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Should I be doing blood sugar corrections?

Discussion in 'Parents of Children with Type 1' started by Adinsmom, Oct 17, 2006.

  1. Adinsmom

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    I am not sure how to phrase this thread so please bear with me. ;)

    When Adin was first diagnosed I think I had the mind set of putting out fires. I have been reading Sweet Kids and it mentions some things that I am comfortable trying. Like the formula for correcting for a high. The endo clinic is very conservative and has never mentioned correcting a high. They tell us to call if we have any questions then they can be completely vague on occasion. *Disclaimer* we just had our 2nd endo appointment and I get very cynical about the doctor then 2 weeks later I think the man is brillant.

    Ok, here comes my dilemna. Hubby is Mr Logical (an endearing quality in a crisis and irritating when I am trying to get him to see things). He looks at what is happening at the moment and doesnt want me to veer off the plan (the sliding scale). The clinic has never mentioned correcting on our own so don't play doctor type of thinking. I am not trying to be renegade mom, I just want to be more proactive.

    When Adin's number is low, if I follow the sliding scale he gets no insulin. So he doesnt have any insulin to cover the food he just ate. No insulin=sky high. I know that is making us have to correct later. It has been coming up at bedtime where the doctor would like me to give a freebie snack with no/low carbs for bg's above 150but follow the sliding scale therefore creating correcting the high from the dinner. Which in return causes Adin to feel the blood sugar lowering and making him irritable. Dh saw this last night and started to see some light. Even thinking forward to wondering if Adin would go low in the middle of the night from no snack but Novolog and Lantus being injected. This scenario is happening more frequently. Why?

    I will call and discuss this with the team before I do anything I am just trying to wrap my brain around it.
     
  2. pookas

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    Do you use carb ratios for Novalog at meal times? Our plan is if Hunter is below 70, have him eat then subtract .5 u. from insulin to be given. If he's over 70, he just eats and we cover the meal as usual w/ our carb ratio. If he's high at a meal, he eats, then we cover the carbs w/ the ratio and then we add whatever amount of insulin to correct the high according to our sliding scale. They need the insulin. If Hunter is low at a mealtime, I immediately get him 1 c of milk or 4 oz juice depending on how low, to get his BS on the way back up, then he starts to eat. This is OUR plan and everyone is different. So, ask your endo. about this. I don't see why he's letting him get high just so you could correct him at bedtime. If low at a mealtime, you should have a plan in place for how to dose the insulin.
     
  3. Ben'sMommy

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    Your team should definitely have set out a regime by now whereby you can treat highs and lows witout consulting them each time.

    They should be handing the control over to you by now.
    You know what's best for Adin. If you're noticing a negative pattern caused by your endos current regime then you should challenge him and request that it be modified.

    It seems very counter-productive for your endo to allow him to go high and then be corrected instead of trying to prevent it. I know that Adin is tiny and the doc would rather him high than low but it sounds like you have a better grasp of what would work than the endo does! :)

    You are right to be a bit concerned and I think a phone call to your team is the right thing to do. :cwds:
     
  4. kittycatgirl

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    I hope this helps

    Hello Shelly,
    I find that Lantus will bring my daughters BS down 50 points overnight without any adjustments to food. So when she is below 120 we give her a little snack (8-10grams) before bed. (Below 80 she gets 15-20)

    Our endo introduced correcting BS on the same day she started on Lantus. Only exception to the rule is you can't correct within 3 hours of her last meal correction. Insulin and food take about 2-3 hours to even out. When she was 1st diagnosed she was on NPH and they did not want us to correct a high because they needed to have a 3 day history before adjusting her NPH.

    Every childs ratios are different but this is what they told me. 12 grams=1 unit Humalog -1 unit of Humalog will bring down her BS 50 points. I only tell you that to get a rough idea how it effects their numbers. You have to follow the plan of the endo. I tend to fall into the trap of thinking I have a handle on it then they come up with something I never thought of. Okay so I am not a doctor. :) I hope that helps.
    Diane
     
  5. Adinsmom

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    They like us to give the insulin first according to bg numbers. He eats after I give insulin. I am supposed to cover his insulin with carbs but the ratios are off since he spikes later. Maybe I am not covering insulin with carbs what is covering the carbs? :confused: I feel like I am guessing in the dark lately. Is there a way to show me how much carbs will raise his bg? I see some posts where x amount of carbs raises "little ones" bg x amount. I am doing trial and error and feel like Adin is an experiment.

    If I am thinking correctly (which I confess sometimes I don't) The lantus and NPH are supposed to be his background insulin covering for highs and lows. Then the slidiing scale should cover carbs right? So theoretically the sliding scale and carbs are off. I am so confused? :confused:
     
  6. Ben'sMommy

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    Shelley, we administer insulin after food.

    Although it is preferred to give insulin first (to give it a chance to work) this is not always the best option when you're dealing with a baby/toddler.

    We started off with insulin before food. Alot of the time we would then have to force feed him if he got fussy. Mostly this was still no use as he would just spit it out. So, he was having lots of lows and we were devastated at having to force him to eat.

