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Insulin needs going up.. up ... up

Discussion in 'Parents of Children with Type 1' started by BCmom, Sep 26, 2010.

  1. BCmom

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    It has been a crazy couple of weeks.

    Puberty must be kicking in full time.. her insulin needs are going up and up.

    Her Levemir and humulog dosages have doubled... and her NPH has gone up 25 percent... food and activity are the same.

    How high will they go?:eek:

    She is 13, and 90 lbs.

    WE are giving extra H during the day to get her sugar down and then adjusting next time...

    Mornings she is often waking hi, 300-310... so next night we increase her levemir.

    She feels so crappy in the mornings...

    I hate this.
     
  2. Christopher

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    I know it's hard not to think of CWD needing a certain amount of insulin, but really, they need what they need, and those needs change as their bodies change. Danielle is now up to 14u of Levemir and a few years ago I would have never imagined giving her that amount. Hang in there...:cwds:
     
  3. emm142

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    Could she be coming out of a honeymoon, which is exacerbated by the increased insulin needs of puberty?
     
  4. TheFormerLantusFiend

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    In an adolescent, you can expect insulin usage up to about 1.2 kg/d. That means up to about 50 units per day in somebody her size.

    I weigh 100 pounds and my daily dose has varied from about thirty to sixty units per day averaged over a one month period. On individual days, I've used as few as seven or as many as a hundred units.
     
  5. Becky Stevens mom

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    Ugh! Im sorry:( I know the irrational fear that insulin is no longer working in your childs body:eek: After a week or more of steady highs Ive had that thought in the back of my mind. Along with the huge amounts of insulin needed because of puberty more is needed because of the insulin resistance caused by the highs that are being caused by lots of growth hormone causing, yep you guessed it, insulin resistance:rolleyes: Sometimes youll feel like your trying to chip away at a rock to make a little dent in it. How much insulin is Emm getting now on an average day? How much basal? What is her I:C ratios these days? have you upped all those too? Any ketones in the morning? How are her #s in the middle of the night?
     
  6. Heather(CA)

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    JMO but it sounds like your chasing rebounds to me, I would try putting everything back to where it was or even lower. Insulin does not double in a week. Have you changed the insulin out? Maybe it got hot? Waking up in the 300's after giving that much more does not make sense. It's either the insulin is bad or rebounds IMHO
     
    Last edited: Sep 26, 2010
  7. Mike&Dans.Mom

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    How many units of levemir is she doing?
     
  8. wilf

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    I'm with Heather - sounds like hard lows followed by insulin resistent rebounds are happening. :(

    Could you please post the full insulin regimen for the most recently available 24 hour period (all injections and the times they were given), as well as all blood sugar readings?
     
  9. BCmom

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    ok.

    Here is the last 24 hours...

    In Canadian units.

    Breakfast BS- 16.9 34 units NPH and 10 units Humulog

    Lunch BS- 13.2 (no correction because the NPH was due to be peaking)

    Dinner BS 7.3 6 units Humulog

    Bed BS 5.2 6 units levemir

    This morning BS 17.2 35 units NPH 11 H
    Lunch 13.7

    And this has been the pattern for a while.

    Three weeks ago she was at 28 units NPH and 5 units H for breakfast and 4 units H for supper and 3 units Levemir for bed....


    so total insulin for the day yesterday was 56 she is about 90 pounds...


    Aren't hormones supposed to be highest late at night and early morning... causing increased insulin resistance then?


    And what do you mean not working anymore??? Can it do that Becky?
    And Emm... I do think she just came out of the honeymoon... haven't had strange lows for a while.
     
  10. Becky Stevens mom

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    No, absolutely not;) Im sorry I didnt mean to frighten you. Insulin will always work in our children but Ive had that fear when Stevens BGs have been real high for a week or more and then something clicks and starts working and hes fine. Im sure that will happen with Emm too
     
  11. Becky Stevens mom

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    Youre right about Dawn phenomenon. If its puberty then growth hormone will cause highs predawn and dawn hours. Can you do more night time testing? especially between 2-5 AM to see where she is then
     
  12. Sarah Maddie's Mom

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    Hormones happen when they happen, not always at night. I'd start checking overnight, and more often through the day to rule out rebounds, but really, it looks like puberty to me.
     
  13. wilf

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    She's getting 56 units and weighs 41 kg, so well over a unit per kg body weight per day. It could be the peak of puberty, but more likely is a cycle of lows, rebounds, insulin resistance and insulin overdosing.

