- advertisement -

puberty has struck - I need a hand and a shoulder

Discussion in 'Introductions' started by bbirdnuts@aol.com, Nov 21, 2009.

  1. Amy C.

    Amy C. Approved members

    Joined:
    Oct 22, 2005
    Messages:
    5,560
    I couldn't tell this from your previous postings: have you been taught how to measure the food and count carbohydrates?

    Concerning night time testing: My son is measured every night. He doesn't wake up. Even when I test him in the morning, he doesn't wake up.
    I would tell her you will be doing this before she sleeps and just test quickly. You need some sort of idea what is happening at night.

    What range do you want you daughter to be in? I consider a low to be below 60 -- otherwise I don't treat. Some endos have different theories. My son gives himself insulin for any reading over 120 (unless he has sufficient insulin on board to cover the reading).

    You are correct in that you should be learning how to change the insulin doses. You have it correct that if she goes low, she needs less insulin. I think it unsual that the meal insulin would kick in and cause a low an hour after eating. However, if this is your daughter's pattern, the food digestion isn't matching the insulin action. Try giving it to her later to see if this helps.

    It was a year before we made too many decisions on our own. Now we never consult the endo for changes.

    My son eats what he wants for breakfast and lunch, but joins with the family for supper. He eats what he wants, but his father or I prepare it, so I guess it is a joint effort. Every carbohydrate is counted and insulin given for it.
     
  2. Becky Stevens mom

    Becky Stevens mom Approved members

    Joined:
    Oct 14, 2008
    Messages:
    8,719
    And a big (((hug))) back to you:) Steven is still on shots. That is his choice, we are very comfortable with that now. Do you use pens for either insulin? If you use pens make sure the needles are the mini ones they are short and tiny, 31 guage I believe. It took Steven awhile to let us use arms and thighs, he has never let us use stomach. For the most part we do not choose low fat foods except for his ice cream at night, that is 1/2 the fat of regular. We also have 1% milk and dont usually have many fatty foods for breakfast anymore. I think the endo should be trying to get you in to see the dietician ASAP. That would be a big help for you just starting out with insulin and your daughters new diet. Good luck! keep us posted please
     
  3. Lee

    Lee Approved members

    Joined:
    Oct 5, 2006
    Messages:
    9,633
    Good to know that you are in contact with your endo. However, if you do not have faith in your endo, it is time to switch! I honestly think it was time to switch at diagnosis when your endo didn't put your T1 child on insulin. Also, you should switch becuase your endo is obviously not up to date - blood ketone strips are a heck of alot more accurate - the urine strips fall behind by hours!!!! I would recommend looking for a new endo. And asking for training on carb counting again...

    With food, every kid is different. The most problematic foods are high in fat. Pizza, cheese, etc. can cause problems in kids. We are lucky and only experience fat spikes with one type of pizza.

    Some people will also subtract fiber from their carb counts, like subtract anything over 5 grams of dietary fiber from the carb count. But we don't, we just dose for all the carbs. It is really how you are trained.

    It is importnat to know how quickly things 'act' with the body. So, if I am giving my child candy (not chocolate), I will increase our prebolus time to try and get the insulin to peak at the same time as the quick foods.

    If I am giving my child something high in fat and lower on carbs, then when on MDI, I would dose after eating - once again - trying to time the insulin peak to the food peak.

    With things like pasta - high, quick acting carbs, I dose right before eating. If I prebolus that, she will go low in an hour, and hten spike at an hour and a half...

    For us, the perfect, and yes, non-nutritious, meal is the fluffer nutter. Peanut butter, marshmallow cream, and bread. Some people really have rotten luck with this; but us, we have a nice steady number all around - the quick acting of the marshmallow, the moderate of the bread, and the longer lasting protein and fat of the peanut butter - it is heaven on her blood sugar!
     
  4. MamaC

    MamaC Approved members

    Joined:
    Dec 9, 2006
    Messages:
    5,292
    I don't think the Levimir is causing the after dinner lows. The morning dose should be just about worn off and the evening dose should not be fully active. (I am not all that familiar with Levimir as we use Lantus.)

    It sounds like the Novolog is working faster than the food is digesting. Almost always, since my son is very sensitive to Novolog, he takes his meal and then takes his insulin. PLEASE NOTE: This is just what works for us. Many if not most take the insulin before the meal. We have come to our uncoventional regimen in full consult with the endo.
     
