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number help/possible babysitter advice

Discussion in 'Parents of Children with Type 1' started by HanksMom, Feb 11, 2011.

  1. HanksMom

    HanksMom Approved members

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    Hi - accidentally posted first in off-topic...belongs here...

    Hoping you can shed some light on a perplexing situation. Hank's numbers have been pretty decent up until the last few days, and now they've gotten all wonky. In talking with the CDE, she thinks he is getting 'extra food' either from his babysitter or a friend at the babysitter's. Would you agree, based on these numbers? If yes, how do we reinforce the importance of this without seeming punitife? If no, what other culprits could be at play? The only other thing the CDE really suggested was a possibility of a growth spurt coming on, thus the high numbers in the middle of the night.

    His regimen is 2.5 units of Lantus in the a.m., Novolog at meals: 1:30 for breakfast, 0.5:40 for lunch, and 1:45 for dinner. Typical snacks are 15 grams, unless high.

    Open to any and all suggestions!

    2/7
    Breakfast - 143, 1 unit
    AM snack - 371 (no carbs given)
    Lunch - 151, 0.5 units
    PM snack - 89
    Dinner - 300, 1.5 units
    Bedtime snack - 249
    11:45p - 405, 0.5 unit correction
    2:30a - 361

    2/8
    Breakfast - 98, 1 unit
    AM Snack - 236
    Lunch - 324
    PM snack - 182
    Dinner - 500!!!! 2.5 units
    Bedtime snack - 187
    1a - 295
    4a - 142, 2 oz juice given (he drops like a rock early morning)

    2/9
    Breakfast - 163, 1 unit
    AM snack - 266
    Lunch - 351, 1.5 units
    PM snack - 71
    Dinner - 155, 1 unit
    Bedtime snack - 177
    11:45p - 405
    1a - 339 (no correction, believed to be coming down)

    2/10
    Breakfast - 288, 1.5 units
    AM snack - 164
    Lunch 166, 0.5 units
    PM snack - 403 (no carbs given)
    Dinner - 216, 1.5 units
    Bedtime snack - 144
    12a - 373
    3a - 300
     
  2. quiltinmom

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    It might help to know how many carbs he has for some of the meals so I would know when corrections were given....but one pattern I saw is that he was high for AM snack...which I would think to increase insulin at breakfast. Another thing I was wondering about is if it's normal to have such a huge difference in I:C ratios for each meal. I don't know much about that, but it seems like lunch is tiny comparatively. YDMV!!!

    I have another theory. If I start correcting every other meal, that might mean to increase basal. This is what I'm thinking: hypothetical scenario: Breakfast--high/correction given. Lunch--normal. AFter school snack--high/correction given. Dinner--normal. The corrections are covering up the lack of basal needed, but it only lasts 4 hours or so. So, every other meal high=more basal needed. Of course, high wake up numbers (if no night time corrections were given) also indicates increase in basal needs.

    Good luck figuring this one out!

    Have a frank talk with the people who care for him. They can't be expected to always understand when a free snack can be given, when it can't, unless you teach them (and it's a lot to learn!).
     
  3. HanksMom

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    Thanks! Breakfast is usually 30 grams, Lunch around 40 grams, and Dinner around 40 grams.
     
  4. Alex's Dad

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    Hi, my daughter was dxd almost the same age as Hank is right now, but she was always in the 15g snacks and 30g meals, isn't 40g too much for his age? I really don't know just asking because my daughter is 2.5 now and we are still feeding her 15gto 17g snacks and 28g to 30g meals.
     
  5. HanksMom

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    Hank is hungry ALL the time...

    40 grams for us quickly adds up at lunch and dinner - 1/2 of a peanut butter and jelly sandwich and a banana. 1 cup of pasta with marinara sauce, veggies, and some applesauce.

    I do notice though that he seems to eat quite a bit in comparison to other toddler girls we know? FWIW, I don't think he stands still for 2 minutes while he is awake during the day, so I'm thinking he is burning through it.
     
  6. BKKT10

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    My daughter is going to be 3 in June and she can easily eat 40 carbs at any meal, with a 15 carb snack in between. It seems like she is hungry all the time too, we often joke that she has a hollow leg. So I do not think that 40 carbs is unusual or too much for this age- they are growing kids. I can only imagine how many carbs a non-diabetic this age eats, between drinking juice and eating any snacks they want!
     
