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BPorath908

Need some help and advice

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BPorath908

Hi All,

My name is Brandon.  My son was diagnosed in September of last year.  I was hoping to get some input from other parents out there.  My son is 5 and we just got him a Dexcom.  We never really saw the trends before but now we are realizing his numbers are all over the place.  His last A1C was 8.1.  We see his numbers drop overnight and he needs a snack and then they go up too high.  He also has high spikes after all meals and they take a long time to come down.  Any help or suggestions on what this could be would be greatly appreciated.  He was on Breakfast - 1 unit/18 carbs, 1 unit/20 carbs - lunch, Dinner - 1 Unit/20 carbs.  He's on Humolog and at night Levamir and he was on 3 units of that.  Any help or insight would be greatly appreciated.  

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JuliaDay2013

Welcome, Brandon! I'm sorry your son is having such highs. What is he eating (give us a day's worth, please). I'm sure some of the parents will be around sooner or later to help. I'm not on insulin, but I wish I COULD give you some suggestions.

 

Cathy

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BPorath908

Hi Julia.  Thanks for responding.  I appreciate it.  We have been getting better with his diet.  Trying to stick to about 40 carbs per meal.  For breakfast he had low carb toast with peanut butter and 1/2 a cup of milk.  For lunch he had a half a peanut butter and jelly we use low sugar grab jelly.  Pretzels, sunflower seeds, and his vitamins.  For dinner he had half a turkey sandwich, a gogurt (he normally hasn't been eating gogurts but we need to get rid of them we bought them before we started tightening up on his sugar).  An apple, veggie crackers, and a piece of low carb toast.  For dinner we actually treated a low and then just gave him dinner too.  He went low tonight so we gave him a kind bar.  He still didn't come up from the low so we gave him another snack 15 minutes later (as per Dr's orders when he is low).  That's a lot of info but any feedback would be appreciated.

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JuliaDay2013

I'm not sure how active this area is, so you might need to go to Chit-Chat or another high activity thread. I realize this needs quick help, so please find a thread with a higher volume.

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NoraWI

Too low carb is not recommended for young children. And a more "normal" diet does produce highs and, sometimes, rollercoasters in BGs. Since your boy is still relatively new with diabetes, I suggest you work more closely with your doctor or CDE (Certified Diabetes Educator) in adjusting his insulin doses. Don't hesitate to ask for a CDE because they are usually much more knowledgeable about diabetes management than your primary physician. Everything will work out soon for you and your boy. It is good that you are seeking information to educate yourself better. BTW, treating lows is much more effective and quick if you use Skittles. Each Skittle contains 1g of quick acting carbohydrate. That makes it much easier to figure out how much you are giving. The rule of thumb for adults is to take 15g of carbohydrate (would be 15 Skittles), then wait 15 minutes to test again and dose more carbohydrate if needed. For a child the amount of carbohydrate would be different because they are so much smaller than an adult.

 

Maybe if you posted in your Subject "Need help for T1 5-year-old," you would attract more attention to your post from parents.

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BPorath908

Thanks Julia and Nora.  I really appreciate the response.  You know it's funny we were actually looking at lowering his 15g snack for lows because of his age and size.  I thought 15 was too much but previously his Endo told us that was right but we saw too many spikes.  A great example is last night he was low so we gave him a half a kind bar, 15 minutes later he had barely moved up, then we gave him the other half of the kind bar, still nothing.  So we gave him a bag of pirates booty.  By then he finally started to go up but I believe that was from the kind bar to begin with.  Then within the next two hours he finally went up but he went up too high.  He went up to around 325 (due to the delay in getting his numbers up).  Then he slowly came down.  Much slower than previous nights because we worked with the Endo and lowered his Levamir by a unit.  I think we have his overnight figured but now it's figuring his meal times better.  I'm thinking for my son he needs around 5-6 carbs.  He's about 3'6 and weight around 43 pounds.  I think 5-6 skittles would work for him.  It seems like some of the things we are giving him are taking longer to get into his system.  The other night he had a low and it took him almost two hours for the two sugar tablets I gave him.     

