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Ugh - Highs!

Discussion in 'Parents of Children with Type 1' started by RobinKop, Jul 31, 2006.

  1. RobinKop

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    Mostly venting - but wondering if anyone has any words of wisdom?

    My 4-year old, Kim, was diagnosed just over 3 months ago. So far she has been honeymooning and we have been fairly successful in "controlling" her blood sugars. We have some highs and some lows everyweek but we could mostly keep her in the 100-200 range.

    For the last month her readings have been climbing and we have been doing more and more "corrections". Not sure if it is the hot weather or the end of the honeymoon.

    Pre-school just called and she is currently at 461! :eek: Eek! Hubby is on his way over there to do another correction and check for keytones. (She did not have any this morning.)

    The endos have been great and have been giving us ideas of adjustments to make and I have anther call into them right now.

    I'm just wondering if any one has any words of experience with dealing with the hot weather and or the end of the honeymoon?

    Thanks all!
     
  2. allisa

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    It is such a GUESSING game all the time as to what is making numbers fluctuate.....

    But...wanted to mention that I notice my sons numbers going in the opposite direction with warm weather....he tends to run lower than usual because of all the extra outdoor activity.

    My non-medical guess would be the end of the honeymoon.....that's when Ty's numbers started creeping up and we had to stick to a tighter mealtime schedule to keep him in the best control.

    Another thought is wether or not the insulin is properly refrigerated...there is anohter thread started right now about this VERY thing....check it out !!

    I remember the "end of the honeymoon" being very nerve wracking for me because his insilun amount nearly doubled & it was VERY scary for me to make that jump:eek:

    But, again....that is why the mealtime schedule had to get very regimented as well...had to "feed the insulin" as they say.

    Continue to keep in close contact with your endo....that is what they are there for.....I can recall feeling badly "calling all the time"....but once the honeymoon is over and insilin ratios aren't changing as much,,,,,you'll find that you rarely need to call.

    Good Luck !!
     
  3. kittycatgirl

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    Hello Robin,
    My daughter was diagnosed in January so we are only a few months further into this then you. My daughter is just finishing up her honeymoon. There were two weeks of bs's that were all over the map..... Very hard to control. Now we are just adding more and more insulin every week.

    If you are pretty sure that her food intake was normal and her insulin is still good then she is probably beginning to enter the end of the honeymoon. One good thing about it is that it is easier to predict what her bs will do when her body isn't producing spurts of insulin.

    I sometimes feel like I am bothering the endo team but I am learning this is what they want us to do....

    Good luck......Note- What insulin is she on? I recommend Lantus!!!!!!
     
  4. isaiah268m

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    The hot weather raises our daughter's....and then once she cools off she bottoms out. Scary and not fun.
     
  5. RobinKop

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    Thanks all...

    I do think Kim is actually slightly less active right now - due to all the hot weather. We air condition a lot and she really dosn't like to be outside when it gets this hot so we do tend to stay in more. I really do think this is part of her highs.

    We do keep her insulin on the kitchen counter to keep it at room temperature to make the injections a little more comfortable. She is on NPH and Regular and I was told that these two insulins were a little more tolerant of temperature than others. Our house is very air conditioned I'm pretty sure it never get's warmer than 72 in there. (We're pretty whimpy about the heat - good thing we live in Wisconsin, huh?) That being said - we did notice the highs started about a month ago with a new bottle of N. We were wondering if it would be possible for a bottle to be "bad" right out of the gate? We normally try to use the bottle for 6 weeks or until we notice it is less effective. Maybe this month well just go ahead and change at 4 weeks and see if this new bottle is better. (We do keep new bottles we are not using in the refrigerator.)

    I have been considering Lantus, but I really don't want to add more shots or have to run over to daycare to give a lunch time shot - but if that is what is needed I guess we'll do what we need to to keep her healthy. I read on a different post about someone with a little one doing a bed time Lantus for the background insulin and then doing an AM Reg and NPH to cover breakfast & lunch and then a dinner Reg to cover diner and bedtime snack. I'm thinking that migh help us ease some of the NPH irregularity too if we were not using as much NPH and covering her more with the Lantus. Has anyone else tried a regiment like that? Do you think that might work? I'm going to ask my endo about that if she ever calls me back today! (She is not normally this slow at returning calls - she must be really busy. If I don't here anything by the time I leave work I'll have someone paged.)

    I am somewhat worried about making an adjustments right now and then having her "bottom out" like isaiah268m said. A few weeks ago when we had a hot spell her numbers went up but then came down a bit as the temp came down.

    I just hate the unpredictability of it all!
     
