- advertisement -

Is this stacking?

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

  1. Christopher

    Christopher Approved members

    Joined:
    Nov 20, 2007
    Messages:
    6,771


    Exactly, Lisa.

    I think it is great that people are trying to help the OP. But when people start giving very specific directions, like what her range should be, etc it can be inappropriate, as each child responds to diabetes individually and based on multiple variables. Additionally, each child has their own goals that may be very different from another child.

    In my humble opinion, maybe it is time to back off a bit, let the OP digest the mountain of information she has been given, implement some of the changes, and then come back in a bit to see how it is going.

    Just my 2 cents.
     
  2. sooz

    sooz Approved members

    Joined:
    Dec 4, 2009
    Messages:
    2,330
    I was trying to point out what a normal range is, and I made it very variable. The OP did not seem aware of what a range is. The reason I commented about the 3 unit correction, is because that is what their correction factor is- as stated by the OP. In fact, had her hubby actually followed the correction formula he should have gven her 3.5. My point was if she is 500 at bedtime her husband was right to give a correction.
     
    Last edited: Aug 10, 2012
  3. sooz

    sooz Approved members

    Joined:
    Dec 4, 2009
    Messages:
    2,330
    I am wondering if some of the confusion is because the OP was gven certain instructions when her DD was Dx at 12 months of age and now her DD is almost five. My granddaughter was Dx at 4 and I can only imagine how difficult and different the protocols are for an infant.
     
  4. caspi

    caspi Approved members

    Joined:
    Oct 11, 2006
    Messages:
    5,134
    I agree 1,000%! :cwds:
     
  5. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623
    Even now, at 9.5 years of age 3 units of insulin would bring Kaylee down 750 points. While there is a general range of where a child could be each child is very different when it comes to specific dosing. Kaylee's always been way off the charts for a correction factor. At 3 years of age her correction factor was .50u would drop her over 450pnts. She has never been 'by the book'.
     
  6. MamaC

    MamaC Approved members

    Joined:
    Dec 9, 2006
    Messages:
    5,292
    I completely agree with Christopher (and anyone else who said it) that it's time to take a step back. Systematically gather information, books, tools, logs. Accept that getting a handle on your daughter's disease is JOB ONE! (You seem to be on track with that.)

    It's going to be tiring, and possibly stressful, but you need to spend as long as it takes. When *YOU* understand what's going on (through reading, checking, logging), you will be in a better position to deal with your daughter's D team. It might be best if you are able to be the sole provider of her D care through this process, so that you have first hand knowledge of every aspect of what's going on, and can process the information.

    I truly believe that it's necessary to go back to square one, and then create a new plan.

    BTW - a JDRF mentor (I am one) will probably NOT be able to give you specific medical advice. Support, yes. Fresh eyes from a 24/7 perspective, yes. Commiseration, absolutely. But you'd be ill advised to expect a mentor to be qualified to dispense medical advice (which you should be getting from your D team).

    Good luck.
     
    Last edited: Aug 10, 2012
  7. Knittingfor4

    Knittingfor4 Approved members

    Joined:
    Aug 18, 2008
    Messages:
    82
    Thanks everyone. I agree, I have plenty to think about right now, but I'm so happy for all the responses.

    To those new here - I cannot leave the practice, it's Kaiser and I can only go to Kaiser. The nurses travel to all the locations, even Salem 1 hour away. So only changing insurance will help, and I can only do that when I get paperwork from DH's work.

    DH is home at night, and does whatever checks I tell him to do. I have told him you guys are helping and we are getting a new system.

    Here is yesterday. I don't see how you can tell anything about Lantus (or anything else) from this, but here ya go:

    5:05am.............303............no correction
    7:10am.............304
    7:40am.............327.............about 35 carbs.........5 units Lantus/4units Novolog
    9:57am.............475............ballet class, no correction
    11:24am...........244............after ballet
    12:29pm...........164............about 40 carbs...........4units Novolog
    3:05pm.............227
    5:00pm.............76..............61carbs.............DH chose no shot bc of low
    7:39pm.............204............bedtime
    10:17pm...........265............no correction
    12:04am...........329............no correction
    4:04am.............211
    7:38am.............143...........gave 4 carbs to check sensitivity
    8:36am.............198...........going ahead with breakfast and shots

    (I did not have a scale for this, sorry, I'm pretty good though, reading the label and looking at what's left after she eats. Dont' worry I AM getting a scale!)
     
