- advertisement -

Lunchtime check, was 65, still give juice?

Discussion in 'Parents of Children with Type 1' started by danielsmom, Feb 2, 2012.

  1. danielsmom

    danielsmom Approved members

    Joined:
    Jul 18, 2011
    Messages:
    798
    Daniel went in for his lunch check..no symptoms....he was 65. Nurse gave him juice, is waiting for recheck and then will give him insulin for his lunch.. So I'm wondering....if boy wasn't feeling low, and sorry if lame question.. could he have just gotten his lunch and meal insulin, or would you have given the juice/tabs and waited first for him to come up?...Nurse will follow protocol regardless. But wondering..

    Interesting night.. went to bed 100, with snack(covered), levimir..woke up 72..usual breakfast and insulin, had his mid day snack...
     
  2. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623
    Before meals we don't recheck. If she's feeling the low we give a juicebox and then let her eat. At school they would have gotten her lunch early. If she's not feeling low and no active insulin we have her eat lunch and then knock 10-15carbs off her final count, we also don't prebolus with numbers that are on the lower end before meals.
     
  3. Beach bum

    Beach bum Approved members

    Joined:
    Nov 17, 2005
    Messages:
    11,315
    Normally for us, we would just give juice and not cover that, but then cover for the rest of the meal. Any lower than that, we'd give juice and then wait a bit and recheck before going to lunch.
     
  4. danielsmom

    danielsmom Approved members

    Joined:
    Jul 18, 2011
    Messages:
    798
    Well Nurse got orders today to up his insulin at lunch to get dinner numbers down...and course I can't tell her to give him less...so we will keep eye on him this afternoon and make sure he doesn't go low again..At home I can handle things differently..
     
  5. Connor's Mom

    Connor's Mom Approved members

    Joined:
    Nov 10, 2011
    Messages:
    564
    Why can't you ask her not to give the new higher dose? Was it too late? If that's the case I understand. If it's because she was told by the Endo to change the dose I think I would have over ruled that and backed off IF that is what my gut told me needed to be done.

    With lunch time lows, if he is in the 60's, I usually give him lunch and subtract the carbs from the count. If he is at school, he has an extra 7g instead of 15g because 15 with lunch will leave him high. We retest after lunch to be safe and make sure he came up well.
     
  6. Christopher

    Christopher Approved members

    Joined:
    Nov 20, 2007
    Messages:
    6,771
    For a low, I would treat it, check in 15 minutes to assure it came up, then dose for the lunch.

    I don't understand how increasing his insulin at lunch is going to have any effect on his dinner numbers? Any insulin given at lunch should be out of his system by dinnertime. Maybe I am not understanding.

    As for the interaction with the nurse, you sound powerless and that is not a good situation to be in. There should be a way for her to take her direction from you. Many people have their endo instruct the nurse in writing that the parent can make changes to the child's diabetes care.
     
  7. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    Well if no corrections are done between lunch and dinner then a higher dose at lunch would mean a lower BG at dinner. I'm assuming that intermediate checks have been done to show that he is also high after lunch.
     
  8. Butterfly Betty

    Butterfly Betty Approved members

    Joined:
    Dec 8, 2010
    Messages:
    540
    If Sophie were 65 at lunch, I would have given her a few extra uncovered carbs and then dosed for the rest of what she ate.
     
  9. Christopher

    Christopher Approved members

    Joined:
    Nov 20, 2007
    Messages:
    6,771
    I didn't sleep very much last night so maybe my brain is wacky, but at least in my experience, insulin given at 11:30am (or 12) will be worn off by 6:00pm. So only the basal insulin would be working on the bg at that point in time not the lunchtime bolus.
     
  10. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    But if the BG is lower at 3PM or whenever the insulin stops working and the basal holds it steady at that point, it will still be lower at 6PM.
     
  11. minniem

    minniem Approved members

    Joined:
    Apr 25, 2011
    Messages:
    286
    I agree with Emma. We were always told to adjust the previous meal dose if the numbers remained high for a certain meal. So for consistently high numbers at dinner, we were told to increase the lunch bolus dose. That will bring the lunch time numbers in range and then the basal would hold it steady and the numbers would be in range for dinner time.

    To the OP, if my DS were 65 I would have treated the low first and made sure he came up before I let him eat and have his lunch insulin. My thought would be that if it were a persistent low and more than one treatment is needed that it is better to treat on an empty stomach so that the carbs can be easily absorbed. If there are protein and fats in the lunch the carbs might not be absorbed as quickly. Does that make sense? For a number in the 70's with no symptoms I would do a negative correction. But for anything below 70 we treat first regardless of symptoms.
     
  12. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    For me it's slightly more complicated. Higher dinner time numbers alone would not necessarily mean that I should raise the lunch ratio, because it could be that my basal insulin is too low. I would only raise the lunch dosage if I was high after lunch (and before dinner as well, if corrections are not being done).
     