    Last edited: Nov 23, 2009
  5. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    Reading through this thread I find I'm really amazed that your daughter was dxd with Type 1 and an A1c of 6.3 30 months ago but through diet alone was able to lower her A1c. Can you elaborate on this diet? You call it, " extreme" and "radical" but I'm afraid I'm still quite curious. Was the whole family on this diet too? How did she cope with it?

    I also think that understanding her diet might help us think through how you might best transition her back into more 'normal" eating habits in ways that could help you avoid some of the post meal lows she's been experiencing.
     
  6. bbirdnuts@aol.com

    bbirdnuts@aol.com Approved members

    Joined:
    Oct 21, 2009
    Messages:
    361
    A hand and a shoulder

    Sarah, I hope you will respect my choice to not disclose the "diet". I cannot handle the thought that one may put their child on it as strictly as my daughter followed it. She had her own food and drink where ever she went (birthday parties, friends houses, vacations, holidays, etc). My daughter was determined to not have to take shots. She would not cheat even with one morsal. I begged her many times to go on insulin and eat what she wanted to. She firmly kept the position that she was eating everything she wanted and was happy. I continued to prepare her that when puberty hit she would have to go on insulin. The endro strongly warned of that 2 1/2 years ago. She could have remained on the diet and taken little insulin. To her there was no point -- it was all or nothing.

    Most people are probably thinking I am the adult and she is the child. This is true. Let me share a few more facts about my daughter. She may be 9 1/2 years old and in 5th grade, but she is extremely intellegent. The end of 4th grade she was given a Stanford Achievement Test and scored nothing below 10th grade level. Part of her scores came back on college level. Her brain is so far advanced yet her emotions (at times) can be that of a 10-12 year old.

    MamaC, Lantus is suppose to work for 24 hours and Levemir is suppose to work for 24 hours as well, but the endro says the Levemir is worn off in 23 hours. The dose of Levemir dose was split in half. Lets say, Carolina was getting 14 units every night at 8 pm. The endro had us to give 7 units at 8 pm and 7 units again at 8 am. The dietician said to us that long acting is like a constant dripping all day long and it slowly releases. She did also say that it does not peak and begins working in 1-2 hours. When does it work?

    Lee, The main endro is a few years from retirement. Within the past 6 weeks he hired a new endo from Joselin and we like her. There is not another ped endro within an hour. I believe we will have to continue to work with what we have here. The endro from Joselin is good. The office has two new dieticians that do not give much information. When Carolina was first diagnosed there was only one. When there was one dietician a few years ago, she was full of information and was very helpful with meal plans, food choices, and suggestions. However, I do not have or cannot find any paperwork from those visits. We were told to feed 60 grams of carbs per meal, 20-30 for bed time snack, and free foods anytime. What are some free foods besides sugar free jello and low fat string cheese?

    One dietican said to deduct carbs if the carbs are 5 or more. The doctor said to only deduct any carbs over 5, but not the 1st 5. Someone else told us not to deduct carbs. So who knows -- I guess consistence is the key there. I would believe that the carbs are still going to raise the blood sugar, but if there is a significant amount of fiber the reaction time may be slower. As I am thinking on this, would it make more sense not to deduct any carbs? Any more thoughts on carb/fiber?

    What do you mean by "increase prebolus time"? Does that mean you give the short acting earlier before the meal or wait until into the meal? My daughters blood sugars are going way too high the 1st hour after eating. I do not know how to correct this.

    Becky, we are using the pens with the mini needles. We have met with a dietician 3 times since they put Carolina on insulin. The 2 dieticians are nice, but evasive. I want to pull info out of them on a string and it won't come out.
     
  7. StillMamamia

    StillMamamia Approved members

    Joined:
    Nov 21, 2007
    Messages:
    13,195
    I understand if you don't want to mention which diet this was.
    I will, nonetheless, ask my question.
    Was the diet a radical Paleo diet?
    You can PM me with a simple yes or no?
     
  8. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    Rest assured, I was not seeking to emulate your daughter's diet. I was simply looking to understand your situation. What you choose to share here is entirely up to you.
     
