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What BG's go with an A1C of 5.3%

Discussion in 'Parents of Children with Type 1' started by Darryl, Sep 3, 2010.

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  1. Darryl

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    She does play sports, but nothing too intense and only during the school year. Nothing this summer to speak of that would have affected the plots I posted.

    She has never been on a restricted carb diet. She eats whatever she wants to. We've eliminated certain foods from the house such as soda, glucose based candy, and we avoid hamburgers because the fat and/or protein content makes her BG hard to manage afterwards. She's never been interested in those kinds of food anyway.

    She's not the type to pig out on food even if give the opportunity. Sometimes if we're out to eat she may end up having a meal totaling 120 carbs or more. We just watch the CGM more often after such a meal to be sure it was bolused for correctly.

    If there is one thing she's had to adapt to, it's breakfast. Anything over 40 carbs will cause a big spike. So she eats breakfasts in the 30-40 carb range usually, with things like eggs or yogurt or milkshakes that are low in glycemic index, but once lunch comes she can eat whatever she wants to.
     
  2. wilf

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    Privacy, schmivacy..

    If we can't speak honestly from our own experiences, and back up what we're saying with real numbers and real events from real people in our lives then we might as well pack up and go home.
     
  3. Darryl

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    It ranges from 1:8 in the morning to 1:12 at night. So 1 carb is always .05 or greater. Just to clarify, she doesn't often say "I'm hungry enough to eat a whole carb" and then plan a 1 carb small snack and bolus for it. Most of the time if she eats 1 carb it's because her CGM beeped at 79, and is stable there. Any time she really eats, it would be a lot more than 1 carb.
     
  4. Darryl

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    And I'm not sure why CGM plots are so private when we all discuss many other aspects of our kids' D management, symptoms, challenges and successes, secondary medical conditions etc. The CGM plots seem to me to be the least revealing personal information of any of these things.
     
  5. swellman

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    Are you saying 1 carb will get her from 70 towards 100? What, other than a quarter of a glucose tablet is 1 carb? I'm just curious.
     
  6. Darryl

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    No - If her CGM alerts 79 and the line is stable, 1 carb will get her back up around 8-10 points, back to around 90. If it was 79 dropping slowly she might have 2 or 3 carbs. If dropping quickly she might have 5 to 10 carbs and decrease her basal. There's no formula, she just glances at the graph and makes up her mind.

    ETA - I say 79 becuase her low alert is at 80, so she makes decisions starting at 79.
     
  7. Darryl

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    Say, Swellman, perhaps you missed Leah's video tutorial last year explaining this better than I ever could....:cwds:
    http://s354.photobucket.com/albums/r439/musictraining/?action=view&current=MVI_0290.flv

    In addition to the 1 carb options she shows in her video, she also carries around Gluco-bits which are 1 carb (http://www.diabetesmine.com/2009/06/glucose-bits-are-here.html)
    We buy them at Target.
     
  8. swellman

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    I was only asking because I was trying to get an idea of the "carb/BG" ratio ... I'm not sure if that's an established ratio or not but I think it's one that needs to be nailed down as does the others.

    It would be interesting to see if age/weight had an effect on this ratio.

    I've seen some 1:10 ratios before but mostly it's way less ... but I can attribute that to a falling BG in the first place - meaning too much IOB.

    The way I see this entire "system" is that it's manageable, at least arithmetically, and this is being tested and observed with the testing of the artificial pancreas. The algorithm doesn't even need to know what carbs are being administered and physical activity is being handled well.

    Also, it has been shown that, with tighter control, insulin needs are drastically reduced. I can't speculate as to why this might be but it could be because the algorithm isn't treating the lows with carbs and, subsequently, insulin to cover them - I guess I just speculated.

    Anywhoo ... it seems to make sense that if you make small adjustments one might avoid the drastic ups and downs however my biggest problem is thinking 1 to 1.5 hours out.

    Sure I can see giving carbs to adjust but, in terms of temp basal, it seems we need to think 1-2 hours out. In fact, it seems that we need to think, at the very least, 30 .. maybe 45 minutes out to 2 hours out. In other words ... what I do right now, with insulin, won't have an effect for, at least 30 minutes and perhaps as long as 2, 3 or maybe 4 hours.
     
  9. swellman

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  10. Mimi

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    Finally, something I can chime in on!! ;)

    We have the Gluco-bits and I love them and find them so useful. They are very handy at dinner time as we're preparing food, if Amanda tests and is borderline low, she can take one or two until the food is ready.

