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Is this stacking?

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

  1. L101418

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    I just got REALLY excited for you! Things are going to get better. You are asking smart questions. You can do this!
     
  2. sooz

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    I just realized that while I suggested a CALORIE KING app or book, I neglected to mention that you can also go to calorieking.com for nutritional info. I hope this helps.

    http://www.calorieking.com/foods/
     
  3. mmgirls

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    I think dropping down to 4 would be fine. yess it takes a couple of days to see the complete changes.

    I have no idea is she is truly rebounding. the only real way to know is to "catch" a low or an extremely fast drop on the meter. you can try to "catch" it by testing more often after a bolus.

    Lowering the lantus will help, it will make her not as sensative to the fast acting and hopefully shorten its duration.

    I hesitate to say this, but I am going to. You already know that I think that she getts way too much insulin from fast acting. And it plays into my rebounding idea.

    everyone is saying that you can not give carbs that are uncovered but your ration is SO low, giving too much insulin(lower the ratio the more the insulin) that I am afaid that if you start covering all carbs with insulin at the 1:10 then you will end up with lows, or rebounding with insulin resistance.

    So i will just say it, I think you need to raise your ratio and correction factor by allot before starting to cover ALL carbs. I would also try to only give carbs every 3hrs so that you can get good info on how the boluses are working.

    when does your daughter start school? this year or next?
     
  4. mmgirls

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    the other thing that I forgot to mention is that you need to be consistant with how you are dosing, you are never going to figure out correct ratios and correction factors if you do not do the samething all the time.

    That means either correcting a low with carbs and retesting and then giving a meal bolus or using a correction factor to mathmatically shave off insulin for the low. You need to have an understanding of insulin duration and active insulin from previous boluses.

    Are you using syringes? are you using ones with a 1/2 unit marking?
     
  5. Charlotte'sMom

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    Very true.

    When I feel like I need to make a lot of changes to I:C ratios and basals (like you're doing right now), I try to make the meals the same for a few days, just to hopefully help with the consistency. For example, we've had the exact same thing for breakfast for the last 3 days (and meticulously counted carbs) because I'm trying to fine tune my DD's pump settings, and I know certain foods can affect her different ways. I usually just eye-ball it and just guess carb counts, but I know I can't make serious changes unless I'm being really consistent and careful.
     
  6. Knittingfor4

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    Ok.

    She starts school Aug 28!

    We are using pens. The Novolog pen has half units, but the Lantus does not.

    BTW, I am seeing changes today! 9am 164, 10:40am 250 (no correction) 8 carb snack, Noon 104, no juice, just lunch!
     
    Last edited: Aug 10, 2012
  7. zoomom456

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    There is a ton of advice here for you to absorb. I'm glad you are already seeing better numbers today. Just jumping on to say hi:) from a parent who walks in similiar shoes. My son was diagnosed at 13 months and just turned 4. Let me know if there is anything I can add that may be helpful.
     
  8. wilf

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    Hi there. I've been away on a long vacation, just tuning in. I'm having trouble understanding what her blood sugars were doing between supper (5 pm) and breakfast (8:36 am). What did she have for supper? I am trying to figure our what would cause her to go up from 5 pm through midnight? It is either very slow acting supper carbs, or a rebound (with insulin resistance) from an earlier (pre-supper) low..
     
  9. Jordansmom

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    Welcome back Wilf! You've been missed. :)

    She mentioned Papa Murphey's pizza for dinner.
     
  10. wilf

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    Ok, pizza makes sense. Certainly the drop from midnight on suggests Lantus is way too high. I would agree with the suggested drop to 4 units Lantus.

    What Correction Factor is being used to deal with highs?
     
  11. Jordansmom

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    Since I seem to be the only person up: correction factor was 1 unit for every 50 points over 250 (changed to 200 today). But full corrections have not been given at dinner or later because of concern about nighttime lows.
     