  9. Nancy in VA

    Nancy in VA Approved members

    Joined:
    Jul 16, 2007
    Messages:
    7,308
    Most people that do Levemir do a split dose - I've never heard it referred to as a 24-hour insulin, like Lantus.

    I would say that your nighttime dose of Levemir needs to be increased. A good way to know is to check her BG 3-4 hours after her last fast-acting dose, and then a few times overnight. If she changes more than 40 points up or down, the Levemir dose isn't right. I would say you need 2-3 good nights to check this to make sure, as activity, high fat food, and other things can affect a single night's reading.

    Once you know your Levemir day and night doses are right, its easier to check the meal doses - but pretty certain that if you are low 1 hour after a meal, then your ratio is too strong.
     
  10. frizzyrazzy

    frizzyrazzy Approved members

    Joined:
    Dec 23, 2006
    Messages:
    14,141
    Just a quick question - has your daughter been diagnosed as a type 1 or type 2?
     
  11. MamaC

    MamaC Approved members

    Joined:
    Dec 9, 2006
    Messages:
    5,292
    Yes, I know that Lantus is supposed to work for 24 hours, and I understand its "sustained release" action. Our problem was that a full dose worked too hard and we had to split the dose. We split it 50/50 until it became apparent that he needs more basal overnight and less in the morning.
     
  12. Lee

    Lee Approved members

    Joined:
    Oct 5, 2006
    Messages:
    9,633
    I drive 1 1/2 hours to the endo and there are many that drive 3...

    Here is the prebolus chart that we follow, although I do vary it depending on what my child is eating:
    View attachment 2051
     
  13. bbirdnuts@aol.com

    bbirdnuts@aol.com Approved members

    Joined:
    Oct 21, 2009
    Messages:
    361
    A hand and a shoulder

    Nancy, I do not understand how Levemir works over time. Not a clue. Is release of Levemir insulin completely steady, does it start working 1-2 hours after injection, How long does it last.

    Amy, last night blood sugar check went well. Carolina stayed asleep. Two hours after Novolog her blood sugar is usually and was in normal range and then blood sugar begins to rise. Therefore, Levemir must need to be raised. If Levemir is raised will the normal blood sugar two hours after a meal go lower?

    A question of yours I forgot to answer earlier about measuring and carb counting. We were told by the dietician to read the labels and count all carbs. We do count carbs and measure food servings. I am wondering if weighing food would be beneficial. Our endro gave us a normal blood sugar range of 70-120.

    Sarah, please understand anyone can read what I write concerning diet.

    Frizzyrazzy, My daughter was diagnosed with type 1 in April 2007. Started insulin Oct. 2009.

    Lee, thank you so much for the chart. I think I understand that you prebolus depending on blood sugar to allow the food and the insulin to meet at the same time or to curve together. Is that correct?

    Mama C, it seems as though Carolina's numbers are the highest in the morning. Guess that is a Levemir change. After dinner lows have not happened again.

    Nancy, I will begin tonight checking 2 hours after Novolog and check 2 hours later. Does that sound good?
     
    Last edited: Nov 24, 2009
  14. Nancy in VA

    Nancy in VA Approved members

    Joined:
    Jul 16, 2007
    Messages:
    7,308
    I'm not exactly sure when Levemir starts working and then peaks - we were on Lantus before we pumped. But, most that do Levemir do two injections, which would lead me to believe that it is only an 18-20 hour insulin.

    The key with Lantus or Levemir is to keep them flat in the absence of any food. That is imperfect at best, however, because most people have different basal needs at different times of day, so as long as you stay flat for good portions of the day, you can know your Levemir dose is ok - overnight is the best time to check because its the longest time without food. Late afternoon before dinner is also a good time as long as you don't have an afternoon snack.

    The Levemir dose "shouldn't" affect the Novolog unless your ratios were built wrong to compensate for the Levemir being off. Once you know the Levemir is right, then you can go meal to meal to determine the right I:C. 2 hours is the best / first place to check after a meal because that's when Novolog is at its peak. Most target to be under 200 at the 2 hour mark, but that also varies because it works longer in some than others. At the beginning, you'll also want to check the 3 and 4 hour readings to get an idea of how long the Novolog works. If the 3 hour check and 4 hour check are basically the same, you know that Novolog works completely in about 3 hours for you. If your 4 hour is still lower, then you know that Novolog has more like a 4 hour window for you. Then, you'll know when to check to see your I:C. You would hope to be under 200 at the 2 hour mark and in your target range at 3-4 hours.