    Very quickly we decided that we would administer insulin after food. We still do and we find it a much easier, safer and less stressful option.

    Just thought I'd tell you. :)
     
  7. twicker1

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    I have to agree that with a child so young I would not give insulin before dinner. Brandon was 4-1/2 at diagnosis, and we still give his shot AFTER he eats. It makes a huge difference. There are times when I think he will eat 30 grams, and he ends up eating about 10. We are on a ratio of 1:25 and a correction of 1:200, but ONLY do a correction based on his pre-meal BG. We tend to see really high numbers up to 2 hours after his meals, but then he starts dropping. Today, he ate lunch at 10:30 (38g), got 1.5u Novolog at 11, was 308 at 12:45, and by 3:00 he was 144.

    With a little one like you have, if you seem to think your child is REALLY sensitive to fast acting insulin then I would be a little cautious doing any corrections. I am not familiar with the sliding scale so I'm not sure if it is just like doing ratios. If Brandon is low before dinner, we correct for low and just give insulin to cover what he eats for dinner. BUT, if he is just a little low then we also don't treat with a full 15g, especially if we are about to eat. If he is high before dinner we calculate the correction dosage and then add that to the shot after dinner based on whatever he should get to cover what he ate.
     
  8. Ben'sMommy

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    Shelley,

    Has the doc told you what Adins Insulin Sensitivity Factor is???
     
  9. twicker1

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    So is he on Lantus, NPH, and Novolog? I have never understood why they would give all three. Or split the Lantus dose on young ones either. We were told that we would only need to split his dose if we ended up seeing that it didn't last the entire 24 hours. We give Lantus in the morning only since it does have a peak around 4-6 hours. If we start to see his morning numbers creeping up then we increase his Lantus by half a unit. So far we have been at 4 units in the morning for about 3 months.
     
  10. rickst29

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    I'll second Mrs. 'Twicker'

    The kinda short and weird activity pattern for NPH (kind big at 6 hours, really big at 8-9 hours, but suddenly out like a switch-off light just a few hours later) makes it really hard to understand what's going on when you've got other 'Basal" insulin aboard.

    I don't like NPH as basal, and certainly not in a weird combination with a much slower and more predictable basal. Unless this is a nighttime "trick" to handle "morning effect", it's kinda like an incomprehensible witches' brew.
     
  11. Adinsmom

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    Yes, he is on Novolog, NPH and Lantus. Which was working well until these lows at dinner started showing up. Here is our schedule:

    Morning:
    Usually between 7-7:30 We check bg and He gets a shot of Novolog on the sliding scale and set dose of NPH in the morning before breakfast. Eat breakfast.
    Snack between 9:30-10AM.
    Nap.

    Afternoon:
    Sometime around 11:30-12 Check bg-Give him lunch. Usually doesnt need Novolog cause NPH is covering.
    Snack, around 1:30 till 2 pm.
    Naps depending on need usually not.
    Dinnertime sometime around 5-5.30 pm Check bg-Give him Novolog. Eat dinner.
    Bedtime 8 pm Check Bg-carb snack below 150. Lantus and Novolog if over 300. In bed by 8:30.

    He is a very active 18 month old so there is lots of playtime and running around. I do random bg checks when I feel it is needed and do overnight bg checks when I think it is necessary.

    This was all working well. The schedule wasnt too confining and we actually liked the structure to his day. Now with these lows I am wondering what is covering the food he is eating becasue the meal plan is obviously thrown out the window. If I fed him according to plan he would be getting 60 g of carbs at mealtimes and 15-30 at snacktime. Which after diagnosis worked well but now is too much food. While the meal plan hasn't been updated the insulin has been cut back.

    I need to take a step away obviously. :eek: The clinic should get back to me in the morning and I will have a night to ponder this. The way I am explaining it, I am feeding the insulin but dosing because of blood glucoses. Which I guess in theory would work if the munchkin didn't eat. :(

    I get what your saying about feeding him then giving insulin but the clinic dissapproves of this. Which with the way they have it set up I dont have a food ratio so I couldnt without causing major harm.

    The Clinic seems very old school but I am not going to do anything without the doctors knowledge. I just wanted to reassure everyone I wasn't going renegade commando. ;)

    *Edited to add* Thanks for the support I do believe they should be handing some of the control over.
     
    Last edited: Oct 17, 2006
  12. pookas

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    Twicker, we started splitting Hunter's Lantus dose, well actually added Lantus at nighttime because he was spiking up between 2-3am to the 300's and his daytime numbers were great. It wasn't the bedtime snack because his numbers were great from 8pm til about 2am. Then spikes after insulin/food wore off. From the research our endo did, when they are such small amounts of Lantus, it could wear off after about 12-14 hours in some kids. It's a new treatment plan and I've read on here that Lantus company doesn't recommend to do it because they wanted to get it on the market quick and didn't do the studies on it. Our endo. has several little ones on this. It just works for some.
     
  13. twicker1

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    Yeah, that's what I heard about Lantus. They told us that we would only need to split the dose if we found that it wasn't working 24 hours anymore.
     

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