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Insulin Resistance and slow GI absorption, a repeating pattern

Discussion in 'Parents of Children with Type 1' started by forHisglory, Dec 4, 2015.

  1. rgcainmd

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    I hear you! I'm pretty sure that situations like the above are the reason someone coined the term "rage bolusing" for the act of repeatedly giving insulin in an attempt to correct a very stubborn and persistent high.
     
    Last edited: Dec 5, 2015
  2. Theo's dad Joe

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    The first time I read you post about rage bolusing I went to find the chapter on it in Using Insulin. Maybe they need to add a chapter.
     
  3. rgcainmd

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    LOL!

    For a more exact definition of the term "rage bolus" and other diabetic "terms of endearment", please check out Kerri Sparling's blog, Six Until Me:

    http://www.sixuntilme.com/blog-mt2/blog_images/Q12011/SUM_Diabetes_Terms.pdf
     
  4. forHisglory

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    I have heard that and that term ran through my mind last night. I backed down on the dose at one point because I thought, "I'm raging and bolusing!"

    We had an almost identical spike this afternoon. Site is freshly changed and we have increased basals by almost 75% and we had a 250 that stuck for 3 hours even with repeated corrections on the hour. He even ran for 1.5 hours this afternoon, playing, watching, and more playing at the Christmas parade (and no candy! boo!)......so now I'm wondering if that excitement caused the spike. But we've never seen that sort of sticky high just from excitement before.....so who knows.

    I expect a new shoe size next week if these spikes are truly from growth hormones!! I'm armed and ready for tonight. Got the basal set to blast this thing 2 hours ahead of schedule.....it's going down.
     
  5. forHisglory

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  6. dpr

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    It definitely looks like growth spurts. The way I handle it is after a few nights of multiple bolus's and loosing plenty of sleep you'll find an amount that worked pretty well. Add that up. The next night as soon you see it starting happen bolus about 75% of that total amount. If you used a temp basal you need to add that in too. For us if you catch it right away it takes less insulin to keep it under control. Just like everything in diabetes you have to just try it and adjust as necessary. The next time in a month or three when it starts to happen again try the amount that worked the last time. Usually it's a good place to start. Sometimes you'll crash them and sometimes they'll keep going up like a rocket, that's just part of diabetes. Eventually you'll find a system that works and you can get it under control pretty fast.
     
  7. forHisglory

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    Just like you said dpr! Sksw was spot on- take that D! Smackdown time! Basal increased to 0.325 (usual is 0.200) at 8 pm and we caught it just in time! The little break in the graph is me correcting Dex via fingerstick. It said 154 and was actually 126. Now, we will see how rest of night plays out. But for once, D we got your nasty tail and not letting you wreck havoc on us and our son!! image.jpg

    There was another nasty 3 hour sticky high period from 3-6 pm and dinner ratios and corrections before dinner were useless. In fact, the whole day was ugly. But, we will chop this up piece by piece until the beast is tame and then we will have to vigilant when this thing decides to end.
     
  8. sszyszkiewicz

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    Excellent! Love that attitude.
     
  9. dpr

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    When you nail it, it feels like you just won the lotto!
     
  10. suej

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    I subscribe to the holes in the cheese theory - when they all line up the aeroplane crashes. My sons basal highest from 10pm to midnight, and also high in evening from 8pm, I think it covers the growth hormone surge as he falls asleep.

    Also I see from your graph, there was a mild low just before beginning of spike - so did you treat that and that together with GH collude, perhaps treat a little less.

    Lastly, Ben's insulin resistance depends mostly on levels of exercise and blood glucose. At 200 1 u will drop him by about 30, but at 130, it will drop him by more. And if exercised recently will drop by 60.

    Such a juggling act.
    Good luck - looks like it is coming right
     
  11. forHisglory

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    Just as quickly as it came, the growth hormones left. 3 nights of battle and last night I was prepared again but the spike didn't come. I did have to treat a low of 50 when spike didn't make his appearance due to the increased basal. Basals lowered back to original levels (from 0.350 to 0.200/hr) but next time I feel so much more prepared. I feel like we've earned our "growth hormone" badge. Good mini prep for the teen years! Thanks to all who helped us this go round!
     