    I hope that helps - this is a lot to absorb at once.
     
  15. bbirdnuts@aol.com

    bbirdnuts@aol.com Approved members

    Joined:
    Oct 21, 2009
    Messages:
    361
    A hand and a shoulder

    Nancy, A big thank you!!! I understand. This morning was a food choice change. Carolina has been consistant with her breakfast meal and today she wanted to change cereal for grits. At one hour after she was 333 at two hour after she was 257. Grits must have been a bad choice for her. Fasting was 231. Most of her fastings are over 200.
    She must not be getting enough Levemir.
     
  16. Becky Stevens mom

    Becky Stevens mom Approved members

    Joined:
    Oct 14, 2008
    Messages:
    8,719
    Im thinking that grits may be high on the glycemic index. Ive started to pay more attention to the glycemic value of foods recently and it helps me to know how far in advance I should prebolus Steven for different types of food. I bought a really good book about that a couple years ago called the :New glucose revolution pocket guide to diabetes" "Manage type 1 and type 2 diabetes using the glycemic index" This book was written by Jennie Brand-Miller, PhD, Johanna Burani, M.S, RD, CDE and Kaye Foster-Powell, M.Nutr.&Diet
     
  17. danismom79

    danismom79 Approved members

    Joined:
    Apr 21, 2008
    Messages:
    5,300
    Considering how high she started out, the grits are probably fine. When they wake up high, there is some insulin resistance. Her 2-hour number was very close to where she started, so it wasn't bad. Do you give corrections for high blood sugars?

    At night, I would check 3-4 hours after her last dose of Novolog, as well as at 2 hours. If she's in range at 2 hours, it's quite possible that she's going lower over the next couple of hours, since Novolog tends to last 3-4 hours. Before raising the Levemir, I would rule out nighttime lows that could be causing her body to kind of rescue itself and send her high.

    The Levemir does kick in after about 1-2 hours. Novolog peaks around 2 hours. So be very careful of overlapping them when you adjust. Raising the Levemir may cause you to have to decrease the Novolog.
     
  18. bbirdnuts@aol.com

    bbirdnuts@aol.com Approved members

    Joined:
    Oct 21, 2009
    Messages:
    361
    A hand and a shoulder

    Becky, thank you I will try to find the book. If something is high on the glycemic index, do you prebolus based on the index of such food and blood sugar? Grits is made from corn so it is probably high on the glycemic index. Now, Carolina's 3 hour post breakfast blood sugar is 177.

    danismom, I understand what you mean about starting out high and returning back close to the same at 2 hours. We do not give corrections for high blood sugar. We do the correction at a meal. Any suggestions?

    Caroilna's blood sugar has been checked some during the night. For a while we did a 3am every other day and she was always high. When she had 2 lows after dinner I began checking her two hours after the Novolog and bed time snack. The lowest was 94. That night I checked the next two hours and each time she was rising. I will start doing a 2, 3, and 4 hour check in the night.

    You are giving me alot to think about on the Levemir. She gets her Levemir and Novolog within 5-10 mins of each other in the morning and her evening Levemir about 2 hours after dinner. We are trying to do 8am and 8 pm. Overlapping is a big consideration, wow.
     
    Last edited: Nov 24, 2009
  19. danismom79

    danismom79 Approved members

    Joined:
    Apr 21, 2008
    Messages:
    5,300
    If you gave a correction with breakfast this morning, it worked out really well!

    In the evening, the Levemir will be picking up while the Novolog will be wearing off. We would see a pre-dawn rise during growth spurts. You could increase the Levemir, but make sure you check to see what the Novolog is doing.
     
  20. MamaC

    MamaC Approved members

    Joined:
    Dec 9, 2006
    Messages:
    5,292
    I am concerned that you cannot rely on your medical team for answers to your many questions. While the help here comes from experienced parents of chidren with diabetes, it must be remembered that each individual has his or her own unique experience regarding insulin regimens.

    I urge you to seek help from medical professionals in addition to, and in consideration with, the anecdotal advice that you are receiving here. You are on new ground, and your medical team should be providing more guidance, IMO.
     

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