Two questions

[stoney]

Hi Everyone.

First question re: Accu Chek Aviva Expert.

James came home from school today after last lesson of Games. Guarantee high BG (today 14.7) tested an hour later 4.3 as tea was ready did not treat hypo just had his tea 90g carbs did insulin after tea and dropped by 1unit from 9 to 8. How can I enter the amount of basal given for that meal as it only tells you to treat the hypo. Have tried to modify data but will not let me?

Second Question: What can I do regarding the BG/insulin before Games Lesson

The problem is his lunch is 1.30 - 2.30 then he has games next lesson(at the moment it is rugby). Any suggestions to get over this hurdle.

Would also like to add that James seems to be having a lot of low BG's (but not when exercising) so over half term I will be starting on the half dose pen to see if we can get more even control.
:roll:

 

[Jen&Khaleb]

Do you find that the low's are coming that night or the following day from exercise? I tend to reduce Khaleb's basal by 10% (so for him half to 1 unit) over the next 24 hours after exercise and I might also need to increase his morning or afternoon tea a little bit. I actually got the 10% advice off another adult diabetic and it stops at least 80% of the hypos I was getting with exercise.

Can't help with the Aviva but my programme wants me to put in a carb amount for any hypos and then I have to seperately put in the meal and bolus amount.

Half unit pens are great!

 

[SophiaW]

When Jess was on injections I found that exercising shortly after injecting (within an hour) caused a rapid drop in BG. Not sure when your son is experiencing these lows but if it's during the game or very shortly afterwards perhaps he can split his lunchtime insulin, half with lunch and the other half after the game. You'd have to experiment to see what split works best, it might not be a 50% 50% split that is needed. I have found the trouble with school sport is that no sooner do you get it worked out then they change the type of sport the following term and it all starts over again. Routine when it comes to sport and diabetes is a good thing and makes life easier, well it does for us.

 

[Geoff]

Hi, Just as a point of interest, in question 1, 4.3mm/lt is technically no classed as a hypo! A hypo is any reading below 4.0mm/lt, so 3.9-3.7 would be for example a mild hypo. Also in question 1, you ask how to adjust the basal dose for his meal? The basal element of your basal/boles regimen has nothing to do with the food you eat, it is to maintain a background level of insulin throughout the day and night, also as it is a long acting insulin it can be more than 11/2 hours post injection before it begins to work.

 

[stoney]

Geoff

I have programmed the expert to show a hypo anything below 4.5mmol/L as James tends to gets the symptoms of hypo (shakiness) around this level.. Sorry my mistake I meant to put bolus not basal.

SophiaW

James tends to get the highs when he tests as soon as he comes in from school (3.45pm) where games is last lesson then about half an hour later he has dropped right down, then he tends to inject after tea/food around 5pm with a drop of 1 unit as he tends to drop again before his supper.

Jen&Khaleb
The lows come as I said to SophiaW about half an hour after he gets home from school. The problem is that I was told to round up the carbs 1:10 so I will definitely do half units over the school hols and see how that works

Thanks again to you all for your support

 

[SophiaW]

Is James' reading at lunchtime within target range? On days that he's not doing sport, is his hometime reading within target range? I'm trying to determine if his high reading only happens on sport/PE days.

It's possible that the high reading is a result of adrenaline and I'm not sure there is a way around that. Reading in my book it says something along the lines of adrenaline secreted in the body causes a reduction in the body's use of glucose but an increase in the brain's use of glucose. Adrenaline is usually secreted in high stress life-threatening situations (but can also be secreted as a result of excitement) when we need our brain to work quickly to save our lives. Our body slows down the uptake of glucose to the rest of our body so that the brain can make full use of it. It also causes the liver to release glucose. In a person who doesn't have diabetes this isn't usually a problem but for a diabetic it will result in a higher blood sugar level. That possibly explains the high reading during and shortly after the activity.

Perhaps (and this is only my way of thinking, I haven't read it anywhere) once the adrenaline wears out of his system his body goes back to using the glucose for all of his body. This might explain the sudden drop in blood glucose levels. In addition to that you might find that the rapid acting insulin is peaking at around the 2 hour mark (I know Jess' novorapid peaked between 2 and 2.5 hours of injecting). If James is the same then that would be around 3.30pm - 2 hours after lunch. It might make sense, if his sudden drop in BG is predictable on sport days, that he eats a carby snack after PE e.g. a digestive biscuit to counter-balance that sudden drop.

