[sweetlife]

Little strange question may be but We are facing this situation,my daughter's BS remains v.high pre dinner around 300mg,she takes 20U Lantus and total 30U of Novarapid(total 4 shots regime),after meal her BS is near 120-140 range,only worring factor is her predinner BS,she used to take Lantus around 6:30 PM and now taking at 10PM but no visible difference.
What I want to ask is can one have any calculator to find exact or aprox. does for Basal Insulin ex.Lantus?

[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.

[sweetlife]

you may be right,she has afternoon school so before going to school she takes her first shot around 7:30 am and next at 11:30(4 hr gap),she returns home at 5:30-when I check her predinner at 8 to 8:30 pm it is most of time near 300mg.I repeat she takes novarapid and lantus.

[Scratch]

The only way to find the exact number is to do fasting tests where with no bolus insulin is active and there is no effect from eating. During a fasting test, ideally the blood sugar should remain nearly stable.

But I warn you about thinking that it is an exact number or a fixed number. Diabetics will see their basal insulin requirements have variations and changes over time, so fasting tests still need to be periodically done even after someone has successfully titrated the basal insulin for the first time.

There are calculators to make suggestions for starting doses. Their purpose is to provide a starting point which can then be refined with the procedures of basal testing. But they can only provide starting points because the calculation is generalized and doesn't calculate for individual variations caused by metabolic differences and individual levels of insulin resistance and how much native insulin production the diabetic has retained.

[xMenace]

She is exhibiting a very unusual pattern. Most profiles I see drop between lunch and dinner.

How old is she? Does she snack in the afternoon? Does she bolus for it?

One possibility is she's bottoming out regularly and getting a liver dump.

[nwmud]

how often is she testing?
I founf that because i suffer from DP I need a different kind of insulin for the night and one for the day and then yet another for meals. If she is spiking like that before diner, I would think her basal levels are off or she has been eating something that is not being accounted for. Like OJ will make you spike like that. see what she is consuming in the afternoon.another possibility would be to change her eating times. I have found my BS is best when i stay on a eating schedule earlier in the evening - I shoot for diner between 6-7. when i eat later my numbers are always harder to control.

just some food for thought.

[sweetlife]

xMenace I have given her dose in above post,she leaves for school at noon and takes light snacks at 3 pm(no insulin shot in this case to cover her snacks).

[xMenace]

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.

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.

There are techniques to match your humpy basals with Lantus, but it involves a lot of work.

[sweetlife]

Dear nwmud
Tomorrow I shall post her readings mostly.

[xMenace]

Originally Posted by sweetlife

xMenace I have given her dose in above post,she leaves for school at noon and takes light snacks at 3 pm(no insulin shot in this case to cover her snacks).

That's very likely the problem, especially if they are carbs.

I'd have no issue with upping her dose to cover them. Insulin doesn't act nearly fast enough to send her low by snack time, but if you do, then you need assurances she will eat her snacks.

[sweetlife]

This her mom can reply I think,we are 100% veggie,what snack is good for her in afternoon?Sorry a dumbo query but your help will deffinately help her a lot.

That's very likely the problem, especially if they are carbs.

[nwmud]

if you are 100% veggie,
try a snack of low carb things. maybe a small salad. a serving of nuts is pretty low. I would avoid carrots. too may people think carrots are great but they are pretty high on the glycemic index and carry lots of sugar and carbs. All y favorite veggies are a bit too high for me. Corn, carrots and spuds. even the little green peas are packed with sugar. I was always brouight up to believe all those veggies were good for me. Now I try to eat low carb most of the time and have much better contol over my BS. good luck.

[oneluckyplay]

What's her BS at noon and when she gets home? Trying to narrow it down some. Just so you are aware veggies are carbs. Tasty ones but still carbs which require insulin. i would lean towards the afternoon snack as probaby the issue. If her BS is normal when she leaves at noon but high when she gets home then she is either going low and rebounding or it's her snack. i know carrots or broccoli would raise me up that high w/out insulin.
Maybe you could talk to the school so the school nurse could give her insulin at school for her snack.

[BlueSky]

Is she eating rice? Because it plays havoc with blood sugar levels. Try and avoid rice, at least until you have the insulin regimen sorted out. If you eat eggs, they are a good source of calories, very nutritious, and good for blood sugar. Nuts are good for snacks.

I agree that you need to ensure that all the carbs are being covered before changing the basal dosage (Lantus). Also remember that once blood glucose gets up to the 300's, we become more insulin resistant. The circulating insulin has a reduced effect. Large amounts of it are required to get such high blood glucose down again, and all the dosage calculations go out the window ... .

As far as dosage calculation guidelines go, they only really apply to insulin sensitive adults. All the hormonal activity in children changes things, and you just have to use a trial-and-error approach. It means that you need to ensure that all the carbs are being covered, youe have to do a lot of testing, and Lantus dosages are titrated to levels that give the best results.

[sweetlife]

No infect she hates rice.Few months back I brought eggs for family,no one even looked at it and finally they went into dust bin!
Yes noted about carrot,nuts etc,thx for all your valued inputs.Her BS is good after lunch and that we have checked in weekend problem is BS shoots up high befor dinner,may be snack should be a issue.Right now she has just woke up and in next 30 minutes I shall describe all these what you have advised and will do a MAJOR change in her snack.Will surely post results here.