  12. wilf

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    This Correction Factor is 1 unit assumed to drop blood sugars by 50 points. That's nutty! :(

    For a kid getting 5 Lantus (and still going low on that amount), I'd assume TDD would be around 10 units. If that's the case then the Correction Factor should be around 1 unit corrections being used to drop blood sugars by 180 points (and even less insulin needed for corrections at night). Carb ratio should be 1 unit to cover 50 g carbs..

    No wonder there's problems with this regimen!
     
  13. sooz

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    Carb ratio has been 1:10 . So glad you are back Wilf and that you are on this! I know it is a long thread but if you could read the whole thing you could understand more about what is going on.
     
    Last edited: Aug 11, 2012
  14. GaPeach

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    Good to see you back Wilf!

    To the OP, Wilf is fabulous at explaining the math. Listen carefully and be willing to give it a chance (even if his advice does not make sense). Simply report back numbers. He will explain what happened and suggest a different idea.

    The books mentioned will help you understand a lot. Wilf will walk you through quite a bit step-by-step.

    As you adjust the basal (Lantus), it is very helpful to do basal testing (no carbs) to "see" how the basal is working. You should see a relatively steady BG. This is usually accomplished in 12 hour segments with nighttime being the first period.

    Most importantly, your diligence to explore, ask questions and monitor your child is to be commended. You are a great mom!!!
     
  15. Deal

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    Good to see you back Wilf!
     
  16. wilf

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    The nurse is not competent to give advice on how to manage the diabetes. That's why nothing is making sense.
     
  17. wilf

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    To the mom who started this thread, I 'm hoping you're not put off by the critical tone of some of the posts in this thread. There are huge problems with the insulin regimen your medical team has had you following, and people are simply responding to those problems.

    In my opinion you've been given chronically poor advice by your medical team. That poor advice has led to repeated overdoses of insulin and has endangered the life of your daughter on multiple occasions. It is time to look for a new medical team.

    In the meantime, you need to establish a new and appropriate insulin regimen including:
    - Lantus dosage;
    - carb ratio;
    - Correction Factor.

    We can help you do this. :)

    If you are game to post yesterday's numbers (the same way you did the day before's) that would be tremendously helpful. :cwds:
     
  18. Mish

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    I think that's what EVERYONE in this thread has said already. And no one has mentioned critical posts until now. So thanks also for that.
     
  19. Knittingfor4

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    Sorry, there's a ton of them! This is for Friday, August 10 - 11. Star line indicates when DH came home and I left, so above is me, below is him, until 10pm.

    12:04am...........329
    4:04am.............211
    7:38am.............143............4 carbs to see rate of increase
    8:36am.............198............55 points per hr per 4 carbs
    9:17am.............164............32 carbs, 5units Lantus, 3units Novolog
    10:41am............250
    11:58am............104............35 carbs, 3units Novolog
    1:56pm..............41.............no indications, she was perfectly normal! 8 carbs
    2:11pm..............70.............no additional treatment
    2:36pm..............57.............4 carbs
    3:06pm..............69.............32 carbs (not a typical snack) no insulin
    3:30pm..............71
    3:55pm..............70.............greek yogurt bc dinner will be late, 8 carbs/12protein
    ****************************************************
    4:32pm..............139
    6:23pm..............293............34 carbs
    6:45pm................................2units Novolog
    7:49pm..............276.............clementine 8 carbs
    8:30pm................................1/2unit Novolog
    11:08pm.............61...............12 carbs juice
    12:00am.............114
    1:14am...............141
    5:03am...............108
    7:03am...............141
    Thank you!
     
  20. nanhsot

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    From midnight till 730a on the first night, is there any fastacting at all, any corrections done? I think your lantus is too high if not. I thought you were going to lower lantus to 4, was this after this day's events?

    It looks like you are at 1:10 ratio for fastacting and that's too aggressive as well given what happens after lunch and dinner, but I'd work on the lantus/overnights first and then tackle that.

    (and just a suggestion that you can ignore, but at some point you might start a new thread, this one is getting ginormous!)
     
    Last edited: Aug 11, 2012

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