I don't know about the meter you're using as we don't use it, but based on our experience of the pump you will need to correct the low blood sugar before you can go ahead and put in the rest of the data. If Jess is low her pump will not allow us to put in a BG reading with insulin delivery, it will keep telling us to correct the low first. Once the low is corrected and her reading is out of hypo then we can put that new reading into the pump and it will let us deliver insulin.

 

[Jen&Khaleb]

Sorry not to have helped that much. Most of working out levels with MDI tends to come from trial and error. Khaleb is on Levemir and I don't think it has a flat profile like some doctors would like to think. The Novorapid seems to fairly reliably do the same thing every time. I find the only way is to keep fairly detailed records to hopefully predict how many carbs/insulin needed for that particular activity. I tend to give Khaleb 1:10 for breakfast but he is on 1:15 for lunch and dinner. I've got it fairly worked out that a half unit correction will drop his blood sugar 4mmol but there is always things to consider - like when he had his last injection. Does your son need to inject at 1st break at school as well as 2nd break?

All the best with your relatively new regime. It must be hard changing over. Were you offered the choice of a pump as well as MDI?

 

[stoney]

Is James' reading at lunchtime within target range? On days that he's not doing sport, is his hometime reading within target range? I'm trying to determine if his high reading only happens on sport/PE days.

It's possible that the high reading is a result of adrenaline and I'm not sure there is a way around that. Reading in my book it says something along the lines of adrenaline secreted in the body causes a reduction in the body's use of glucose but an increase in the brain's use of glucose. Adrenaline is usually secreted in high stress life-threatening situations (but can also be secreted as a result of excitement) when we need our brain to work quickly to save our lives. Our body slows down the uptake of glucose to the rest of our body so that the brain can make full use of it. It also causes the liver to release glucose. In a person who doesn't have diabetes this isn't usually a problem but for a diabetic it will result in a higher blood sugar level. That possibly explains the high reading during and shortly after the activity.

Perhaps (and this is only my way of thinking, I haven't read it anywhere) once the adrenaline wears out of his system his body goes back to using the glucose for all of his body. This might explain the sudden drop in blood glucose levels. In addition to that you might find that the rapid acting insulin is peaking at around the 2 hour mark (I know Jess' novorapid peaked between 2 and 2.5 hours of injecting). If James is the same then that would be around 3.30pm - 2 hours after lunch. It might make sense, if his sudden drop in BG is predictable on sport days, that he eats a carby snack after PE e.g. a digestive biscuit to counter-balance that sudden drop.

I don't know about the meter you're using as we don't use it, but based on our experience of the pump you will need to correct the low blood sugar before you can go ahead and put in the rest of the data. If Jess is low her pump will not allow us to put in a BG reading with insulin delivery, it will keep telling us to correct the low first. Once the low is corrected and her reading is out of hypo then we can put that new reading into the pump and it will let us deliver insulin.

Hi SophiaW
Yes on looking back over his records, it does seem that on the Monday, Thursday and Friday his lunch time Bg's are within target, also when he gets home from school, but on the Tuesday (Games day) and Wednesday (PE Day) he does have target at lunch time, highs when he gets home after Games but low when he gets home after PE. Obviously timings and peakings.

If he does have a carby snack on say Games day on the way home from school, he already has a high Bg so that would take him even higher. I would say he drops in readiness for tea and hour later from school, but I am unable to put that data in the meter then. As for Wednesday PE day, he has that last lesson before lunch, so I could try to get him to eat something on the way home from school cos he tends to arrive home low. Does this make sense or am I waffling a bit and confusing myself :?

As far as the meter is concerned it sounds exactly the same as the pump then :roll:

 

[stoney]

Sorry not to have helped that much. Most of working out levels with MDI tends to come from trial and error. Khaleb is on Levemir and I don't think it has a flat profile like some doctors would like to think. The Novorapid seems to fairly reliably do the same thing every time. I find the only way is to keep fairly detailed records to hopefully predict how many carbs/insulin needed for that particular activity. I tend to give Khaleb 1:10 for breakfast but he is on 1:15 for lunch and dinner. I've got it fairly worked out that a half unit correction will drop his blood sugar 4mmol but there is always things to consider - like when he had his last injection. Does your son need to inject at 1st break at school as well as 2nd break?

All the best with your relatively new regime. It must be hard changing over. Were you offered the choice of a pump as well as MDI?