    The other time we use them is after a high bg, Amanda will feel the drop and think she is low when what she is really feeling is the drop. Taking one Gluco-bit will help calm her about going low while having little effect on her bg.

    We don't have them in Canada yet, so I beg anyone I know when they are going to the US to get them to stop at Target and pick up some for us. :p
     
  11. sarahspins

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    You know, I strongly believe this is a YMMV thing.. prior to wearing a CGM, I had no idea how often I went low (shortly after meals) without knowing it.. because I wasn't normally testing 20-30 minutes after eating. Well, turns out I do go low, becuase the insulin peaks before my food really has a chance to hit (sometimes before I'm even done eating). I had no clue. I don't suffer from gastroparesis. When I switched to Apidra last year, it got much worse, because the insulin was faster. So far it hasn't been an issue since I've been using regular - I'm back to pre-bolusing a good amount before meals, and I will sometimes use a shot of rapid before certain foods I know will be "trouble".

    Anyways, back to the point I wanted to make - I've never had symptomatic lows.. you can call my hypounaware if you'd like to, but I really can't tell I am low until I am <40, though usually closer to 30, and I never have. Lows in the 50's, or 60's? Nope, can't feel a thing.. I've surprised myself more times than I can count with those.. and prior to wearing a CGM, it was always shock to test and see one (even now, a random low is still surprising, but I can almost always catch them before I am <50 - and OFTEN before the CGM picks up the drop).

    That said, I have caught MANY rebound highs wearing my CGM... I can probably go through and pull some up if you'd like to see. Perhaps they don't occur for Leah, but that absolutely does NOT mean that they can't or don't occur for other people. I've personally had a nasty hypo in the middle of the night, treated it with 24g of carbs (6 glucose tabs), which "should" raise me from 30 to about 110 (and yes, I have been as low as 34 and did NOT respond to the dex alarms right away - if I am sleeping on it, I can neither feel ir or hear it), and woken up (4 hours later) well over 300, and I struggle to bring those #'s down for the rest of the day. You tell me how 24g of carbs can do that, and I'll tell you that I don't believe in rebound highs.

    I honestly think that what is more likely for Leah, is that she's never been low enough to *trigger* a rebound high. I'm not sure exactly where that threshold is for me, but I suspect it's somewhere in the low 50's... but sometimes I have lows that low that don't trigger one. I think part of the rebound may have to do with duration.. rebounds for me hit about 60-90 minutes after I have treated a low. I would presume that a threshold, if it exists, is slightly different for everyone. I know for certain though, that I can be 50 and have my Dexcom still reading as high as the 80's or even 90's because it can't catch that drop fast enough.. so those lows can and do still happen. It's an imperfect technology, and while I do feel as if I use it to the best of it's ability, for me, and my diabetes, it still leaves a lot to be desired.
     
  12. Ali

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    I am not a kid or Leah or Darryl, but I will contribute what i can to this discussion as an adult fully in charge of my self. One carb for me raises me 5 to 7 points. You can eat one skittle or just eat 1/2 a glucose tab (2 carbs) this is what I do. For calcs I used to think 1 carb raised me five points, after being on the CGMS I think 7 to 10 points. When I adjust with insulin I do not think about specifics nor with food corrections but I think with in 20 point ranges. So if the CGM shows a 90 I figure I may be a 80 or a 100 and eat to bring me to a 80 to 100. So if no downward trend I do nothing. If a downward trend I eat according to IOB on top of the downward trend, if going up the same, IOB, food eaten recently. I actually do not correct when i am between 80 and 100. I only treat when about 30 (higher) points out of my range when no food or no IOB around or when I hit 80 and going lower. But with the new MM Revel pump they give you a heads up on how fast your BG is changing and you can really make advance changes to drops in BG with food. So arrows going down at 100 I will treat. Arrows going up at 130 i will start watching. Frankly I do find insulin adjustments only good for me in terms of two to three hours out. So if I make corrections with boluses and see no change in the CGMS data after 60 minutes then I will put in place a temp basal increase for 3 hours.(If I am sure of food and food bolus rates earlier) or if I have eaten a bunch and am dropping then I will decrease my basal. It is not that I expect a quick turn around from the basals but I hope to get ahead of the issue with a basal change which I can stop or adjust after 2 hours if needed. If I keep needing food then a lower temp basal needs to be in play. With the GM I always assume I am lower rather than higher and correct based on this thought. I too have days where I am eating, eating and eating to keep from going low (under 70 all day) and days where I am adding insulin, insulin and insulin to keep just under 200. This has been true for all my life on all different insulin regimes. The CGMS and faster insulins just allow me to react quicker and more accurately. Up until 35 years ago all I could do was to eat all day long or wait 12 hour till the next shot to get a grip on highs after not eating all day.:cwds: Ali
     
