Discussion in 'Parents of Children with Type 1' started by Knittingfor4, Aug 8, 2012.
Can't wait to see the results!
Keep in mind that often kids have different carb ratios for different times of day. So you may see your experiment working for one or two meals and not the others. Usually breakfast needs a lower carb ratio. But my DD was odd when she was younger. She needed less insulin at breakfast.
It makes good sense to proceed in this manner. Just measure often (including midnight and at least once overnight), and let the numbers guide you.
The cool thing with the equations is you can keep using them as TDD changes. Also, you can adjust them to fit your child better. But for many of us, they work just fine as they are. I have used them hundreds of times in developing and adjusting my daughter's insulin regimen over the years.
Good luck and keep us posted.
Keep in mind that the equations are just starting points and are not THE answer. Once you learn more, you'll discover what your particular child's insulin needs are.
For sure. But you've got to start somewhere, and they're particularly good in that regard.
Just one last post to perhaps increase your comfort with the above equations for carb ratios and correction factor.
They appear in Chapter 7 of my edition of Think Like a Pancreas (the chapter is titled Bolus Calculations) on pages 122-124 and 126-131 (correction factor is referred to as "sensitivity factor" but it is the same parameter).
You might want to skip ahead..
Glad to see that you went to 1:20 it is a big jump for you but as i have been saying I think she is getting way too much insulin at 1:10. i agree that in most cases you dont want to change too many thiings at once but this is definately the safeest route for you.
You might see higher numbers at the two hour mark, but we will have to see.
Making this change first then working on covering all carbs and doing corrections based on a correction factor will come into play once you hammer out the right basal and ratio.
Please also work on getting her insulin to her as soon as you can, the longer you wait to give insulin the higher her number will go.
Just wanted to wish you all the best as you start these changes. You will get it right! I can't even imagine how it's been for you for the past 4 years, living with the sliding scale. I remember it as a nightmare for those few weeks we were on it after dx.
You've gotten awesome advice, this is a great place to learn. I've learned here much more than I did from our endo's office (though they are great).
Hopefully your nights will get much better with Lantus adjustments and then you can go from there!
Just to clarify, the OP's daughter is very high very often and you are suggesting the 500 Rule which would be lowering the amount of insulin her daughter is currently getting??
things ar not working with the regime that the have.
1:10 ratio for a child that wheigh 38ish pounds and a 1:50 ratio for corrections.
I think that Wilf and I and other beleive that this child is in a constant high to low roller coaster with the parent scared and not knowing one end from another, because they have no time in which insulin is not too high.
High numbers do not always mean more insulin, because too much insulin can cause the body to take things into their own hands. Rebounding and or a stress responce can explain allot here. and if it does not pan out then at least we know that that is the case and can move on to other issues, like the insulin itself or the method of administration.
Look at the overnight numbers, they speak for themselves. She does not need more Lantus.
Then look at the daytime numbers, they likewise speak for themselves. She has been getting way too much insulin at mealtime.
I think she's been stuck in a chronic cycle of hard lows, followed by rebounds and insulin resistance. When this is happening children tend to be stuck high most of the time, except for brief and terrifying periods when the insulin resistance from the last low wears off. They then go brutally low again (either with the next bolus or overnight), rebound and are insulin resistant again. The lows can be marked by seizures (which she has had) or other symptoms - in this child's case apparently vomiting. Many people don't know that the physical act of vomiting raises blood sugars.
I think this child and her family have been living through a nightmare, but I think we can put a positive end to that very quickly now that they've found us.
That having been said, I'm open to hearing how you would suggest proceeding if you have an issue with any aspect of what is being proposed. :cwds:
I was just going by the OP saying her daughter was mostly in the 300s. And I was referring to bolus not basal.
All that matters is that she get her more evened out, and I hope she does that, by whatever method.
Just look at the last couple of day's numbers (which the OP posted a couple of days back). The necessary course of action is obvious - reduce the amount of insulin she's getting..
OK, you being a seasoned parent.
If you never had a proper training, how do you know if anything you have is set right?
You have to stop your world and reevaluate everything you ever learned.
like i said just because you have highs it does not mean that more insulin has to be given. MAYBE, the body is conpensating for TOO much insulin by kicking out glucose, IT IS a normal bodily function that is not normally impacted by an autoimmune responce.
Once you stop the body from kicking out glucose you may very well end up with better control with LESS insulin.
i could be totally wrong. but just looking at the numbers, this is what I see.
Ok guys, I did something wrong! I can't see it, please tell me what it is!
Today's numbers, using a 1:20 carb ratio, the idea that 4 carbs raises bg 55pts, and 1 unit Novolog lowers by 150pts:
8:03am............................25 carbs, 4.5 units Lantus, 1 unit Novolog (for carbs, no correction)
9:55am............427............2 units Novolog correction
1:52pm..............................4.5 units Novolog (for carbs)
3:06pm............324.............10 carbs, 1/2 unit Novolog (for carbs)
8:32pm............245..............22 carbs, 1/2 unit (half dose for carbs because it's bedtime and we were nervous )
Was the 4.5 units for lunch too much? Or did she go too long w/out a snack? And why was she 427 after her breakfast shot? Thanks
What was her blood sugar at 8:03 when she ate? What did she eat at 1:12 for 96 carbs?
No worries, you didn't do anything wrong.. :cwds:
It actually looks like the 1:20 is not bad as a carb ratio, and the Lantus is looking good. No bad lows today, and no insulin resistance. Excellent work - I'd stay the course for another day!
But now it's time to start fine-tuning. And that means it's time to talk about pre-bolusing. For your daughter's meals, when do you give her the bolus? Before, during, or after the meal? My guess is during or after..
It is looking like her carbs are hitting the bloodstream before the boluses have started working, so that she's spiking high after a meal but then is back at her starting point 4 hours later. This is something that most of us on here wrestle with at one time or another.
Bottom line is you will have to start giving the insulin sooner than you have been. But this is a very modest and manageable change, compared to the major changes you've already made.
You're doing well. Stay the course!
We give it after. They said within 30min. Some days she doesn't eat all we give to her. Like today, her lunch was actually 130 somthing carbs, but she she only had one bite of the mac and cheese, opting for the milkshake and fruit instead. How can I give her insulin when I won't know the dose until she's done?
Is it an age thing, because they said we'd change to before meals when she's older and can be counted on to eat everything.
You have gotten great advice. It will take a bit to digest everything.First. get the books mentioned. Read them and then read , and re-read them. Then start talking with your Docs. If they are not working with you then switch to new Docs, get some references first. It is OK if it takes you a year to get this all figured out. Ali
Maybe she was too high after her breakfast shot because you don't know what number she was when she ate her breakfast, and she could have been higher than the 291 an hour before which wasn't corrected. Maybe the 2 unit correction at 9.55am wouldn't have been needed if it were corrected earlier.
Your giving insulin for carbs actually seems to quite a lot longer than 30 mins after.
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