  7. quiltinmom

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    I have all boys, so I know what you mean! I've never been told that he should be having X number of carbs. I feed him and he eats. I do my best to feed them healthy foods. Sometimes he eats 120 carbs at a meal, other times it's only 30. That's the way we roll. You can't compare it to girls. :) They eat and eat and eat...and eat! I hardly ever hear the words "I'm full."

    I'm not in a place where I can sit and do the math on your numbers. I asked my endo about increasing lantus, and he said that it should be about the same as fast acting, on average. :confused::confused::confused: That method hasn't worked well for me. If I find I'm giving more than 2 or 3 corrections in a day, I suspect it's time to increase lantus. He doesn't have as many snacks as Hank, which helps me figure it out. If he consistently goes high after novolog is out of his system, that usually means he needs more basal. He said to increase by no more than 10% at a time, but in your case, that would come out to such a tiny amount that you couldn't measure it. I'd only go 1/4 or 1/2 unit up at a time.

    It might help you find some answers if you give him only carb free snacks for a few days. It's hard to know what's going on if snack and meal insulin doses are overlapping.

    Good luck! Hope this helps!
     
  8. HanksMom

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    Don't know if this is what you meant or not, but his snacks are uncovered by insulin.
     
  9. PatriciaMidwest

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    It's hard to say. He could just be needing more insulin, maybe his honeymoon is ending. He could be in a growth spurt due to the late night numbers being high, but you are also giving an uncovered bedtime snack. If it were me I would talk to the doc about covering snacks with insulin first and then go from there.
     
  10. Cookie's mom

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    Ok, bear with me for a moment. My 2 year old was diagnosed a year ago. Your numbers are really familiar to me, because I've been there not long ago. The system we have, everyone hates it, because we don't use Lantus anymore, but NPH, which can be very tricky and irregular. By looking at your numbers I can tell you that's too many carbs. I used to think that 1/2 cup of pasta and apple sauce was 25 grams. I was wrong!!! 1/2 cup of pasta, with cheese, not even marinara sauce, was around 23 grams and 1/2 cup apple sauce (no sugar added) is 11 grams. My dinner was 1:25-30 so you can imagine. A whole banana is a big deal, and in the afternoons it becomes lethal! None told me this, I learned the hard way. Because the main problem is their age. Mine is a difficult eater, she is very hard to introduce to new things, so I had to manage with what she liked. At some point I blamed my babysitter, but she was following my orders to the core. So either you need more insulin, or less carbs, that's the bottom line. It gets better, I know it does. This is a sample of a regular day a year later.

    7:30 am BG 136 / 4.5 NPH + 1 Humalog / 12 grms carbs
    10:00 am (we don't check at this time anymore) 12 grms carbs
    12:00 pm BG 102 /no humalog unless over 200 / 30 grms carbs
    3:00 pm BG 199 / no humalog unless over 200 (here she was close, so instead of 15 grams and the insulin, we gave her 7 grams and no insulin)
    6:00 pm BG 221 / 1 Humalog / 30 grams of carbs
    9:00 pm BG 136 / 1 NPH / 12 grams carbs
    12:00 am BG 196 (when we used Lantus, we used to need more than 250 to make it to next morning without giving her a snack overnight, now it just works fine with the NPH... It beats me!)
    3:00 am BG 148
    8:00 am BG 120

    This is a pretty decent day for us. But sometimes it goes crazy every where, between the growth spurts and what ever excitement or stress comes. I'm not trying to tell you the Lantus or plan you are using is no better, but if you want a humble opinion here, "less carbs, wouldn't hurt to try". Unless you have a good eater in your hands and then theres the insulin increase. ;)
     
  11. hawkeyegirl

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    Well, I suspect that part of the problem is the uncovered snacks. Your son is small enough that each carb he eats probably raises his BG 10-12 points. So an uncovered 15 carb snack could raise him 150-180 points. Many kids can have uncovered snacks early on, and some people mess with ratios and basal to accommodate uncovered snacks, but we reached a point pretty quickly where all carbs had to be covered with insulin unless we were treating a low.
     