Hi Jen&Khaleb,
James has a 10g snack at first break but only injects for his lunch which is always 60g carbs. I think the answer is to try over the hols the half units and see how we go. We were not offered the pump at our hospital but the DSN said before she left that if we were thinking of the pump in the near future, we would need to refer to another hospital cos our consultant was not interested in knowing anything about pumps . So we shall see how we get on.

 

[donnellysdogs]

Stoney, have sent you a pm...best wishes Sharon

 

[Jen&Khaleb]

Wow. In this day and age I would have thought all the options would have been given to you to see what would work best with your family/lifestyle and not a decision based on what a nurse wanted. It has actually become the norm here that many kids are going straight onto pumps from diagnosis. At the last camp I attended about 75% were now pumping and 25% MDI and none on mixed insulin. Some of the teenagers wanted to go back to MDI as the pump was interferring with their social lives (girls/boys) but I imagine they will go back to pumping when they finish school.

If Khaleb was having high's and then low's from exercise I'd start to ignore the slightly high figures to avoid the low's. I've always been told that the low's are more damaging than any temporary higher figures. I'm never asked about high's but always asked how many low's Khaleb has between clinic visits.

You'll get there in the end but it is always such a juggling act.

 

[grh1904]

Hi,

I had quite a bit of trial & error with my insulin when I started to get back into my running. To give you an idea of the intensity of my running I do about 5 runs a week, usually 5 to 7 miles at a time, I often include interval sessions & average about 40 to 42 mins for 10K.

What I've found that works best for me is to have some carbs before my run (say a bottle of isotonic lucozade or a bar of chocolate) but I don't take any insulin for it at all. I check my blood sugars after my run but not straight away. I find it's best to leave it for at least an hour.

I often run to work if I'm on a late shift or nightshift & I always have food ready at work to eat once I've got showered & changed. Whenever I'm eating my evening meal at home or eating at work before the start of a shift I always ROUND DOWN the insulin I intend to take and never by just 1 unit, always at least 2, sometimes even more.

What you have to understand is that the body continues to burn up calories for a long time after you have finished.

I'll try & explain the above: -

A couple of months back I was counting my calories (bit of fun, bit of science for my running), and I worked out that despite a bowl of porridge for breakfast, a bar of chocolate & an isotonic drink about 45mins before an 11.5 mile run, a couple of toasted "T" cakes on my return, "7" yes SEVEN pints of beer with my father-in-law followed a HUGE Sunday roast dinner and I was still in negative calories for the day.

I had ran off so many calories during my run & upped my metabolism so much that the continued burn meant that I used more calories that I consumed.

This can also apply to glucose as well. Any distance runners or athletes that do endurance sports that I have come across that are diabetics always take onboard carbs/glucose before exercise and afterwards, and take less insulin than they normally would for the after sport carbs.

Everyone is different, as everyone on here would testify to!!!!!!! but you may want to try and and either lower the insulin taken before exercise or up the carbs/glucose intake and/or alter the insulin taken at the next time of eating post exercise.

I can eat after a run & work out that I would "normally" take say 8 units of insulin. I round it down to 6 and even then often find that when I test myself about 2 hours later I'm down in the very low 4's or even dipping just under.

The philosophy I adopted while trialling the above was that it was easier (and safer/healthier??? :?: :?: ) to have my BG's run higher as I can always adjust by taking a bit more insulin to compensate when I tested myelf 2 hours after eating, as opposed to going hypo and then trying to correct that!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

[Jen&Khaleb]

Great post grh1904. I so try to do like you do with my son but sometimes I still find him dipping down too low. I thought I had things sussed when we go swimming but the water is getting colder so I have to factor in some extra carbs for that atm.

 

[RussG]

Agreed - great post by grh1904. Exercise rules are fairly tricky, I think. I'm just getting back into some more consistent exercise and although I've gone low a couple of times, I have found it improves my sugars for a day or two after the exercise.

I'm also a bit in awe of 25-35 miles a week! I'm such a poor long distance runner and am only doing 2-3 miles a week but looking to up that. I will definitely absorb this advice.

 

[grh1904]

Agreed - great post by grh1904. Exercise rules are fairly tricky, I think. I'm just getting back into some more consistent exercise and although I've gone low a couple of times, I have found it improves my sugars for a day or two after the exercise.[/b]
I'm also a bit in awe of 25-35 miles a week! I'm such a poor long distance runner and am only doing 2-3 miles a week but looking to up that. I will definitely absorb this advice.