  6. mischloss

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    Hi Robin,

    I just posted this morning regarding unusual high numbers for my son for the past 4 or 5 days. He was diagnosed last Sept. so I am pretty sure honeymoon is pretty much over for us. :eek:

    I suspected the insulin going bad. We use the Humalog pens...comes 5 to a pack. I refrigerate all but the one I break open to use. We keep it in the fridge at all times, except when we are going out to eat. I then pack it into the "Lantus" carrying case (came with the Lantus, soft-sided small zippered 'wallet') with extra alcahol pads and pen needle tips, and place it into a lunch bag (soft sided again) with a bunch of those re-freezable ice "igloo" shapes and boxes. Keeps it pretty cool at all times. But a coupe of times this past week, the boys (darling hubby and son) were out by themselves and could have placed it next to them in direct sun, so it could have warmed up too much even with the ice packs. Don't know for sure. But last night at 2:30am I ran downstairs and correct with a new insulin pen (2 units, his BG at the time was 394!) and it went down to a nice 106 by 7am.

    So I would try to use a new vial or pen and see if this matters.
     
  7. EmmasMom

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    Oh Robin! It's all so frustrating isn't it!!
    It's probably a variety of factors but may just be a result of less insulin production.
    I have found that when Emma is hot her BG is almost always high. She also spikes dramatically with any kind of stress, so pre-school could cause this w/o any other factors. I see it happen in Emma every time I take her to the gym nursery. We leave the house and she's 160, then 5 minute after arriving she's 300. I am stunned at how much stress affects her numbers, and it doesn't have to mean she's upset, she may just be excited.
    I really hope you get it figure out quickly! I know all of those extra shots aren't fun for any of you :(
     
  8. EmmasMom

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    I just read your next post...
    I say try a new vial of NPH and/or R! We got a few bad vials several months ago, so now if we have unexplained highs for more than a couple of days I always try a new vial of insulin. You just never know what the insulin has been through before you get it!
    What else! :D
     
  9. hold48398

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    Arrgg, so frustrating!! Some good suggestions were already made, also keep in mind that a growth spurt may change her numbers temporarily: Mia had several days of high numbers last month, and we found out in today's appointment that she grew 2 inches and put on 4 pounds since our last visit!! We had adjusted to the highs only to have to reduce everything again after a few days....It is so hard to figure out what's causing what....also agree with the hot weather...since we are in Florida and it is hot pretty much all year long, we definitely have to make sure to keep the insulin stored in a cool place, and when I take the vial with me, I always include a small icepack wrapped in a paper towel with the vial of Insulin.

    Good luck!!
     
  10. RobinKop

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    Thanks again everyone - I'm always so amazed by all the wonderful information you all have! I love this forum! It makes me wonder what people with D did before the internet! ;)

    I have noticed changes with Kim's reading due to all sorts of emotions (excitement, happy, scared) and we have had a lot of birthday parties and picnics in the past 3 weeks. Lots of active playdates. But normally those bring her low - not high. It's been really wierd.

    I don't think it's just the stress of going to daycare - she has really gone to daycare every day since she was 13 months old so this is just a normal day. Well... I suppose she could be experiencing more stess this summer because she is one of only 2 girls in her class this summer. All the other girls in their age group went home for the summer so Kim is "hanging" with the boys all summer. I suppose that could be stressful. ;)

    Fortunately today is the day we get to pick up new insulin - so we can crack into the new bottles today. Has anyone ever brought a bottle back if they suspected it wasn't working? Does Wallgreens accept returns like that? Our insurance only covers 1 bottle a month and we have not had enough time to build up a back up supply yet - I'm not sure how we would handle that...

    Highs due to a growth spurt are interesting to me, Kim is certainly growing. She has put on at least a lb in the past 3 weeks and both Grandma's commented that she looked bigger to them this weekend. And they both live right here in town so they see her on a regular basis. So they noticed that she is growing. I should check her height tonight.

    Cloths are a little snug - but I was just blaming the dryer. I'm trying to hold of on buying new cloths until the fall! :p
     
  11. Carrie

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    Hi, Robin!

    We have an almost 4-year old daughter that was diagnosed three days before your daughter, Kim! BG numbers can be so frustrating! I hate the over 200's! I always think that I'm doing something wrong, but I'm trying to get away from that type of thinking. There are so many things that can affect the BG. Especially when they are so little. Even food can affect them. We've also noticed that pizza and Twizzlers licorice have shot her through the roof! We've noticed with the heat her numbers being higher. With younger children, it is quite the guessing game. At our last (required) diabetes class last week, the nurse said that you are checking and charting to basically watch for trends. That really does make a lot of sense. I'm trying to approach diabetes with the attitude of don't panic--fix it! :D I guess until they get on the pump, monitoring BG numbers will just be an annoying pain in the butt! And even then, I'm sure there will be some snags!

    Do you have any plans for going on the pump any time soon? I'm so dragging my feet on that one.:(

    Carrie
     
  12. RobinKop

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    I'm doing all sorts of resarch on the pumps and I'm very interested because it really does seem like the right thing to do.

    But, I would really like Kim to be part of the decision. I want her to understand and be at peace with it instead of just doing it to her. We grab every learning moment we can with all this D stuff - but I can tell she really dosn't get it.