  13. Mish

    Mish Approved members

    Joined:
    Aug 20, 2009
    Messages:
    1,393
    When we were newbies, we always treated a low and then rechecked and only then did we eat and dose insulin. There is nothing wrong with doing it this way now. It's safe, and if your nurse has zero flexibility then this is easy. Now, your son better like having his lunch with the nurse though, because he'll probably be there quite often.

    On the other hand, now that we know better how food and insulin effect him for a 65 at lunch at school (he self manages) if he felt fine, he would chomp 2 glucose tabs on his way to the cafeteria then he would eat and then (if there was no outdoor recess) he would bolus and if there was outdoor recess he'd bolus half and then recheck and correct any high in an hour or so. But that's very specific to him and his situation and there are days where we will do it differently depending on the circumstances. These things might not work for you. Or they may be ideas that you tuck aside for once you're all more experienced.

    My last point; your nurse needs to work with you. You've got to figure out between the two of you and your endo how she can understand that on a day to day basis there will be changes. If dosing changes you're not going to want to wait until your endo sends new orders. He's going to have to have something written up that indicates that you're allowed to change amounts as needed. How to treat a low before lunch is one of those things where it might be different today vs tomorrow and today you might need less insulin and tomorrow you might want a snack.
     
  14. danielsmom

    danielsmom Approved members

    Joined:
    Jul 18, 2011
    Messages:
    798
    Endo does not want 200's for dinner...granted we take into account if he's had evening sports activity..too many dinner numbers coming in higher....at that time, so we upped his lunch insulin.. He has 15c uncovered snack after school...
    I was not at school, and nurse had just gotten new orders so she will follow that not what I tell her, unless I"m there...But here's the deal now.. I went to school to review and sign the orders.. There was extreme change that I do not recall endo reviewing with me a few weeks ago. His correction up to now has been over 200 with half units...but now the school form stated corrections at 150 with whole units.. I know this will eventually be the case, but if he is coming down where he should be with .5 I don't see why we are now correcting at lower amount with more insulin...Unless she is trying to tighten the numbers since ideally Daniel should more often be below 150 at meals and not above??

    15g of juice brought Daniel up to the 80's, he then was bolused for lunch.
     
  15. BittysMom

    BittysMom Approved members

    Joined:
    Aug 21, 2011
    Messages:
    870
    Gosh, I wish you had more flexibility. I text with our nurse and sometimes I'll just say something like "Caroline's been running low, maybe you should just give her a conservative .5 instead of a full one like usual" She appreciates this. It seems this kind of interaction is rare, but I'm going to keep it going as long as I can;) Third grade will be a new nurse and from what I know of her, she'll want strict Endo orders. That'll be fun, lol.

    As far as your question, our nurse would treat, retest and then lunch with a normal bolus.
     
  16. danielsmom

    danielsmom Approved members

    Joined:
    Jul 18, 2011
    Messages:
    798
    We get 200's regardless..these new changes came about just recently...but I was not understanding at the time that we had to correct at a lower number..I told CDE endo did not make that clear.. What she made clear was that I was to cover the night snack with more insulin, which apparently I was supposed to be doing since the last visit and I did not comprehend that(my husband was there too and he doesn't remember being told that).. So when I saw the changes for correction I called CDE right away..she will speak with endo tomorrow and call me for clarification.. I am willing to do what is expected, but I am the one seeing the patterns and will make changes immediately if it has a negative effect on Daniel.
     
  17. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623

    Because it was at school I'd just let them do it this way. Its what they were told to do, they're following protocol so I'd leave it alone too.. We do things differently at home than at school too because I know Kaylee better and I take more things into consideration, the school does what they are told, using common sense only when really needed. ;):D
     
  18. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    You need new orders that say that you are allowed to make dosage changes any time you choose to do so.
     
  19. Beach bum

    Beach bum Approved members

    Joined:
    Nov 17, 2005
    Messages:
    11,315
    That's one thing I love about our practice. First is that everything is practically done via email, second EVERYTHING is put into writing, even if it is discussed over the phone, then it is emailed to us.
    We get this great chart with dosing, carb ratios, correction factors etc.
    Maybe you can nicely ask your doctor to do this for you? This way nothing will fall through the cracks.

    And yes, you are the ones who do this 24/7 so you know if it's working or not. As for school, I'd just do what is ordered for right now. If you find the changes are working, ask the endo to send new orders to the nurse.
     
  20. Jilleighn

    Jilleighn Approved members

    Joined:
    Jan 25, 2009
    Messages:
    746
    If it is my daughter and she was 65 before lunch I would have given 1 glucose tab and then let her eat and bolus for her carbs. In the years past I would have rechecked at 15mins and then let her eat, but now we do not. She also wears a cgms so we can see it on the graph when she is starting to go up from the glucose tab. If the nurse was following the orders then I would just do that
     

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