[Gary_W]

A few things to consider here:

Lantus is supposed to keep you flat in the absence of bolus insulin or food. In a lot of people it manages this quite well, but as XMenace rightly says this is not the case for everyone as some people's basal just isn't that kind. If you do some fasting tests with her then you'll begin to understand where this goes. Having the basal (lantus) adjusted correctly gives you your best chance of the rest of the variables making sense.

Next point is insulin profile vs food absorbsion.

Novorapid typically peaks after 1.5 to 2 hours. In most people, it's pretty much gone by 5 hours. 90% will be gone by hour 4. But everyone differs!

Food. Rapid acting carbs such as white bread, potatoes, pasta, rice or most breakfast cereals will tend to absorb very quickly. The vast bulk of their carbs will be absorbed into the body within 1-2 hours. Again, everyone differs a little. Slower acting carbs may take longer. Add fats and proteins into the mix and your meal can take anywhere up to 12 hours to absorb if you get an extremely fatty mix. If you have a restaurant Indian meal over in the UK with meat curries, breads and rice then it's the gift that keeps on giving. Just when you think you've caught it all and your BG cannot rise again, up it goes once more. It really can be 12 hours before you've got everything!

Fats by themself won't raise her BG. Proteins will, but only to a tiny, tiny extent compared with carbs.

Next thing is timing. She is having a bolus for lunch at 11.30 / 12 noon? Then her next bolus is before dinner at 8.30. So you have 8-9 hours between bolus shots and, it seems, with no blood tests.

Ideally, test before the afternoon snack. She may still be high from lunch due to wrong carb counting, low GI food still absorbing, wrong ratio etc. Then she is putting in another snack with no insulin which adds insult to injury.

Also, do you blood test when she gets home at 5? You've got 3 hours before you have dinner where you can put right any high BG's before you sit down for your meal. Starting a meal with a high BG is a really bad idea. You are high, you go higher still. It upsets your whole cycle.

Lots of food for thought with this one. Let us all know how it goes.

Gary

[sweetlife]

Ok noted Gary,first I shall post here her tonight BD reading of BS,I agree on what you said and tomorrow when she comes back I shall check her BS and let you know,keeping my fingures crossed.

[sweetlife]

Next thing is timing. She is having a bolus for lunch at 11.30 / 12 noon? Then her next bolus is before dinner at 8.30. So you have 8-9 hours between bolus shots and, it seems, with no blood tests.

Yes that is the case here as her school timings are like that.

Ideally, test before the afternoon snack. She may still be high from lunch due to wrong carb counting, low GI food still absorbing, wrong ratio etc. Then she is putting in another snack with no insulin which adds insult to injury.

Now I have decided to check her BS before her afternoon snack,shall post it tomorrow here.

Also, do you blood test when she gets home at 5? You've got 3 hours before you have dinner where you can put right any high BG's before you sit down for your meal. Starting a meal with a high BG is a really bad idea. You are high, you go higher still. It upsets your whole cycle.

Will also check her BS today when she comes back home and let you all know.

[sweetlife]

By the way last night predinner was 320mg!We gave her very light snacks during her school.
Dose was 13U Before b.fast
Pre Lunch 12U
Lantus previous night was 16U.
And after seeing 320 reading she had 14U of N.Rapid.
It looks I have to start all over again,first I need to know below-
*How to calculate total carb intact for her?She takes pur veg.Indian food,I have found a link which tells me total calory for our food and I found that from that figure I can find how much carb she eats by multipling it with 0.6(Nutrition-Carbohydrates)

*I also want to know how much 1 unit of N.Rapid will bring her BS down.

I am really thankful to all members here who are putting their inputs for welfare of my child,praying for all of you indeed.

[sweetlife]

I have today calculated her total carb intake using online calculator for Indian food and it came around 220-230Grams,her height is 4feet and 10.5 inches(150 cms),age 11 and weight is 54 kgs.Now you are having some picture of her hence please advise further on this issue,thanks in advance.
one can see her dose in my above post.

[Lizzie G]

Originally Posted by hodgsonsurvivor

I don't think the Lantus is the issue. My doctor says that you can tell if you're using the correct dosage of Lantus by your Fasting results. You may want to see what's being eaten at lunch time or between lunch and dinner. Maybe the ratio of insulin and carbs isn't quite right.

This isnt necessarily true re the basal- its true if you go to bed with a good reading with no rapid insulin stilling being used, ie a stable 100 for example, and you wake up with a stable 100 (unless you have a strong DP like me which I cover with something else). however, if you go to bed high with no rapid acting still active and wake up at 100, it kind of suggests your basal is far too high and that if you went to bed with a normal number you have a high chance of waking up low in the night as the amount you are pulled down will be pretty much the same whether you start out at 150 or 100 (so if you go to bed with a 150 and wake up at 100 it follows that if you go to bed at 100 you wake up close to 50 maybe a little lower as you could be less insulin resistant at a lower BG) equally if you go to bed low and wake up at 100 you are probably not having enough lantus and if you had gone to bed 'normal' you would wake up high.

From what you have said it sounds like you need to work on establishing what the basal need (by fasting and daytime testing) is and then to work on carb counting to figure out the exact carb ratios required for what your daughter eats so that the insulin is injected as and when needed....i dont know how old she is or how it works at school but if she is having carby snacks in the afternoon she will need insulin to cover them and will end up high if she doesnt.

[ant hill]

Originally Posted by xMenace

That is not actually true for everyone. The big problem with Lantus (and Levemir) is it is a flat insulin. Many doctors and much literature will say that's what we need, but practice tells us that this is not the case. Nobody is perfectly flat and about 35% of us have wide swings in our daily basal needs. For us, pumping is the best way to get under control.

The only true flat Basel is pumping. The Lantus & Levemir is better than the Proaphane or NPH. For those who can afford it is to pump!!

[sweetlife]

Atlast I had some inputs finally,was thinking where all have gone!
By the way today she is having a holiday and I have decided to spend time for her,I shall post all her readings tonite for today.I wish to get some real help from all of you,few things I have figured out ex her carb ratio etc..all I shall post tonite.

[Gary_W]

Sweetlife - It is very hard to say 'take this much', so instead, a few random thoughts.

Do the basal testing ASAP. The overnight one is going to be difficult with your current routine, as you eat quite late at night (well, for my taste anyway!)

When you start a basal test, you really want no food or bolus insulin to still be active.

When I do an overnight basal test, I ensure my evening meal is about 5pm. I go to bed at midnight, and in that way I know that my midnight blood test is a good starting point for the basal rate test as all my bolus insulin and food is gone. In your case, eating at 8-9pm, she could still have food or bolus insulin working at 2am in the morning.

So to test the overnight basal, I test at midnight, 2.30am, 5am and 7am. What you are aiming for is for all the readings to be more or less the same. Hopefully, you'll be able to achieve this and can adjust the insulin accordingly.

You can also test the basal for other parts of the day, but this involves missing meals. Again, ensure that no active food or bolus insulin is around to foul up the results.

Next, food. Get into the habit of blood testing before every meal, then two hours after the meal and then again before bed. You are looking at 7 blood tests a day minimum. Set an alarm so you get the timing right.

Ideally, you want your blood glucose before a meal to be between 4.5 and 5.5. This is 80 - 100 in US figures. You want this figure back again 4 or 5 hours after eating any meal, and you want the 2 hour post prandial to be as low as possible WITHOUT GOING HYPO at hour 3, 4 or 5.

Are you actually carb counting, or is it the case that you are calorie counting and then doing some sort of calculation based on that? If so, that won't work. Go to the calorie king website, or buy a carb counting book. Get some electronic scales and weigh everything out. Until you get used to carb counting, perhaps make the diet a little more boring with foods that are easy to carb count; you can go back to normal once you are better at carb counting. Stews and curries are quite hard to carb count as when you weigh it out with its multiple ingrediants it's hard to say WHAT you've got on your plate. Bread and rice is not hard; you weigh it and it's more likely to obey the rules.

That will do for now... I'm sure others can contribute more to my rather random output this evening.

Gary

[sweetlife]

Tx Gary,
Problem is here in India we cook foods and do not buy ready packs in which carbs are mentioned in label,this is a problem for me to count carbs rt now-what we do is we use floar of wheat and prepare rotis which is also call chapati,calorieking site I am not sure wether they cover what we eat,will chk that site after posting this message.
Here is her readings for yday.
Yes Gary I use online counter to count her carb inputs and links I have given in my earlier post but repeating here again
first is a link to count calories
Diabetes India - Calorie Counter
then I go here and check how much carb inside the food she takes(after getting data fm the 1st link)
Nutrition-Carbohydrates

I just now checked calorieking site and found that a Roti being served in hotel has 89.1g carb,next what I did was I filled the calorie count shown in c.king site to the 2nd link above,result came was 92G carb so not much difference to be honest although we dont eat such roti in our home,ours are quite thinner and carb contains is 13-15g per roti.
now her readings for yday.

*Fasting was 213 at 8.25am she took 10u Novorapid
after 2 hrs her BS was 253,she perhaps ate 50g carbs(I am still learning this)
*Pre lunch was 194,she took 14u NR,BS after 1 hour was 254 and ppbs was 130 !total carb intake was 75-80g.
*her fasting was higher as I am still in a process to adjust her basal,it will take 4-5 days still for me to decide her exact basal need.
*I could not test her predinner and carbs in dinner last night as I had to go out for some very urgent work but I was told
it was around 280mg predinner and she took 14 units of NR last night before dinner.

My rough calculation say that her carb ratio is 6.5.
thats all for me friends,would love to have your inputs here.Gary you are right she perhaps needs to take her dinner early and this I shall discuss with my wife today and keep you updated regarding this.Thanks so much for caring us.

[Lizzie G]

Hi Sweetlife;

Gary's got great advice re the basal testing, so Id follow his instrucations and that should really help that side....on the carb counting side:

I know it can be a bit overwhelming particularly when you cook for yourself and dont use much prepackaged foods. I dont eat anything that comes out of a packet, obviously a lot healthier but ironically a lot easier to get it wrong.

I presume you have some household weighing scales or cup measures? If you cook with a lot of rice and lentils and other pulses its quite an idea to pre measure some of the quantities you use in a recipe work out the rough proportions and carb content of the average plate. Once you have your basal correct then you will be able to get a really good idea of the rough carb content the meals you eat and to bolus accordingly - if you build up your mental repertoire you will get to the point where you can look at a plate and without even necessarily thinking number of grams of carbs you kind of know instinctively what insulin you need. Obviously this is far easier for an adult managing their own diabetes but im sure you can do so much for your daughter (which by the way you already are its great you are here chatting and figuring out what to do as the doctors arent really good at the practicalities of living with diabetes!)

Anyhow i hope this is a little helpful. treat it like a scientific experiment in the order 'basal, bolus, lifestyle' and sort them out in turn and you will gradually understand how different things work and affect your daughter....and by the time you have that figured it will be time for her to learn for herself and you can take a back seat and breath a sigh of relief that you got through some difficult years!

[Gary_W]

Hello Sweetlife,

I've looked at the links you've listed and I'm sorry to tell you but this is not going to work in most cases. You cannot convert calories into carbs in a reliable fashion. The website is saying that 60% of the calories you eat should come from carbohydrates. Some here would argue that point anyway, but that's not up for discussion here. Just because the site says you should get 60% of your calories from carbs does NOT mean that all food has 60% carbohydrate. If you are using this to count carbs, I think we've just found your problem! Some examples for you.

1 Katori of Urad dahl from the site comes in at 104 calories. Your converter then turns this into 15.6g of carb. I think that this is about right; 15-20g of carbs per 100g of cooked dahl isn't far out from my own experience.

1 tablespoon of butter from the site comes in at 100 calories. If you put this into your converter, this also gets turned into 15g of carbs. I can assure you now that there are no carbs whatsoever in butter.

Same goes for dishes that are high in protein. Using this method is so hit and miss that you'll never get it right.

I admit that Calorie king is full of packet foods. I don't eat packet foods either and I do cook a lot of Indian food at home; I'm British, and Indian food is the most popular kind out here with many people!

It's a lot of work, but what you have to do is weigh out the ingredients you are using in a home-cooked dish and do the maths of the carbs in it. You can easily find out on-line and from various books the carb content of the individual ingredients. I'll give you an example.

I'm a bit low on lentils (dahl) at the moment; I have only Urid and small red lentils in the cupboard. Urid dahl have 43g of carbs per 100g of DRIED PRODUCT. The red lentils have 61g per 100g of DRIED PRODUCT.

An example for you. I'm going to cook a dahl dish with onions (10g of carbs per 100g of onions), garlic (33g per 100g of garlic) dahl (see above), ghee and spices

250g of onions
50g of garlic (I like garlic)
500g of urid dahl
3 tbs ghee
1 fresh green chillies
tsp turmeric (haldi)
1tsp black mustard seed
1/2 tsp asafoteda (hing)
Water
Fresh corriander (dhania (cillantro if in the USA))
Fresh Fenugreek leaf (methi leaf)

So the onions are 250g. That gives 25g carbs
The garlic gives 16.5g of carbs
The dahl gives 215g of carbs
The ghee is free of carbs
Spices DO have carbs, but they are fairly minimal. 1 tsp of turmeric has 1g of carbs. 1tsp of mustard seeds is also about 1g. In the great scheme of things you can mostly forget them, but be aware that they are not entirely free! Same goes for the dhania and methi; you'll get away with not counting them.

So for our whole dish, we have 258.5g of carbs. Let's call it 260g. Now you cook it, add water etc.

Then what you do is weigh the finished dish. Let us keep it simple and say it weighs 1000g (1Kg). What you can then say is that your dahl made your way has around 260g of carbs per 1kg. So if your daughter eats 100g, she is getting 26g of carbs.

I know it is a lot of effort, but you can apply this methodology to ANY of your recipes. You can see from the relative carb contents that weighing spices really isn't needed as it makes little difference. Weighing onions, lentils, wheat flour, vegetables, fruits etc is absolutely essential to get this right. Once you've got a recipe broken down into its carb content, to make it again you weigh the significant bits and do the ghee / spices to taste and you'll be fine.

A further thing to mention is that lentils are a low GI food. This means they take quite a while to be absorbed by the body. This is good in many respects, but coupled with a high amount of ghee, certain Indian foods take many hours to absorb in the body. If I eat a meal which included pakora, poppadum, paratha, a creamy dahl and some meat then it will take anywhere up to 12 hours to be gone! This gives my blood glucose real problems. Whilst I love Indian food, it is not the easiest kind to manage with type 1.

Good luck

Gary

[sweetlife]

Gary and Lizzie
Now I feel the power of unity and international brotherhood or motherhood or fatherhood (all are applicable here),I so much touched by your advises and feel that my daughter is getting more attentions not only from us(after she diagnosed t1)but from all those whom we don't know and never met in our life!I really pray for all of you and wish one day God will fulfill your dreams,there is nothing better than helping a needyone and thats you ALL are doing for us.
I hv noted all containts posted here,Gary you are right about those calculation for butter etc..that site gives wrong info-I agree with you.
Will post her tonite readings in late night,cheers friends.

[Gary_W]

Originally Posted by sweetlife

Gary and Lizzie
Now I feel the power of unity and international brotherhood or motherhood or fatherhood (all are applicable here),I so much touched by your advises and feel that my daughter is getting more attentions not only from us(after she diagnosed t1)but from all those whom we don't know and never met in our life!I really pray for all of you and wish one day God will fulfill your dreams,there is nothing better than helping a needyone and thats you ALL are doing for us.
I hv noted all containts posted here,Gary you are right about those calculation for butter etc..that site gives wrong info-I agree with you.
Will post her tonite readings in late night,cheers friends.

This site has helped me a great deal, and I owe my current good health to the advice of complete strangers. If those of us on here who have received help can pass that on then it keeps it going. We are all glad to help when we can.

Diabetes is hard enough for me and it is ME with the disease. I have two daughters who are free of it and I hope that continues. I feel for anyone who has to manage this in a child. You are right to seek out the education, as it is only by education and understanding that you will turn this disease from a major problem into a minor problem. There is no magic bullet with this thing, just understanding and applying the things you learn to YOUR lifestyle. It is a lot of work, but you have the will and I'm sure you'll be able to improve things

[ant hill]

Originally Posted by sweetlife

her height is 4feet and 10.5 inches(150 cms),age 11 and weight is 54 kgs.Now you are having some picture of her hence please advise further on this issue,thanks in advance.
one can see her dose in my above post.

Hello Sweetlife, I have found that 0.50U Per Kg is being said in this .PDF so 0.50U X 54Kg = 27U of lantus and split that over 12 hour intervals would be 13.5U.

Originally Posted by sweetlife

Lantus previous night was 16U.

MMMmmm..... Not far off to what your child should be I would think.
instructions for use: (Please refer to SmPC for full details) The insulin preparations to be
used and the insulin doses and timings must be determined individually and adjusted
to suit the patient’s diet, physical activity, life-style and blood glucose levels. Daily doses:
There are no fixed rules for insulin dosage. However, the average insulin requirement is
often 0.5 to 1.0 IU per kg body weight per day.