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Is this stacking?

Discussion in 'Parents of Children with Type 1' started by Knittingfor4, Aug 8, 2012.

  1. Knittingfor4

    Knittingfor4 Approved members

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    Since my team won't respond to me, I'll ask you. I want to know if dosing for snacks would be called stacking. If you need more info, lmk. Here is the typical daily schedule:

    8am test, breakfast, novlog, 5units of lantus
    10am snack
    Noon test, lunch, novolog
    2-3pm snack
    5-6pm test, dinner, small amt of novolog
    8pm test, bedtime, no insulin

    Carb ratio is about 1unit per 10carbs (eyeballed)
    Correction is 1unit for 250-300, 1.5 for 300-350, 2 for 350-400, 2.5 for 400-450, 3 for 450-500, 3.5 for 500-550 and 4 over that
    The correction gets added to the carbs. So if she's 300 and having 20 carbs she gets 3.5units Novolog.

    Are snacks covered by Lantus (what team told us)? If I dose for them, will she go low, or will she get better numbers? Since we stopped mixing insulins, we've knocked her lows w/vomiting down to once every month or two, but she spends the rest of her time usually over 300. Increasing the Lantus seems to increase lows. Increasing mealtime Novolog seems to increase lows slightly. If I dose for snacks wont' that be like mimicking a pump? Thanks :eek: ;)

    Edited to add: not looking for medical advice, just thoughts, opintions etc... and I will get ahold of someone tomarrow and talk it over with them.
     
    Last edited: Aug 8, 2012
  2. jbmom1b2g

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    If she is eating more then a 10 carb snack then yes you should be giving her a shot of insulin for it.
     
  3. kiwikid

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    Dosing for food isn't stacking. You may be giving too much Lantus which IS covering your snacks and causing the lows if you up it even more.
    You could reduce Lantus slightly and bolus for all carbs and see what happens.
    You could basal test by just giving Lantus and then no carb snacks and meals and see what numbers you get.
    Or just trial and error, testing a lot.
     
    Last edited: Aug 8, 2012
  4. misscaitp

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    It all really depends on what her insulin duration for Novolog is, and whether with that snack you are testing and giving her a correction + carb dose of Novolog. I say as long as you don't count her blood sugar at the moment you give the snack you'll be fine.

    Oh...it doesn't exactly mirror the pump as it doesn't take into account things as insulin on board as a pump would.
     
  5. sooz

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    Giving insulin for carbs eaten is not stacking. How many carbs are in the snacks she is eating? You generally have to keep the snacks under 5 carbs to not give insulin for them.
     
    Last edited: Aug 10, 2012
  6. Lee

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    Stacking occurs when you give insulin for corrections, not carbs eaten. For example, you give a correction for a 300 at 1pm, and then test at 2pm and get a reading of 220. If you correct that 220, that is stacking. If your child eats a granola bar and you dose for the carbs, but do not correct, that is not stacking.
     
  7. MomofSweetOne

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    I'd recommend getting a copy of Think Like A Pancreas by Gary Scheiner for your library. It will help you so much. Every child is different, but your ratios look like a lot of insulin for a little one to me. My daughter is on 1:10 in puberty. Before that, she was on 1:15 or higher.

    Gary Scheiner recommends letting insulin completely wear off (4 hours for my daughter) before giving more to maintain best control. It doesn't always happen with kids. Our pump will adjust for insulin still acting, which if you don't subtract it, will lead to stacking. Gary includes a chart of approximately what percent of insulin is still acting at each hour that you can mentally reduce doses by while on MDI.

    You mentioned in another thread that you're scared of pumping. I can relate. I was terrified of dropping out basal insulin and the higher risk of DKA. Almost a year later, I can tell you we do like pumping, that losing Lantus was something to celebrate, and the pump adds lots of flexibility to life. It would be really hard to go back to MDI now.

    If you prefer classes to reading a book, Gary offers excellent classes at his website. Google Type 1 university and you'll get to them.
     
  8. Flutterby

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    When you give insulin for food you aren't stacking, stacking refers to corrections that are to close together. When you increase lantus you often have to decrease the ratios.. sounds like you need to go up on the lantus and adjust the carb ratios so she would be getting more carbs per unit or half unit of insulin. What about regular meals? Are you giving fast acting for that?
     
  9. Ali

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    MDI in theory is just like pumping. You have a basal of insulin given by pump, or given by one or two shots of long acting insulin, and then you also give extra insulin for food, either by shots or by the pump. If you are eating without extra insulin then your long acting is too high-either accidently or on purpose.:p:)ali
     
  10. Lee

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    Great catch!

    So - in your example, your child is 300, so you give 1 unit of insulin for the correction. Then your child has 20 carbs as well, so you give another 2.5 units to cover the carbs.

    It looks like you are giving one unit of insulin (Novalog) for every 8 carbs eaten. That is extremely aggressive. My 14 year old usually takes 1 unit for every 10 to 15 carbs eaten.

    This could actually be one of your major problems and causing numerous and dangerous low blood sugars, as well as possible and unexplainable rebound high blood sugars.
     
  11. Knittingfor4

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    Hmm, so we are being too aggressive? That's odd. So if we increase Lantus, we should lower the carb ratio? And we should give Novolog for everyting over 5 carbs?

    This actually makes sense now. I mean why she's so high all the time. She's having 10-15 carb snacks with no insulin 2-3 times per day. So if we only correct at 3 meals, and dose for everything that goes into her mouth, that should work out better?

    Ok, this is really dumb :eek: MDI means Lantus plus Novlog, vs pumping which is just the Novolog? Does it stand for manual somthing injections? Trying to learn here :eek::eek::eek::eek:
     
  12. Sarah Maddie's Mom

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    Invest in Ragnar Hanas' book, "Type 1 Diabetes" http://www.amazon.com/Type-Diabetes-Adolescents-Adults-Caregivers/dp/1569243964 You can get it used for $13.

