1.5 hour mark would have been roughly halfway through the insulin action.
     
  7. HelenaHandBasket

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    I've never bolused for a meal with meat in, but my sources would indicate that it slows digestion. Prebolusing for a meal with meat would seem to cohere with the drop followed by a gentle rise?


    I think this gets back to the type of program they have him on right now. Correction and coverage for the next meal all inclusive in his dosing.

    So you wouldn't bolus for a meal with meat in it? Even if it had carbs in it? Are you depending on the basal to take care of those carbs? Is that what the ultimate goal is?

    My BIL who is likely not too well managed because well, he doesn't do what he's supposed to do :rolleyes: takes 30u of Lantus in the am and doesn't EVER monitor or give boluses unless like he's going to have a piece a cake, he will bolus for the extra, otherwise, he stays "stable" in his mind. Of course, don't ask me what his A1C is. :eek:
     
    Last edited: Jun 28, 2011
  8. HelenaHandBasket

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    Ok. Gotcha. But, he didn't drop 220 from the 147, he went UP? :confused:
     
  9. emm142

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    Sorry for the confusion. I didn't mean that I wouldn't bolus for a meal with meat in it, only that I can't personally attest to meat slowing digestion since I haven't eaten meat since well before I was diagnosed with D.
     
  10. danismom79

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    It's more the type and amount of meat than just the presence of meat. We don't have issues with leaner meats, but something like fatty ground beef, or pork sausage would be a bit of an issue.
     
  11. danismom79

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    This is why I'm thinking there isn't enough Lantus, and too much Novolog. Today, he has had a pattern of being high before meals, dropping strongly halfway through the insulin action, and then rising again, yet coming right back down after the next bolus (rebounds, from what I've read, don't respond so nicely). The leftover insulin on board is trying to make up for the missing basal but doesn't last long enough to get him to the next meal.
     
  12. wilf

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    Thanks for the info. This is a pretty straightforward meal (in terms of effect on blood sugars) compared to something like pizza, which even those of us at this years tend to struggle with.

    This is a good way to do the boluses right now..
     
  13. HelenaHandBasket

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    Bedtime was 272. :confused:
     
  14. HelenaHandBasket

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    Ahhhh got it! ;)
     
  15. wilf

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    Sorry, there are lots of calculations and assumptions in there - this is a fair bit more advanced than what people normally think about 8 days after diagnosis. I'll break it down.

    1) A way of calculating how much 1 unit of insulin (in the absence of carbs) can drop blood sugars is given by the "1800 Rule". You can find it in various diabetes reference texts including Type 1 Diabetes by Ragnar Hanas. The 1800 Rule is an empirical equation which can be used to get a rough estimate of how much 1 unit of insulin will drop blood sugar levels.

    2) To use the 1800 Rule, if you divide 1800 by the "total daily dose" (or TDD), then it gives you a rough estimate of how much 1 unit of Novolog will drop him.

    3) TDD is the sum of all insulin given in the past 24 hours (which in his case was 16.5 units).

    4) So applying the 1800 Rule we get 1800/16.5=109, or a rounded off estimated drop of 110 points for a unit of insulin. This is what is predicted by the 1800 Rule for your son at this moment in time. Obviously the drop per unit insulin changes as his TDD changes, but for now this is what the 1800 Rule predicts.

    5) The next part of what I went through there was guesstimating how much insulin he had on board after 1.5 hours. There are no easy to use tables for this, but I have observed my daughter carefully over 5 years and have found that at about 1.5 hours about 50% of a Novorapid injection will still be active or "on board" at the 1.5 hour mark.

    6) Now every kid is different, but IF your son is similar in his response to Novorapid then of the 4 unit bolus after 90 minutes he had 2 units still active or "on board".

    7) IF the 1800 Rule estimate is also in the right ball park, then if he had about 2 units on board at 90 minutes after supper then this could have been enough to drop him 220 points. It should be noted that that is in the absence of carbs coming into his bloodstream from food.

    8) At 1.5 hours there are several possibilities re his meal:
    a) it is mostly digested and most of the glucose from the meal has already hit his bloodstream;
    b) it is barely digested, and lots of glucose is still coming in;
    c) something between a) and b).

    9) Under Scenario a), he has 2 units on board and blood sugar is 147. He is going to go low, and rebound back up to above where he was at 90 minutes.

    Under Scenario b), he has the glucose from most of his meal still coming in. Depending on how much glucose is coming relative to the 2 units on board, and he will rise quite a bit (likely also to above where he was at 90 minutes).

    10) The way I try to eliminate Scenario a (lows/rebounds) in analysis of this sort of situation is to give a snack at the 1.5 hour mark and measure again 30 minutes later. If there have been lows/rebounds then when the snack is given it will keep him from going low and blood sugar levels will tend to be steady compared to the 1.5 hour reading or even lower.

    If you're dealing with a Scenario b) situation, then the snack will push him way high..

    Anyhow, I'm just putting this out there to explain my thinking. None of this is gospel, and it may or may not apply to your son. But this approach has worked for me in a variety of situations and I am comfortable with it.

    Anyhow, lots of time to speculate further before breakfast tomorrow.. :cwds:
     
  16. wilf

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    Did he get Lantus this evening?
     
  17. HelenaHandBasket

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    Ha! As long as I can do the speculating in my sleep!:p

    I just got the littles to bed. Time to take a break myself! Thanks for your help and I will do the experiment tomorrow at breakfast.

    Orrrr should I wait until Thursday when he's had two days of am 3u Lantus?
     
  18. wilf

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    That's the fun part - YOU have the power to decide.. :)
     
  19. GaPeach

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    This line along with the report of better BGs today have made my evening. :)

    I want to say that the nurse and mom parts of your life have collided. You are way more "into" conquering diabetes at the 8 day mark than most of us here. We were mostly doing what the dr said and trying to believe that things would become some kind of normal again sometime in the future.

    Wilf is wonderful at feeding you the math that helps explain what the insulin is doing to the BG after it is in his system. You can read Using Insulin and Think Like a Pancreas to get even more info about how the "formulas" work. They are not an exact science (diabetes doesn't cooperate that way :mad: ) but based on years of observation.

    Following the 1800 rule theory and I:C of about 1:30 for meals, here is my explanation of where the latest number came from.

    245 prior to meal - and 52 carbs with 4u given = 2u correction which would by the 1800 rule bring him down about 220 points. The other 2u was to "cover" the 52 carbs as they digested and made BG rise. So, 245-220=25. the drop didn't happen immediately upon injection - but over the course of time as the insulin worked. At the same time the BG was rising from the carbs digested but the other 2 units was covering it as it happened.

    If this is true, the 272 "could" have been from a low (correction and bolus) followed by a rebound high. Theory 3 from Wilf


    The meal was relatively easy to digest except maybe the bagel but the peanut butter has protein and fat which can last a while and cause the BG to go up. But there is still a little insulin on board at 3 hours post meal to cover a bit more of that 272
    Theory 1

    Or the Lantus from the AM is wearing off - Theory 2

    Stay the course tomorrow and see what happens after the complete Lantus change to morning. Keep TESTING, testing, testing.

    I see an answer on the horizon. All theories are still in play. BUT todays 150 - 200's were better than the 300's from before.
     
  20. hawkeyegirl

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    Do you have any cites to literature supporting this "idea"?

    These numbers do not look like a rebound. At all.
     

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