  12. dpr

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    We had growth spurts last 1-5 days, sometimes twice a month, sometimes it would skip a month. They started when she was 6 and at almost 10 she's just slowed down on them.
     
  13. Theo's dad Joe

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    I have wondered if this is not why early (young) diagnoses might result in shorter honeymoon periods, because, well, there is organized chaos and there's total chaos, so maybe the fast growth in kids up to about 10 just makes it impossible to extend the honeymoon very long.
     
  14. dpr

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    Joe, I have no doubt it could shorten the honeymoon. The more you stress the pancreas the less it puts out during the honeymoon. When my daughter was honeymooning if she ran high for a day she would need more insulin the next day or two and if she ran low for a day she would use less until she had a bad high. She was 5 years old in kindergarten and went on the pump Dec 1. She was "practicing" clipping and unclipping the infusion set from the pump and when she was done she didn't get it clipped all the way back on and didn't get any insulin for I don't know how long. Pre CGM days for us. I got a call she was 500 and came and got her. Up until that point her TDD was about 2.5-3 units a day and over night her TDD doubled and never came back down. How's that for the first day pumping:blue:
    So yes you can kill the honeymoon or at least severely shorten it with bad highs and strong growth spurts can certainly send BS to the moon.
     
  15. Theo's dad Joe

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    It just seems like there is more that we have no control over than I first thought. Endo never mentioned night time growth hormone highs, or lows after an illness etc.
     
  16. dpr

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    Yea, there seems to be an awful lot endo's don't tell us. You will learn 100 times more from a T1D parent! I sure did. And things that are actually useful..
    When we came home from the hospital they never even told us the honeymoon might kick in. We had no idea why she was crashing all of sudden within about 5 days. I'd like to just erase the whole first year from my memory.
     
  17. nebby3

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    My dd was dd at 19 months old and had zero honeymoon. Thus far I'd say toddler years were way tougher than teen years.
     
  18. forHisglory

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    Our endo is a T1 since he was a teenager but it's like he gives us more info as we go along. Maybe they think it will overwhelm us in the first year? I guess there is only so much they can talk about in 20 minutes every 3 months. Also, our office cannot review numbers if we send them in. You have to get a nurse to call you back. There is apparently a shortage of ped endos. Makes me so thankful for CWD and our local support group/JDRF
     
  19. forHisglory

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    Well, maybe this is the beginning of the end of the honeymoon. Things continue to be rocky. IC ratios, basal, and correction factor have all been increased and our data is looking horrible. The Dex graph looks so horrible I'm almost embarassed to post it. Check out the 10 pm to 9 am time period. It looks like a wavy ocean (no corrections or changes, this is one basal rate until a 0.175 to 0.200 at 6:30 am). Changed pump site, fresh insulin, restricted carbs a bit (only 21 at lunch, salmon dinner, spinach salad, etc) and it looks like we've been pigging out on Chinese the last 48 hours. I just keep increasing and inching up basal. This is stressful, hope we find our new happy spot soon. image.jpg

    At 8:00 am he prebolused for 39 carbs of oatmeal 15 minutes ahead of time and I couldn't believe the spike. This was after I almost doubled the IC ratio.
     
    Last edited: Dec 9, 2015
  20. Theo's dad Joe

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    How much did he get for the 39 grams of carbs? My son went from 30 to 1 to 12 to 1 at breakfast in a span of about 4 weeks but we got to 12 to 1 and have been there for 14 weeks with good results. I am sure that if I went back to 30 to 1 he'd be between 300 and 400 at breakfast every morning. He went from 36 to 1 to 15 to 1 at lunch and 30 to 1 to 12 to 1 at dinner as well within a very short period of time.

    When I had to do a correction at a meal twice, I added that in to get a new ratio, so if he had 40 grams at lunch with 1.5 units and needed half a unit correction at dinner twice, I just went to 40 and 2.0 and that became the new ratio. I figured I'd rather give the insulin before he ate, and watch then after he ate and spiked, only to watch anyway. Now when I did make a change like that to the ratios, I gave it at least 3 days to work. I don't know why, but they seemed to do better at 2-3 days after the changes.

    I don't have enough experience to tell you if the basals are off from looking at the graph because I can't really see the through the meal time spikes there.
     
    Last edited: Dec 9, 2015

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