    I think your medical team has failed you. You should be more informed of how insulin works and how to use it - Hanas' book is a wonderful resource that you can read straight through or use as a reference.

    I cannot say it loudly enough - buy this book, right now.
     
  13. caspi

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    I agree 100% with Sarah. PLEASE get the books that have been recommended to you. It will really help you understand things better. :cwds:
     
  14. Lee

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    You NEED this book! (ETA" We ALL needed this book many times through a D journey :))

    MDI stands for Multiple Daily Injections.

    Lantus is used to keep the blood sugar steady all day without carbs; however, many people may need to give a free 10 to 15 carb snack here and there.

    Carb ratios are how much Novalog you give to cover a set amount of carbs.

    Novalog is used for food while on MDI - injections. Lantus is used to keep the BS steady.
     
  15. Ali

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    Pumping and MDI are the same concept. With pumping you are giving the background insulin with the pump and with MDI you give it with one or two shots of long acting insulin. The pump allows you to vary the background insulin-i.e.what your body needs without food-with various levels of background insulin depending on exercise or hormonal changes during a day. That is harder to do with the shots. With MDI and the pump you also give extra doses of insulin for food or corrections. With the pump you have a bit more control over how that extra insulin is delivered with fewer shots. In general your background-basal-insulin covers your basic needs for insulin without food, and your bolus, extra shots or pump deliveries cover food or changes in the need for insulin due to other causes. The pump is better at reducing insulin needs then shots due to the way the basal is delivered. Hope others chime in.:)ali
     
  16. MomofSweetOne

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    You don't necessarily need to change the carb ratios when you change basal. The first thing you need to do is test basal insulin. Watch how her BGs track at night, checking every 2-3 hours throughout the night. If her BG is increasing or decreasing by more than 30 points in a 4-5 hour period, her basal needs adjusted. With the major growth of puberty, we're changing the basals almost daily right now, but my daughter's carb ratios are not touched often.

    Once the basal is adjusted, then you need to figure out the bolus ratio. If you're seeing lows after meals or giving that many carbs without dosing, I would probably try a 1:20 ratio at a meal and then test every hour to see what happens. If she doesn't come down to the number you started with, then she needs more insulin and I would lower the ratio by 2 carbs at a time. If she comes down further than the number you started with, then you need to increase the ratio by a couple carbs. Different meals often require different ratios. My daughter is on 1:10 at breakfast, 1:11 at lunch, and 1:9 at supper, but that's unusual. Most kids need the most insulin per carbs at breakfast. The only way to know what your child needs is to run your own science experiments.

    You'll also need to determine her insulin sensitivity - how much a unit (or half unit) of insulin drops her BGs when there is no food involved. For that, once basals are determined, you need to get her BG to about 200, give her insulin and test how much it drops her by the time it wears off. Once you have all these factors figured out, Gary Scheiner gives a formula that will give you much more stability in her BGs. At every meal, you'll be adjusting her BG back into range along with giving her insulin for her carbs.

    I'm sorry you've had such a hard time with your daughter's diabetes. You've come to a good spot to learn; get the books, read them and then reread them until they make sense, and keep asking questions here. Your daughter will thank you!

    On a side note - we have a scale that calculates carbs for it, and my 12 year old doesn't like guessing because of how much less accurate it is and how much more out of range she goes and thus affects how she feels. I recommend getting one. It's much easier than guestimating once you're used to it. It will also let you know your portions are accurate when you're determining bolus ratios, etc.
     
  17. sooz

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    MDI stands for Multiple Daily Injections. I would definitely give her insulin for her 10-15 carb snacks, or alternatively keep her snacks to 5 carbs or less. Pumping only uses fast acting insulin like novolog, but to take the place of long acting insulin like lantus, it drips a tiny amout of calculated fast acting insulin at a measured schedule throughout the day. The beauty of it is, that schedule can be changed depending on what her needs are at any given time of day, and she can eat as many covered snacks as she wants with the click of a button without extra shots. Also her carb ratio can be set to different amounts for different times of day depending on factors such as activity levels. Once it is set up, the pump will figure out how much insulin she should be given for the carbs she is eating and whether she needs a correction.
     
  18. Lee

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    I know this sounds daunting - but it really isn't to bad.

    Step 1: Is her Lantus enough? Does she stay within 30 to 40 points everynight? Yes - Lantus is fine, no, I either need to add more or take away.

    Step 2: Are my Carb ratios right? She has a nice, in range blood sugar prior to eating, so she has no correction working, she eats an easy to count amount of carbs. In two hours, is she about 80 points higher then hr bs test before eating? Yes - then this 1 meal ratio is correct. No? Then you need to adjust.

    Step 3: When I correct, does she come back into range? Wait 3 hours, no food, and see if she is in her range. Yes? Her corrections are good. No - you need to make an adjustment.

    Three steps and lots of blood sugar tests later, and you will be doing a lot better. But read the book so you understand how insulin works and peaks and covers food and such.

     
  19. caspi

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    I know you've been given a lot of information already, but I have one more question. :) Are you only testing your daughter before meals and before bed? If so, you need to start testing 2 hours after she eats so that you can get an idea of how the novolog is doing.
     
  20. Ali

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    Agree with the prior post. A useful critical tool is a scale and to read labels. Within three months you will need it less but I still 40 years into it still use a scale most of the time to figure carb counts. Using the scale allows you to "guestimate" much, much better. As a side note, when I eat out I tend to reduce the carbs as they are harder to guess at, but carry the Calorie king book and use your cell phone and you can figure a lot out.:p ali
     

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