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I'm stumped . . .

Discussion in 'Parents of Children with Type 1' started by Blue, Apr 8, 2011.

  1. Blue

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    Normally when he needs more or less Lantus it's pretty obvious - he'll have random lows and steady dropping overnight if he needs less Lantus or steady highs and rising between meals and overnights if he needs more Lantus.

    But for the past two days . . .

    Overnight he is going up pretty steady about 50 points or holding even. So normally this indicates Lantus needs to stay the same (or soon increasing) . . .

    But the three hour after meal number is high (indicating carb ratio needs changed) but then he is dropping anywhere from 50 to 150 points within the next hour or so. . . . Which would normally make me think Lantus would need decreased.

    Activity, foods, etc. are all the same as always . . . Any ideas on what would cause these contradictory things? Why would he be overall good overnight but dropping after the long lasting is done through the day?

    Please give me your ideas since I'm all out! :cwds:
     
  2. kiwiliz

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    As a general rule we only use overnight numbers to adjust the lantus. We check 3 1/2 to 4 hours after the last meal is finished and if she wakes on that number, then the lantus is ok. Any other adjustments are down to carb ratios and correction factors.

    Are you having the same sort of balance between GI/protein and fat in your meals? Things can go pear shaped here pretty quickly when using mdi if we change the whole nature of a meal and have super low carb - or no protein etc. Logging meals and the insulin reaction to them is the only way you can find out.
     
  3. Heather(CA)

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    Sounds like he needs more fastacting at dinner and less Lantus.
     
  4. wilf

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    Going up or staying even overnight to me indicates the need for a smidgin more Lantus.

    Being high 3 hours after a meal and then dropping would to me suggest the need to prebolus.

    One question - is he getting any activity/exercise after the meals that could be causing him to come down?
     
  5. Blue

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    Sorry it took so long to get back to my own thread!

    Thank you for the replies . . .

    We can't base Lantus on just overnights because he's got such severe growth hormones when he's sleeping. We log everything - meals are the same as always.

    It's not just dinner he's been high at - it's breakfast and dinner. He has some severe growth hormones at night . . . Even 1/2 a unit less and he was going up over 200 points overnight!

    I'm not ready to increase the insulin at meals because of how much he is dropping . . . For example three days ago he was 212 three hours after breakfast but 43 at four an a half hours when I went to give him lunch.

    I usually bolus when he first starts eating and I see how hungry he is. Since he's a toddler I can't really predict when he'll be hungry or how much he will eat. The one time I did prebolus was breakfast. I didn't think it would be too much of an issue since he always eats breakfast. Nope. He wanted half a slice of toast and that was it! It turned in to a food war with me holding him hostage in his high chair until he ate his normal amount of carbs. Not something I want to repeat!

    No extra exercise - he's normally bouncing off the walls all of the time!

    So . . . to sum up the answers it could be what he is eating, his carb ratios, too much Lantus, not enough Lantus, or activity level.

    Well that narrows it down! :p (to his having diabetes, anyway! ;))
     
  6. joan

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    Just a few more factors you may consider are the sites you are giving the insulin. Are you always giving the lantus in the tush? Where is he getting the novolog? If its in the the legs and if he is running around a lot it works faster. Is there any insulin leaking out of the site after you give it?
     
  7. Heather(CA)

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    Lower the Lantus first, then work on the meals :)
     
  8. Blue

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    He gets Novolog in his upper arms and Lantus in his thighs (at bedtime so he's not running around). My husband asked about using his tush and the endo said they only recommend using thighs for Lantus. I have had leakage at times but not lately . . .


    If I keep seeing the drops I will try this. I have a feeling he is about to hit (yet another) growth spurt and that's why I'm seeing such erratic numbers.
     
  9. BKKT10

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    I don't have any answers or suggestions for you, but I can definetely say that K has the same issue in the morning- she can be in the 200s up until 3 hours post breakfast and then the 4th hour- BOOM, she's 60. She drops so fast during that 4th hour that I very rarely correct her in the morning. It's very frustrating, so I feel your pain!
     
  10. Heather(CA)

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    Please don't take this the wrong way, I'm just wondering what your waiting for? Lows at night and highs after two out of 3 meals right? I change things after two days, one day if it's an unexplained low over night...It's not like you can't change it back kwim?:cwds:
     
  11. Flutterby

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    Are you correcting these highs 3 hours after a meal and then seeing a drop an hour later?
     
  12. Blue

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    Thank you for letting me know I'm not the only one waiting for the drop! I wonder if it has something to do with the insulin absorption being slowed by growth hormones? I've just noticed that the main times I see it is after breakfast and the meals right after naps - when his growth hormones are the strongest . . . Hmm . . .

    He goes to his Mom's house every weekend and one day during the week. Since she is on a different regimen (sliding scale) it makes finding a pattern pretty darn difficult. By the time I recognize it sometimes it's already changed!

    No - Just bolus with meals and check three hours later. If he is high enough to correct I'll do so conservatively, but even if I don't we have seen the 100 plus point drops.
     

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