  8. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    Wow. What did she have for supper?

    I think the Lantus is too high, but that's just my best guess. (Mostly because it's CRAZY that she could eat 61 carbs uncovered starting at a 76 (which is a perfect number to start eating at) and only go into the low 300s. But also the drop between the midnight check and the 7:30 check.)
     
    Last edited: Aug 10, 2012
  9. MamaC

    MamaC Approved members

    Joined:
    Dec 9, 2006
    Messages:
    5,292
    Down the line, you may want to consider splitting the Lantus dose. Doesn't have to be 50/50...can be adjusted if her basal needs are different throughout the day. My son used to do 70% in the AM, 30% in the PM. Your D team (and I am so sorry to hear they are Kaiser, because my Kaiser peds endo team was A-freaking-mazing) may balk at this suggestion, but it's quite common to split the Lantus. You'll be able to tell once you get a good log going, and there are PLENTY of people here with experience splitting the dose.

    Make a list of things you need to try. A physical, away from the computer list.
     
  10. Knittingfor4

    Knittingfor4 Approved members

    Joined:
    Aug 18, 2008
    Messages:
    82
    I just spoke with her nurse, and she sent me the following email:

    ADA guidelines recommend an a1c for 0-6 year olds of < 8.5%. I think this is a reasonable goal for Ravyn if we are more aggressive with her insulin dosing and pay more attention to carb counting (although I know you are already doing this). Over the last year Ravyn's a1c has been ~ 9.0%, so we are very close to her ADA target.

    Research has also shown the more often a patient checks their blood sugar the better the a1c. So I think your idea of checking blood sugars at snack time would be helpful. You can avoid insulin stacking at snack times as long as there is at least 2-3 hrs between insulin doses. For example, if Ravyn received insulin at 12pm for lunch, she could then be given a correction for a high blood sugar and/or carb intake at 2:30-3pm. Of course you still need to take afternoon physical activity into account when giving insulin for snacks....

    Ravyn's blood sugars over the past week have generally been elevated (except for this morning of course). I think this trend would support increasing the lantus back to 6 units.


    On the phone she said we could ease slowly into this by only giving an afternoon snack shot first, then moving onto mornings snacks. Also, we should wait to start the increased Lantus until after Legoland since she had a history earlier this summer of lows on the 6 units. They share my fear of lows during our time at an amusement park!

    I'm not sure this makes sense anymore. If she went low multiple times on 6 units Lantus only a couple months ago, why should we try again so soon? And it looks like everyone here agrees her Lantus is too high? I'm so confused.

    Oh, and I am also supposed to increase her correction to 1 unit per 50pts starting at 200 (instead of 250).
     
  11. Knittingfor4

    Knittingfor4 Approved members

    Joined:
    Aug 18, 2008
    Messages:
    82
    Papa Murphy's, the new personal size kid's kits. Decorate your own pizza basically. I looked it up online, so that one's accurate.

    And those #'s are pretty typical for us. We would not usually give a shot for eating if she's 76. Of course, she usually doesn't have that many carbs in one sitting, so I might have been tempted to give 1 unit.
     
  12. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    Not going to go massively in depth because I think you've already been overloaded. What I will say is that I am certain she needs LESS Lantus. I am an adult, and 61 carbs uncovered would raise a 76 to almost 700. The fact that someone with T1, particularly a small child, ate that many carbs and only went into the 300s is ringing massive alarm bells about her Lantus dose. Add that to the big drops overnight, I really think you should try knocking a unit from her Lantus and seeing where it gets you. Although she is running high, that's because you're having to skip boluses etc because you're worried about lows.
     
  13. MamaC

    MamaC Approved members

    Joined:
    Dec 9, 2006
    Messages:
    5,292
    Well done, Emma.
     
  14. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    I think this is one of the biggest issues. Skipping insulin to cover meals, failing to correct highs out of fear because the basal is too high is leading to an impossible cycle of highs and lows ( when highs are finally corrected) which makes it impossible to to really gauge her true I:C ratio and correction factor. ( and I think sliding scales are useless btw - she needs an actual correction factor)
     
  15. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    For a child her size, every carb is likely to raise her BG in the neighborhood of 10 points. So if you wanted to be extra safe and bump her BG up to 100 before eating, that's only 3-4 carbs "free." Giving her 61 free carbs (or 30, or even 10 for that matter) is HUGE overkill.