  12. HanksMom

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    I was wondering this myself...but I'm not sure how to cover a snack with insulin when there's less than a 3 hour gap before and after the next meal.

    Also, as an update, he was with a close friend today, whom I implicitly trust when she told me there was no extra food (the babysitter is out of town), and his day was beautiful, until dinnertime when he was 445. We're going to try 3 units of Lantus tomorrow and see what happens.

    I feel like his basal needs are very different in the day and at night, and that the best likely way to improve this is with a pump.
     
  13. hawkeyegirl

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    Well, you would just dose for the carbs eaten, and not correct any high BG at that point. It's okay to dose for more carbs within the 3 hour window, but not okay to correct before that point. (That's an oversimplification, as you can do partial corrections before the DIA is up, but you get my drift.)

    It would not be unusual for his basal needs to vary fairly drastically throughout the day. A pump is very helpful in that instance. :eek:
     
  14. bgallini

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    I suspect it is the uncovered snacks too. You can definitely give insulin to cover carbs whenever he eats them....whether its 2 hrs apart or 15 min apart. I also wonder why you let someone take care of him that you do not trust. Diabetes or not, I'd want to trust the person who takes care of my child for 8-12 hrs a day!
     
  15. HanksMom

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    I don't mean to give the impression we don't trust her. We adore her, and our son adores her, but she is still very much in the learning process (as we are too), and she is still learning some of the nuances that come secondhand to us. She very much wants to be a part of his care, is eager to learn, and is receptive to anything we tell her. We think of her as a surrogate grandma. I don't so much think she is intentionally sneaking him food, but that one of his buddies (there are two other toddlers also), might be slipping him some goldfish or an animal cracker here or there in the spirit of sharing...
     
  16. Nancy in VA

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    A goldfish or an animal cracker here or there isn't going to cause these numbers.

    If you are on Lantus, you should have an I:C ratio for each meal. You would just start by using those for the snacks inbetween - for AM snack, I'd use the lunch ratio and for afternoon snack, I'd probably use the dinner (although maybe the lunch one too).

    He definitely needs insulin for his snacks. Most kids on Lantus can't get away with those kinds of snacks without a strong honeymoon. My Endo told us that you don't see 400s with a honeymooning child - you see low 200s. So I don't think he's honeymooning, if he was before, so you are probably going to have to cover every carb he eats that isn't treating a low
     
  17. Becky Stevens mom

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    Hi Kim, I agree with the pp's that Hank probably needs a little insulin for snacks now. It may be the best way to accomplish this is by using diluted insulin. If you find that he only needs say 1/4 unit to cover the food and 1/2 unit is too much then thats where diluted insulin can help with a toddler. Also, you mentioned how he is hungry all the time. That to me sounds like major growth spurt. Has he been gaining weight recently? More then usual? Steven has gained 2 LBS over the last 3 months which is alot for him and his insulin needs have risen right along with the weight gain.
     
  18. HanksMom

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    Thanks for all of the thoughtful advice. We did change his Lantus to 3 units, and that seems to be helping, and we've changed snacks from 15 grams 'no matter what' to a range of 0-15 based on his blood sugar/activity level/timing between meals. I don't know that we can eliminate uncovered snacks altogether yet because he is like a little bundle of energy, and I can just picture him going low all of the time...but it might just be my comfort level that needs to change.

    The best news though, is that we held off on a bedtime snack last night, and put him to bed in the low 200's. He slowly dropped from 8pm until 3am (LOTS of nighttime checks), and around 3am was 104, and we gave 2 oz of apple juice, and his breakfast number at 6:15 was 164. Beautiful! And, he slept so much better than when he is high, and a dry diaper, no less! :D
     
  19. wilf

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    That's a pretty major drop over night. Lantus just went up, eh? I don't think it was the Lantus, and unless you want to plan for such drops every night I'd go back to the 2.5 units.

    No, the problem here is not the babysitter or the Lantus - it's the uncovered snacks. I'd have two snack plans if you want to give them uncovered - snacks with carbs for days when he's on the low side or getting lots of exercise, and free snacks on days when he's just sitting or on the high side.

    Good luck with your little guy. :)
     

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