    Looks like she had rebounded to the morning 16.9, was coming down steadily through the day as the plentiful insulin she's getting got the upper hand on the low-induced insulin resistance, was in range at supper (7.3) and headed low by bedtime (5.2) - by which time the insulin resistance from the previous day's low had worn off.

    Notwithstanding the absence of overnight measures, I'm pretty sure the 2nd morning's 17.2 is a rebound from a hard low overnight.

    But the only way to know for sure is to either measure every couple of hours over night, or to dramatically drop the insulin she's getting (back to what it was before all this started).
     
  14. Darryl

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    Leah's insulin needs are as high as 80u on some days, averaging around 50u. This is 3x what is was just 15 months ago.

    It's important to provide enough insulin during puberty to support the growth process. Once growth hormone begins to kick in, it is more commonly after bedtime or in the morning, but as Sarah pointed out, it can happen any time of day. Next to overnight, we see it kick in on random days starting around 3 PM. As Becky pointed out, it sometimes take large amounts of insulin to bring it down, but by providing this insulin - even if BG is stuck at a high level - you are still providing insulin that is needed to support the growth hormone process.

    Here's a post on how puberty affects growth hormone and insulin needs:
    http://forums.childrenwithdiabetes.com/showthread.php?t=45635
     
  15. wilf

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    I'm not saying it can't be puberty, but this is what has me worried.

    Here is the sequence of blood sugar readings:
    Breakfast - 304 (16.9)
    Lunch - 237 (13.2)
    Dinner - 131 (7.3)
    Bed - 94 (5.2)

    Just looking at that sequence of steadily dropping numbers and then knowing she got 6 units Levemir (twice what she was getting a short while ago) has me worrying about an overnight low. :( Plus at the high NPH dosages she is getting there is a "tail" of NPH that will keep working into the overnight hours as well.

    This morning's reading of 310 (17.2) is precisely what I would expect to find if she had gone low and rebounded.

    Overnight testing is in order. We can all debate until we're blue in the face about whether it's puberty-related hormones or lows/rebounds, but there's one way to find out for sure.

    Test.. :cwds:
     
  16. Heather(CA)

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    Thanks Sarah, I could not make heads or tails of those numbers:eek:

    After seeing this I am still thinking rebounds are most likely the culpret...Going to bed below 100 and waking up in the 300's for one thing, and giving more insulin is not helping for another. If you have doubled it, in a week, it would have worked on normal insulin needs needing to be increased.

    Did you give her anything to bring up the 92? Or did she go to bed at that number? You really need to test often over night for a night or two to know for sure...
     
  17. BCmom

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    Oh she always has a snack at bedtime. And has since Dx. Because she has been on the low side I give her 30 carbs. Otherwise it is 15 carbs. I will definately give her the snack tonight because she was swimming today.

    I will test tonight. It never occurred to me to because she has been high not low...:rolleyes:

    Any suggestion as to what times I should test... to see if it is hormones or not?

    Oh one more thing. If she was going low she wakes up, she always had in the past. But I will check to make sure.

    I do want to make sure she is growing properly. She has always been on the thin side and she has been getting taller by leaps... and only has just started to develop a bit. I am terrified that I could be depriving her off normal growth. I hate being a pancreas!
     
  18. Darryl

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    That's why I didn't comment on whether or not it was a rebound... I don't know and can't really tell from the daytime numbers alone. The only way to know is to test throughout a night leading up to the high, or decrease the Levemir/NPH and see if that helps, or increase the Levemir/NPH and see if that helps. Probably testing through a night is the best way to start.
     
  19. Heather(CA)

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    Hmmm, I didn't know about the snack...A 30 gram snack if she was steady at 92 could send her into the 300's. I would have given Seth 4 grams of milk if he was 92. BUT, since needs have doubled, you still need to rule out rebounds. Just in case.

    Test at 3 hours after last shot, then again an hour after that to see if she's staying steady. then every two to three hours after that. Let us know what you find out:cwds:

    JMO but uncovered snacks at bedtime (Not counting ones given because they have had a lot of exercise) can REALLY screw things up.
     
  20. emm142

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    Am I reading right that she's getting over 50U per day but only 6U of lantus? Sounds way skewed.. i think you might need to up the basal and decrease the bolus. If I got 30g uncovered at any time, my BG would rise over 300 points..
     

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