    My overall take on your situation is that you and your endo team are so scared of lows that you overreact to low-normal numbers. (I understand with your history why you are afraid of lows, but you need to learn to get more comfortable with numbers in the low range of normal.) Because you massively overtreat lows, she ends up very high. You then run into insulin resistance, and you end up having to overcorrect highs. That drives her low and the cycle repeats. (I also think that your actual correction factor will get higher (i.e., she will need less insulin for corrections) once she is not running high all the time. She is going to be insulin resistant at 300 and 400 in a way that she is not at 235 or 180.

    My advice: Lower the Lantus a half unit and see what happens. I think you'll end up reducing it at least a full unit, but she's on such a low dose that I'd start with a half and go from there. ETA: I see that Emma recommends reducing Lantus a full unit, so since she's much smarter about this stuff than I am, I'd take her advice. ;)
     
    Last edited: Aug 10, 2012
  16. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    did you give them the information for the overnight numbers? because looking a just the overnight I would not increase Lantus.
    Your daughter started into dinner with 76 then had 61 carbs with NO fast acting insulin and most likely no active lunch insulin left. with 61 carbs I would have expected her to to go over 400 yet she went to 329 and came down on her own to 146 when you gave a conservative 4 carbs that rose her to near 200.

    I beleive a few things from the numbers that you gave.

    I beleive that the Lantus is too high based on last night numbers, unless she she was extremely active yesterday, and if that is normal then still it is too high.

    She might have a "peak" from her Lantus, that means instead of it being steady and consistant it does work harder and brings her number down, most people report that this happens between hours 3-6 of the dose and then it does level out. I can not be certain because she has ballet in ther at that time, and depending on its endurance that alone could bring down her number.

    I beleive that the duration of action of the fast acting at the high doses that you are giving is lasting in her system for an extended amount of time, up to 5 hours.

    How does she do at ballet? is she able to consentrate and do what they instruct?

    You are using Novolog? please double check the insulin you are giving at meals.

    I can not beleive that your ratio is 1:10 and correction factor is 1:50, that is a heck of allot of insulin for a 5yr old that weights under 40lbs. I wonder if she is consitantly rebounding, that is that her body is kicking out its own glucose because how fast she is dropping (from the big boluses) and then at night she is pulling glucose back into storage and that is why she is dropping overnight.

    These are just my thoughts and guesses.
     
  17. Knittingfor4

    Knittingfor4 Approved members

    Joined:
    Aug 18, 2008
    Messages:
    82
    She does great at ballet, yes she can concentrate. She seems perfectly fine almost all the time. She's even been 45 with no indication if she's busy. Only at night does she cry, shake and throw up.

    So tomorrow I will give her 4.5 units Lantus and see what happens. The nurse said it takes 3 days for a change in Lantus to fully play out. So I won't go down to 4 units until the 4th day - correct? Or is it really safe to go down to 4 right away? She might not be so sensitive to the Lantus as she is to Novolog.

    If I try a whole new correction and carb ratio, will that be safe? Will we see an improvement? How do I get out of the cycle of rebounding?
     
  18. MamaC

    MamaC Approved members

    Joined:
    Dec 9, 2006
    Messages:
    5,292
    Generally speaking, changes to basal and bolus should NOT be made at the same time, particularly when things are as jumbled as they are now.

    Three days is a good amount of time to see if the basal adjustment is working.
     
  19. caspi

    caspi Approved members

    Joined:
    Oct 11, 2006
    Messages:
    5,134
    I agree with Becky - start with lowering the Lantus first and don't worry about the carb ratios right now.

    When your daughter is low before a meal, give a few carbs to bring her bg up and then dose for the meal. When you don't give insulin for a meal because she is low, that's why she is spiking afterwards.
     
  20. DsMom

    DsMom Approved members

    Joined:
    Nov 9, 2010
    Messages:
    1,700
    If you could possibly fit all of this info into a nutshell;)...I think this should be the one to use!! I would use this mindset as your guide...and go from there.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice