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Low melt downs and tantrums with a 2 y..o

Discussion in 'Parents of Children with Type 1' started by natallia, Oct 28, 2013.

  1. mmgirls

    mmgirls Approved members

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    After re-reading and seeing that he has lows in below 36, and sometimes into the 20's.

    I have to be honest here, in the 7 plus years we have been at this since my daughter was DX' Ed at 13 months we have only have had a handful of bgs under 40. Most of those while actively sick or on an antibiotic.

    Somewhere things are really off for you guys, and you have to stop the severe lows.

    Maybe if you post a days numbers and insulin given we can help you compare and see the "tree in the forest."
     
  2. Amy C.

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    Your child will not be 2 forever. Eventually he will mature in different ways for you to deal with lows. I would raise his target blood sugar to be much, much higher -- more in the 150-175 (8.3-9.7). Going low must be avoided at all costs. The A1c will be higher for a couple of years, but that is the trade-off of no lows.
     
  3. mom24grlz

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    if your range is 100-220 I'd do a target number right in the middle, which is 160. However i've never had a baby/toddler with type 1, so not sure if the is to high of a target number or not. I just know Ashleigh's target number is right in the middle of her target range.
     
  4. momtojess

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    My daughter was dxd at 11 months, and I know how hard it is to handle D in a 2 yr old. I can tell you 11 years later, that is really does get better, both because as they get older they tend to be less sensitive to insulin and they learn to communicate and can tell you how they feel.

    I have a question, Is your son only acting so horrible when he is low? or are there other times that he seems to be experiencing extreme temper trantrums? If it isn't just during times when he is low, then I would talk to a dr about other causes for the behavior not related to diabetes.

    If the tantrums are only during lows, then I would run him higher for a month or so (150-ish both day and night). Prevent the lows before they get so low. It may give you a higher a1c, but in the overall scheme of life it isn't going to be rememberable in 3 years and especially in 40 years from now. Our kids will look back in 20 years from now and either remember a great childhood that diabetes tagged along in, or look back with regret because diabetes robbed them of a childhood.
     
  5. natallia

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    thank you so much, everyone!

    I think he is acting up when in is in range too, but he is def. miserable when low or high. And he is always squinting his eyes when high, maybe his vision gets impaired too? I just can't wait till he can communicate with me about how he feels!

    I have adjusted his target to 140, I agree 100 and 120 is way too low. This is what was set up for us when we started pumping but I think it is way too agressive. We are always chasing lows just like when he was on MDI.
    I am attaching his ratios and basals here. Maybe I can get some input whether it looks right or not for someone who is only 2. I would really really appreciate any advice or suggestion at all!

    His ratios:
    breakfast: 1:9 (I know its very aggresive, but its the only way to combat the post meal spike)
    uncovered snack in the mid-morning when he is crashing from breakfast bolus.
    lunch 1:25
    aft. snack 1:30
    dinner 1:25
    anything in between 1:30

    basals:
    9am-10pm: 0.25
    10pm-3am: 0.05
    3am-4am: 0.15
    4am-9am: 0.1
    (he is still almost always low at 2 am even with the minimum basal rate)
    correction factor:
    1:20 9am-7pm
    1:30 7pm-9am
    he usually wakes up in low 4s and I always test him at night at least 2 times even with the dexcom, because we had a couple of times when the dex was showing over 100 and he was 1.4 (20) on a finger and 1.7 (22). I am scared now to trust it completely.

    Our hardest time is usually in the afternoon and especially evening and early night. We never see consistancy in the bgs then, he is either high or low. I was told not to treat unless he is below 80 and to correct anything above 180. would sleep time schedule affect his bgs?
     
    Last edited: Oct 29, 2013
  6. nebby3

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    When my dd was a toddler naps definitely affected bg. A long nap meant highs. I think she would even sleep soundly enough her body would release growth hormone and send her shooting up. But of course you never could predict how she would do from one day to the next.
     
  7. missmakaliasmomma

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    Ok, I do know our kids are all different and my daughter is 5, not 2. Your 3am-9am basals seem very high. My daughter's never went beyond .150 I think and that was during the day. At night, never more than .075 and she went low even with trying to lower it too. There was a period in the night when my daughter would dip low, despite her low basal at that time. Maybe he doesn't need any basal around 2am.

    My daughter's ratios are the same throughout the day... she eats a lot of healthy things that we have found don't spike the BG. 1:9 for breakfast is more like a teenager's ICR. That's wayy too aggressive. what are you feeding him for breakfast? It makes a big difference. If you're feeding him cereal, muffins, pancakes, etc I'd highly suggest not to as you can spike really high but come crashing down within an hour. Also, my daughter's ratio at 5 yo is close to the ones you have. Her rates around his age were more like 1:35 and 1:40. I do think if this is your endo team making all of the ICRs and Correction factors and things, they are being way too aggressive and need to relax.

    Is your correction factor in US measurement? (I don't know anything about conversions between countries) I'm assuming not since 1 unit for 20 or 30 points is way too much. What is it converted? My daughter's is 1:170 and sometimes that is actually too much. The only time her correction factor doesn't bring her down is when she's sick or had a really fatty meal.
     
  8. ksartain

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    Our eye doctor told us that if we notice Christopher squinting, that is a sign of high blood glucose. He was a little giddy when we came in. There are only 5 T1D in our half of the county, so I think he was excited to get to use his diabetic eye knowledge. LOL

    He said when a blood glucose average is over 200, that's when it starts to affect the eyes. If he's squinting a lot, it could contribute to headaches, so that may be going on in addition to everything else. The eye doctor also said if Christopher starts coming home with headaches, that we need to come back in for another exam ASAP and take another picture of his eyeballs.

    Have you taken your child to an eye doctor? They can do exams on young kids and it may be worth it to get a baseline for the future.
     
  9. mamattorney

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    Maybe for now just changing the target will help. I don't have enough experience to comment on the profile. But my thought is . . .

    If you were correcting back to 100 and he was often dipping into the 40's - then correction to 140 would, in a perfect, logical (ha!) world, have him dipping only into the 80's.
     
  10. mmgirls

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    Please clarify the correction factor. and how you have the POD setup to do corrections or how you do a correction.

    Also how do you treat the lows at night?

    how often are you correcting?

    Don't kill me for asking, but have you basal tested?

    I wonder how often you are using the mini glucagon shots and if his body is stealing glucose back from the blood to replenish its stores and you are in a cyclical chain of events.
     
  11. natallia

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    thank you so much everyone for your help!
    I see the improvement after bringing up his target to 140. We actually haven't had a low for the last 24 hours, which is new.
    Please clarify the correction factor.
    its huge:
    1:360 day
    1:540 night
    he is super sensitive

    and how you have the POD setup to do corrections or how you do a correction.

    Only every 3-4 hours. We use apidra. But I noticed even if there is IOB after 3 hours it doesn't do much anymore.

    Also how do you treat the lows at night?

    a tsp of dex gel (4 carbs) followed by 2 tsp. of greek yogurt for most lows.

    how often are you correcting?
    3-4 hours. sometimes I overcorrect. Just can't wait for him to come down.
    Don't kill me for asking, but have you basal tested?
    yes, although it is very hard for 2 year old. the mealtimes boluses seem to overlap each other. I would have to starve him for a day to really test the basals during the day. Night time is easier.
     
  12. Sarah Maddie's Mom

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    That's great :cwds:

    I'll bet that you all will be feeling better, calmer and less fussy with the new target number. ;)
     
  13. MomofSweetOne

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    Such good news!

    I was thinking about your post, and one thing that hasn't been mentioned here is for little ones, some parents have actually turned the basal to 0 every other hour or so (or however Omnipod lets you do it) at night to avoid lows.

    Also, have you tried another type of insulin? If I remember correctly, some people here said that they had a hard time getting basals, etc. adjusted and that the post-meal plunges with Apidra left them not feeling well.

    No experience with either, just odd rememberings of other's posts.

    Another thing that is jumping out at me is that you're overlapping meal boluses. We've used both Medtronic & Omnipod, and there is NO comparison in the IOB calculations between the two pumps. We went back to stretching to boluses four hours apart or more when she wears a pod because overlapping them really messes with my daughter's BGs. I wonder if there's a better way for you to be calculating IOB for your little guy. I don't understand why Omnipod didn't at least use the dose chart in Think Like A Pancreas rather than just acting as if insulin works the same for each hour of duration.
     
    Last edited: Oct 30, 2013

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