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BPorath908

Hi.  It's nice to meet you!  Today's numbers have been better so I think we are getting there.  Thanks to everyone for the input.  If anyone else has anything else to offer I'd appreciate it. Thanks!

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NoraWI

You might google the effect of fat on carbohydrate absorption. That is the reason that bars of any kind (or cookies or cake) are not good for treating hypos. Besides the sugar in them, they contain other ingredients that include fat. Fat delays the absorption of sugar at a time when you want it to happen as soon as possible. You have a steep learning curve in managing your son's diabetes. It will take a bit of time but you will make it and he will be all the better for having a proactive father. Ask as many questions as occur to you. And keep reading and googling. Parents are the ones who spend time with their diabetic child and have intimate knowledge of his reactions to food and treatment. Your doctor is at arm's length and miles away. DM in both children and adults requires immediate actions and a nimble mind. And that you have.

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BPorath908

Thanks for the kind words Nora.  It's been a challenge but we are trying to understand his numbers better.  He was good for a while but the last few weeks have seen his numbers go up like we have never seen before.  Last night his numbers were very high overnight.  300-400 almost all night.  I'm not sure if his drop in levamir did it or his snack to get him to 120 before bed.  I was so optimisitic after the night before.  Oh well we will keep trying and see what we can do.  I'm calling the dr. tomorrow to go over numbers so hopefully they can help this time.  Thanks Everyone for the help I appreciate it!

 

Another question: Has anyone noticed different effects from different insulin?  We noticed some of the change to when we switched from Novolog to Humolog.  Thanks!

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JohnSchroeder

Brandon...wish I had noticed this thread a week ago.  You may not even be checking anymore.   Nora was right.. this particular section doesn't get much traffic.

 

Different insulins can have different effects in terms of the time it takes them to kick in and to peak.  Although I don't think there is much noticeable difference between Novolog and Humolog.  Usually people notice a difference in basal between Levimir and Lantus.

 

I just looked up KIND bars.  I wouldn't recommend using them to treat lows.  They may give a spike in blood sugar, but it will likely be a bit delayed.  Like at least 15 minutes, probably closer to 30.  And speaking personally, I wouldn't want to wait that long when I am low.  Better to give some juice/gatorade.  the impact is near immediate.

 

One more thing to consider is that sometimes the blood sugar alone is not the whole story.  There is a 'vector' as well.  Meaning is he dropping fast, staying steady, or already rising?  If his blood sugar is dropping fast, a KIND bar may not have enough kick to stop the blood sugar from dropping.  If he is already rising, gatorade might be overkill if he drinks too much. 

 

A couple things to keep in mind.. that you might already know.   Being active makes the insulin work better.  So if your son had a really active day, you probably want to cut back on his bolus at meals.  If you know ahead of time that he is going to be active... like swimming for a few hours.. you might even cut back on the basal dosage for the day.

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BPorath908

Hi John.  Thanks for the post I appreciate it.  We actually have been giving him less carbs for a snack if he was getting low and that has helped.  His Levamir seems to be off still but he's getting 1 Unit per 15 carbs now and that has helped out.  His bolus still seems off so I am going to check with his Dr. today and see if they want to do anything about that.  We generally try to stay away from gatorade to treat lows and we try to give me things that will slowly get him to rise and keep his steady.  We are still new to this so we are learning what affects him in different ways but things are much better now that a few weeks ago.  Thank you very much John.  I really appreciate it!

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JohnSchroeder

  His Levamir seems to be off still but he's getting 1 Unit per 15 carbs now and that has helped out.

 

Is that correct?  You are basing Levamir (the basal insulin) off of carb intake?   I'm hoping this is a typo or a mistake.

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BPorath908

I think you are misunderstanding how I typed that out.  I was just saying his levamir seems off.  He gets humalog 1 unit per 15 carbs after meals for his bolus.  We are working to get him to take before his meal but it's still hard with a 5 year old but he's getting there.  

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