    For now the 2 shots a day are working for us & I'd even be okay with adding a bedtime shot. But if things go really haywire and we're not able to get control of it - we'd probably start pursuing Lantus or a pump a bit sooner. Daycare has been great with everything so I'm pretty sure they would support us with whatever direction we go...

    We're actually part of a JDRF Family Support group and there is a little girl in the group that is 5 years old that Kim just adores. This other little girl has begun to express interest in getting a pump so I hope if she gets one - maybe Kim will want one too.

    We are still so new to all of this and Kim is so little. She is very smart and I'm sure on some levels get understands. But it is just so hard.
     
  13. allisa

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    I would ask your endo about leaving the insulin out on the counter....does it ever get refrigerated ? I remember my endo or nurse telling me that NOT refrigerating cuts down on its shelf like.....if you expect to get 30 days from a bottle and DON'T refrigerate you may only get 2-3 weeks out of it.

    And growth spurts do bring on the high numbers....I hear the teen years are VERY rocky with hormones all over the place !!


    Allisa
     
  14. RobinKop

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    I'll ask about keeping them in the fridge but with N & Reg I don't think that is our issue. We're hot weather whimps so our house it pretty cool.

    I have read that temp is an issue with Lantus.

    If something did happen to this vial of NPH - I think it happend before we even got it. It did come out of the fridge in it's little cool wrap from the pharmacy when we first picked it up & we did transfer it home in our cooler. But like EmmasMom' s said, I have no idea what it went through before it even got to the pharmacy! :p

    It sat in our fridge before we opened it up and started using it - and BS numbers went up with that very first dose. So I'm really leaning toward a combo of a bad bottle of N, less activity while we hang out in the air con, a growth spurt, and general hot weather highs!;)

    Boy I can find all sorts of things to blame this on can't I ? - I'm sure it has nothing to do with me?! ;)
     
  15. jeep_bluetj

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    I'll agree it sounds like end of honeymoon. And that's a tough time. You just need to keep on top of it and watch the BG more carefully and adjust dosages more often. (or bad insulin, I'd put it in the fridge or switch to pens if your insurance covers them).

    Since you've mentioned lantus and pumps:
    Switching from reg/NPH to basal/bolus using lantus was the best thing we ever did for my son. We did it pretty much end of honeymoon too, and in retrospect I would have wanted to switch earlier if I knew then what I know now.

    We now pump, but the real benifits of pumping for us was to reduce injection sites, have less daily injections (6 wasn't unusual), and be able to dose in smaller than one unit increments. We feel like we've got better control with a pump, but not a huge amount better. When bolusing with a pen, we'd tend to ignore a 7 carb snack (not worth another injection). With a pump, you can bolus a half unit anytime, which helps out snacking and corrections alot. We've seen unexplained highs that we'd never see with lantus though - bad sites, bad insertions of sets, etc.

    I've heard of using NPH to just cover lunchtime bolus, but I'd worry about daytime lows, and postprandial highs for lunch if it's not very low-carb. We had good luck with our school giving the bolus for lunch (humalog) so we never went the NPH route.
     
  16. hold48398

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    Yes, I have. We had 2 bad vials of Lantus on different occasions (there were bits floating around in them after a week's use!!). In both instances I brought them back to my pharmacy (Publix) and they replaced them without hesitation. They even called the manufacturer and placed a complaint on my behalf. Also beware that it's not only how the insulin is kept at the pharmacy but also how it is DELIVERED TO the pharmacy which makes a huge difference!! If the delivery driver is not diligent about keeping the insulin in a cool environment, it might get spoiled prior to even arriving!!!
     
  17. mischloss

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    :( Never brought it back. Oh well. But I think I might just wait a couple of weeks to re-order the pens. I still have a whole box of 5 in the fridge. It is the summer months and I am thinking anything they are delivering on trucks right now might just be subject to suspicion because of the heat wave here. If I order in let's say September, it might survive longer making the trip to the pharmacy.

    Good points all. Glad I check into this forum often!

    You are a bunch of "with it" Moms and Dads!!!:cwds:
     
  18. georgia

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    geez, we were told to leave ours at room temp. Atleast the bottle in use, the extras stay in the fridge. we were told to discard left over after a month though, doing that for the first time tonight. I'll have to check with our endos, i remember them saying it ould hurt if cold while injecting.

    Also, our prescription is for 2 bottles of humalog a month, so I always have extra, (i forget the poster about one bottle a month), maybe your doctor could redo you prescription, ours have been very helpful about changing ours to meet our needs.

    You all are great.
     
  19. EmmasMom

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    We have always left our insulin at room temp, (humalog and novalog). We use it for about 28 days and never have a problem with it going bad.
    We always seem to have a vial of insulin waiting for us at the pharmacy??? I guess the Rx refills automatically, so I usually have an extra in the fridge if I need it.
     

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