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Is this stacking?

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

  1. hawkeyegirl

    hawkeyegirl Approved members

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    I'm not wilf, but Think Like a Pancreas has a chart for IOB at various DIAs. You can also use the more basic 25/50/75/100 rule, assuming that 25% of the insulin is used up every hour for four hours. IOB is not linear, but it's a place to start, and has the advantage of simplicity.
     
  2. wilf

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    The tables pertaining to "unused insulin" as it is referred to in Think Like a Pancreas are in Chapter 7 (Bolus Calculations) - Tables 7-5 and 7-6.

    The problem I have with the table is that they are based on the assumption that all insulin from a Novolog/Humalog injection will be used up in 4 hours - and I know that for some children, my daughter included, it can be 5 or even 6 hours.

    But the idea behind the tables is valuable - the author is showing that it takes a span of several hours before the insulin from an injection is used up. This is important for 2 reasons:

    1) When it comes to prebolusing (which many people are hesitant to do), the tables show us that if we give the bolus 15 minutes before a meal then there are no immediate or dire consequences if the child doesn't eat all the carbs right away. The insulin will be working for hours, and if say you bolused for 50 carbs and the child only ate 30 then there's lots of time to make up the missing 20 carbs - either in the form of a dessert after the meal or even in the form of a snack an hour or two later.

    2) When it comes to "insulin stacking" (which the header of this thread asks about), it shows us that a measurement of blood sugars say 2 or 2.5 hours after a meal is not yet reflecting where they will drop to by the time the insulin is done working.

    So to take today's numbers, when the OP measured a blood sugar of 320 at 10:06 am there was still a good bit of insulin in her daughter's system. If you use the table in Think Like a Pancreas, then there was still 20% of the insulin remaining. For my daughter it would be more like 30%. But let's say it was 25% remaining, that would be 1/2 unit of insulin still working. So the 320 reading at 10:06 am would actually drop by 90 points over the next couple of hours once the insulin left in the system had acted.
     
  3. wilf

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    There is no question that giving smaller boluses means that any post-meal spikes will be larger, with blood sugars spiking higher. But that is something that can be corrected by bolusing earlier, or using Apidra.

    From my perspective the situation is much improved in that the OP now has a safer carb ratio to use, and a Correction Factor which is likewise safer than the previous sliding scale.

    The dire problem this family was facing was recurring severe lows, and I think that good progress has been made in establishing a new approach that should help them to avoid such lows in the future.
     
  4. Christopher

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    I was looking at it differently, I thought the chronic highs were more of a problem. And the child is still experiencing them, so while I see what you are saying, I think time will tell. I must have missed the recurring, severe lows.
     
  5. wilf

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    The repeated lows (in some cases accompanied by seizures or vomiting) were what I really picked up on in reading the OP's earlier posts in this thread. So avoiding with those is what I see as the most urgent priority, but I think that's on track.

    After that, it's a matter of seeing what she's doing overnight (to confirm that the current Lantus dosage is appropriate) and refining the carb ratios and the timing of boluses.

    It may be that at the end of the day she needs more insulin than currently, or just that the timing or the amounts need to be adjusted. Her numbers will be the surest guide. :cwds:
     
  6. Charlotte'sMom

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    My daughter was dxd 23 months and she is now 5, so from my perspective the insulin dosages that the OP's daughter were at just seemed ridiculous for a child that small. I know "YDMV" and no 2 people are the same, but DD's lowest ratio is 1:23. A 1:5 ratio just seems absurd and to give more insulin than that is unthinkable! I don't claim to know as much as other more experienced parents on this board, but Wilf's explanation of rebounds and insulin resistance makes more sense to me than that she's not getting enough insulin.
     
  7. Flutterby

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    Eating and correcting 7:36 and then checking 10:06am is only 2.5 hours between, you are almost certain to see a high number here.. you still have active insulin AND food absorbing.. if she was really hungry, I'd push for a 'free' snack for now, so you don't have 9 more carbs and possibly another shot of insulin messing up you're prelunch numbers. Once you straighen things out a bit, you can let her have the snack and cover it.. or if you know she's extra active, a 9 carb snack with no bolus is OK too.
     
  8. Flutterby

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    I kind of wonder if the OP's daughter was in a constant state of rebounding.. I know there are some that don't believe in it, I know there was at least one person here who's child was in a constant state of rebounding... she was taking a lot of insulin for such a young child. Just my thoughts though.
     
    Last edited: Aug 13, 2012
  9. mmgirls

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    This is exactly what I think was happening. She was on a crazy amount of fast acting insulin for a 38lb child.
     
  10. GaPeach

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    OP - Just wanting to say that I'm thinking of you today. I'm hoping that a few days of the "new" plan is working to stabilize the nighttime lows. As time goes on, you can make small "tweaks" to the daytime I:C to see what happens.

    The numbers are always revealing. It can be a good thing to post them and let a few other eyes analyze. Bottomline - you are the one that sees and knows your child the best. Dr. Mom can improve the situation better than Dr. Endo many times because you actually have more data at hand.
     

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