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Medication nightmare

Discussion in 'Parents of Children with Type 1' started by Kaileen, Sep 20, 2008.

  1. saxmaniac

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    You did really well for your first bout with pizza. Everything looks great. Next time you do pizza either delay the bolus more, or split it to avoid that low that always seems to happen at the 2 hour.

    That's what it's all about. You know you're doing the right thing!
     
  2. wilf

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    Yes, good night last night at this end :) And at your end as well, as I see!

    Today/tomorrow will be time for further tweaking. The anticipated further decline in insulin needs has started, as marked by the first mild lowish readings.

    So my approach at this point would be to leave the night-time Levemir at 11 (it seems to have worked like a charm), and to drop tomorrow morning's Levemir to 22 (I agree with you that this needs to come down).

    Also, with mild lows happening a couple of times yesterday we adjust TDD downward by about 5% to compensate so let's work with an assumed TDD of 60 and recalculate things.

    Your homework: for a TDD of 60, what are her Correction Factor and Carb Ratio? :)

    You'll want to use the new Correction Factor and Carb Ratio starting immediately.

    *****

    A question I should have asked much earlier is whether she is good at feeling her lows?

    *****

    Finally, some thoughts on how things went since yesterday:

    1) Now that she's been spending more and more time in range, her insulin sensitivity is increasing (which is why you're starting to see repeated lowish readings as her needs are continuing to come down).

    Amazing that, with TDD now at 60, her TDD was 50% higher just a few days ago. It was so good that you decided enough was enough and to make the necessary changes! :)

    2) The supper-time correction was one unit more than I would have gone with (keeping in mind a target BG of 200)

    3) There was no correction for the 188 this morning, which in hindsight is ok because we're moving to a new Carb Ratio and Correction Factor.

    ****

    I know Q/A and work don't mix, so maybe leave any response till later. But do that homework, and start applying the new Carb Ratio and Correction Factor as soon as you are able.. Good luck!
     
    Last edited: Sep 26, 2008
  3. Kaileen

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    Correction is easy. 1800/TDD: 1800/60 = 30. So 1 unit of NovoLog should bring her down 30 points.

    Elissa posted the computation in a previous thread:

    ... but I'm not sure I comprehend it. Not counting uncovered snacks: breakfast intake was 57g: lunch was 55.24g: and dinner was 68g. Total of these is 180.24. Average of those three would be 60.08g. So... 60.08/14 (where does the 14 come from?) = 4.291. That would make it 1:4.

    Oh, yes. Maybe a little too early. She starts feeling shaky around 75-78.

    We actually just now applied it for lunch, so I hope it was right.

    11:00am: 215 BG (She had recess, but she forgot her homework at home this morning. They have to sit out recess and do their homework if they don't bring it. So I'm sure her BG would have been lower if she had her homework!)

    Lunch: 1 ham sandwich (Ham, 0g: bread, 18g/2 slices): carrots (8g): water. Total 26g.

    Did two correction units to get 215 BG down to around 155 BG: plus with a 1:4 ratio, 26/4 = 6.5. So we gave her 8 units NovoLog for lunch.

    Man, I hope that was right...
     
  4. Kaileen

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    I will absolutely remember this. I've read too many pizza horror stories on here, so there was a lot of trepidation on my part. But better to get it out of the way sooner and have the confidence to roll with it later than put it off... :D
     
  5. zoesmama

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    Ok, the calculation I was given for figuring Carb Ratio was 500/TDD. I'm also not entirely sure where the 14 came from..... but we know Elissa/Wilf/others are around to help.....


    YOUR WHOLE FAMILY is nothing short of amazing, Kai'leen!!!!! You guys are really rolling with the punches and rallying to make sure your DD gets the best care possible! GREAT stuff! :D

    I agree with Wilf on knocking back the morning Levemir a bit as well. And just so you know, when I split my DD's Levemir I also saw insulin needs come down significantly. This has already started for you guys, but I would imagine it will continue.

    So anyway, I'm still around cheering you along and thinking of ALL of you often! Good luck today! :)
     
  6. wilf

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    Shoot - I'm such an idiot. Just realized you didn't have the equation for carb ratios. :(

    It's the 500 Rule: 500/TDD = carb ratio

    So 500/60=8.3, so you should be using a carb ratio of 1 unit covering 8 g of carbs.

    I see from your post you used a 4:1 ratio. She will be going low if she doesn't get a hefty snack at about 1.5-2 hours after the meal..

    Will post in a minute about how many carbs are needed.
     
  7. Kaileen

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    Calling James now to warn him. He may need to take something up to the school for her ASAP. Thanks!
     
  8. GaPeach

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    The "14" in that long ago post came in trying to determine what carb ratio you were using since the endo didn't "give" you one. At the time she was eating around 100g per meal and receiving about 14u, therefore, the 1:7.

    This is the formula you want to use to calculate the current carb ratio. 500/TDD - OR - 500/60 = 8.33

    So, for lunch ---WAIT - I see wilf posted.

    Just have the school check her and make sure she didn't go too low.

    She probably will enjoy having a snack since she has been deprived of those a little lately.
     
  9. Kaileen

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    The school's been called: James is headed up there with various amounts of snackage. He'll test her BG and call me when he gets it.
     