  13. Ali

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    I posted earlier and it sounds like I do stuff alot. I do not. I wait to hear alarms, I look down when I think there may be a problem, i.e after a party, a wild guess after eating out, unusual exercise. Other wise I actually pay no attention to my CGMS. My purpose in using pumps and new insulins and the CGMS is to reduce the time I spend working on my T1. So less time spent on dealing with lows, less time eating snacks for lows, less time waiting to eat cause of highs, less time poking myself to check on highs and lows. I can glance down at my CGMS, for me maybe once an hour see what is happening, decide if I should check the CGMS or my BG sooner before another hour or take action and then move on. This night I have not looked at my device in over three hours, no alarms and I feel okay so no checking. I go all night without waking up to do BG checks. If my CGMS shows a low I do not care if I am really 110 and not a 70 at two in the morning, I ust want to not be a forty. So if it shows 80 I eat a bit of candy and do not care if I am ending up at 95 or 115 after eating the candy just so I am not at 60 or lower. :DAli
     
  14. sooz

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    In all due respect, I am totally sorry that this has been your experience. For me, language is so powerful, I just want discuss the possibility that is it not the low that may cause the brain damage, but the seizure? I realize that you would say "but the low caused the seizure," but not every cwd has seizures from lows. It still bothers me to read that lows cause brain damage when my understanding of what people are saying here now is that SEIZURES cause brain damage. Is that nit picking or fuzzy thinking or me being confused again?? I am never nonchanlant about lows, never. I respect your journey and your horrifying experiences and am grateful to you for sharing them. Of course it is your right to feel however you feel, and understandable. I hope that my question is not out of line.
     
  15. wilf

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    That's interesting. For DD, 1 carb will bring her up around 4-5 points if she's on the low side but stable.
     
  16. Lee

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    Actually - it IS the low that causes damage - not the seizure. The reason that the lows cause the damage is becuase the body is going without enough glucose to support itself. Just like oxygen, glucose is vitally important to our brain, organs, and muscles. SO it is the lack of glucose that triggers a stroke, or impairment, or nerve damage - NOT the seizure.

    One of my daughter's severe low blood sugars - she didn't have a seizure. She had a prolonged overnight low. Based on what her rebound blood sugar was, and her lack of body soreness, her endo figures her bs sat around the high 50's or low 60's for a few hours. However, she still had the same physical symptoms - soreness in her right arm, lack of control of her right side facial muscles, disorientation, calling water a book, me her teachers name, etc.

    Mama C's son has had many episodes of extended mild lows that trigger a similar response. One of his lows, which occurred in a pool, caused him so much damage -that and being underwater while it happened - required surgery and weeks of hospitalization.

    The only point I am trying to make is that lows can be and are, at times, physically dangerous. We had no issues until our 3rd year. And then our entire world changed. Just becuase one or two studies say nothing bad happens, there are just as many studies that says it does. And there ARE children that die from low blood sugar. Dramatic of me, I know - but it is true. Some kids are just lucky enough to have CGMS which provide a measure of security.
     
  17. wilf

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    With all respect for your endo, on this point I disagree with him or her. It appears that there were no BG measurements from this low, so your endo is speculating that it was an extended period of 50s and 60s that caused the symptoms. Based on the severity of symptoms you are reporting, I would speculate that this was an extended low in the 30s or 40s..

    I think I understand the point you are trying to make overall though, which is that lows should be avoided.
     
  18. Lee

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    But we cannot avoid all lows. My point is more that lows should be treated with caution, not played with and seen as harmless.
     
  19. Lee

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    With all due respect - you were not there, you do not know my child, and you can only speculate on this. I trust her endo a heck of alot more then I trust you - a man who has never met my child or been involved in her health care.

    I have seen her have severe hypos (going on the above definition) when I cannot get her up from a 60...we have all had those nights where we treat and treat and treat and the BS barely moves for a couple of hours. She DOES have a strong physical response to extended semi-low bs's. And there are some other long term members here whose children have the same response to semi-lows. Just becuase your child doesn't respond this way does not make it scientific fact that it can't happen.
     
  20. momtojess

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    and with all due respect, what makes you more qualified to better specualte than the kids own dr who has all the information? and why does it really matter, the point being extended lows are bad, not all an be avoided.

    Thanks for your arrogant speculation.
     
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