  10. wilf

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    It's not a dire emergency since her BG was on the high side, and it will take a little while for the extra insulin to whittle the BG down and deal with the carbs from lunch. But she should get a snack.

    And hey, let's look at the bright side.. :) You've just done your first "overbolus" (giving more insulin than needed to cover a meal, to bring down BG faster and allow for a post-meal snack).

    *****

    Anyhow, for a 26 g meal she needed 3.25 units at the 8:1 carb ratio. So in essence she's gotten a 4.75 unit correction, which at our Correction Factor of 30 means she's coming down about 145 units - from 215 to 70.

    My sense is that a snack of 20-25 grams should do it. 1.5 to 2 hours after the meal is plenty of time.
     
  11. GaPeach

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    OK - 26/4 = 6.50 + the 2 for correction = 8.5 which you rounded down to 8.

    Should have been - 26/8 = 3.25 + 2 correction = 5.25

    8.5 - 5.25 = 3.25 too much. Give her 26 more carbs to match the 1:8 ratio.
     
  12. GaPeach

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    Since James is on the way and nothing drastic will happen in the immediate timeframe, stop and breathe.:)

    Although none of us wants to deal with a severe low, it is nice to see that her overall TDD continues to go down and those numbers are staying out of the always high range.

    You are doing a fantastic job. Have you gotten the new endo appointment yet?

    That new endo is going to either "love" the CWD gang for helping you out, or wonder about your taking advice from total "strangers".:eek:

    If you ever join the "I gave Novalog instead of Levemir" club - you'll have a head's up on "feeding the insulin" boo-boo.:eek:
     
  13. Kaileen

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    Wel, that's a relief. She'll appreciate getting out of class to eat more food. :D

    True. But why did it have to be on a school day? She can't eat us out of house and home with abandon now! ;)

    He took just the right thing, then. She currently has 149 BG. She also has PE at 12:55. So, James gave her an extra snack. We told her to check BG before and after, and eat if she feels shaky. So she's covered. :)
     
  14. Kaileen

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    Not yet on the new endo appointment: but our pediatrician is working on it as hard as we are! And he can feel however he wants to. When it comes to everyone here: we're all in the same boat. You guys have a lot more experience than I do in this (and apparently, more than my old endo as well!) so I trust you. And I'm neurotic about the NovoLog for Levemir club: especially since we give the two close together in the mornings. But the rest of the day we use a whole different NovoLog pen, and it's stored separately from the other two, so we're cool.
     
  15. wilf

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    Phew, all's well that ends well. Lesson learned though. We'll make sure "homework" is assigned correctly and done correctly before applying new ratios/factors. :rolleyes:

    DD loves the days when I make a mistake and she gets an unplanned snack (esp. if she gets pulled out of class) - I'm sure your daughter is no different ;)

    The 149 BG a couple of hours after lunch shows the power of overbolusing (which is a lesson I'd been saving for a bit further on).. See how it not only covered the carbs from the meal but also corrected her back to range so quickly? :) But we won't try any more of that until her TDD has stabilized, ok?! :D

    *****

    By the way, it's great that she feels her lows at such a high BG level. Gives you a factor of safety in dealing with them.

    *****

    Ok, now get back to work. My goof has probably totally disrupted your and James' afternoon - again, my apologies.
     
    Last edited: Sep 26, 2008
  16. zoesmama

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    Yep, all's well that ends well. Glad to see that the crisis was averted. :) Oh, and now I know where the 14 came from when Elissa did the calculations..... and had I gone back and read that post and the few before it I would have figured it out. :rolleyes:

    See, we're all learning here. This is kinda like deja vu for me.... and I'm just so glad that things are going well for you. Elissa, Wilf, and Scott were instrumental in my DD's Levemir split and progress since. It's so cool to see the pattern repeating! :D
     
  17. JamesofClinton

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    I know Kai's already responded, but...

    She is good about feeling them, but she's early. Most times when she feels shaky she's in the 60-80 range. Every once in awhile she won't notice until the 50's. We've only had one scare at 34, thankfully.

    I feel like I'm back in fourth grade again. Eek! :)
     
  18. wilf

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    It's GREAT that she feels her lows early. You want to make sure she retains that ability, by always measuring if she feels low (helps her to refine her ability to sense lows) and by responding promptly. A little bit of praise doesn't hurt either.

    We had a family friend with Type 1 who couldn't feel her lows at all, and that is a truly scary situation to be in.

    Fortunately DD is great at feeling them as well. It means we can get by with less BG readings and it makes our unusual insulin regimen workable.
     
  19. Kaileen

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    You're silly. :) As much as I love my job (and I do!), my family is #1. Thankfully, I have a job that encourages that. And we only live less than a mile from the school, so it was no problem for either of us. I thought I was going crazy: I searched the board for the carb ratio. I was sure you'd given it, and I was insane for not finding it. At least I know I'm not THAT crazy. ;)
     
    Last edited: Sep 26, 2008
  20. wilf

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    Well, NOW you've got the 500 Rule for the carb ratio - as well as a first hurried application.. :eek:

    My guess is insulin needs will keep coming down some more, so you'll get a chance to use it soon enough.. :)
     

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