Yes, totally agree, I find that it helps me a lot with long term BG control, partly because I have to work so hard with the taking on board carbs/glucose bofe & after excercise & getting the insulin right before & after as well.

I think one of the reasons it helps so much is that without realising it I put the same effort into my insulin regime at every meal, I even think about how long I'm going to take the dog for a walk or how long it'll take to wash the car/push a trolley round morrisons etc.

 

[grh1904]

Great post grh1904. I so try to do like you do with my son but sometimes I still find him dipping down too low. I thought I had things sussed when we go swimming but the water is getting colder so I have to factor in some extra carbs for that atm.

It's something that takes a lot of work, and even now I still don't always get it right, but the more you stick at it & work at it the greater understanding you get, although I don't think I'll ever get it 100% right.

How old is your son if you don't mind me asking???

I wasn't diagnosed until into my 30's and I suppose having served in the forces for almost 12 years & been into running etc for a long time before diagnosis helped me, but I really think that if I'd tried to get my head round this at a young age I'd probably have given up on doing any sort of sports.

I appreciate I don't know you or your son but I would suggest that as he starts to develop an understanding of it you try & get him to have as much input as possible, so that as he grows up & his mates organise an inpromptu game of footy/rugby etc he can join in and be safe with it at the same time because he'll understand what he needs to do before/during and afterwards.

I recall many years ago hearing that the then professional footballer Gary Mabbutt (Tottenham Hotspur) was a diabetic having been diagnosed as a child. Just goes to show that you can reach the heights of a top professional sportsman/woman AND inject insulin. I've never googled (etc) Gary but it might be worth a go. Perhaps diabetes.co.uk could help with providing details of other top sports persons/athletes who are also insulin injectors???? These people may be able to advise what it was they did as teenagers etc when trying to break into their chosen arena?????

 

[grh1904]

Okay, decided that after advising someone to lok up Gary Mabbutt I should practice what I preach & I found this: -

http://news.bbc.co.uk/1/hi/health/4674166.stm

 

[stoney]

Great post grh1904. I so try to do like you do with my son but sometimes I still find him dipping down too low. I thought I had things sussed when we go swimming but the water is getting colder so I have to factor in some extra carbs for that atm.

It's something that takes a lot of work, and even now I still don't always get it right, but the more you stick at it & work at it the greater understanding you get, although I don't think I'll ever get it 100% right.

How old is your son if you don't mind me asking???

I wasn't diagnosed until into my 30's and I suppose having served in the forces for almost 12 years & been into running etc for a long time before diagnosis helped me, but I really think that if I'd tried to get my head round this at a young age I'd probably have given up on doing any sort of sports.

I appreciate I don't know you or your son but I would suggest that as he starts to develop an understanding of it you try & get him to have as much input as possible, so that as he grows up & his mates organise an inpromptu game of footy/rugby etc he can join in and be safe with it at the same time because he'll understand what he needs to do before/during and afterwards.

I recall many years ago hearing that the then professional footballer Gary Mabbutt (Tottenham Hotspur) was a diabetic having been diagnosed as a child. Just goes to show that you can reach the heights of a top professional sportsman/woman AND inject insulin. I've never googled (etc) Gary but it might be worth a go. Perhaps diabetes.co.uk could help with providing details of other top sports persons/athletes who are also insulin injectors???? These people may be able to advise what it was they did as teenagers etc when trying to break into their chosen arena?????

Thanks for the info. James was 14 on 9th April just gone, and has been diabetic since he was 3. The problem I have at the moment is not only exercise but blinking hormones and puberty and to cap it all he has Year 9 exams this week, hence he has been running high with correction doses all the time. He has now gone off to play a mid week catch up football cos of bad weather interrupting weekend games. He was 10.2 premeal and rushed off without testing again, but equipped with snacks and lucozade if necessary. He will no doubt be high again when he gets home but by the time he has had a bath/shower an hour or so later and he will have dropped (that's if his swatting for tomorrow does not keep him high). It feels sometimes that just when you get to grips with it we are bashing our heads against a brick wall again. :roll:

 

[grh1904]

Stoney, I note from your signature that your lad is on Novorapid & Lantus, same here.

When I did my DAFNE course one thing we looked at was getting the "background" insulin right. Perhaps as well as looking at the novorapid you also try adjusting the lantus.

One tip I got given in relation to the Lantus was to not only check yourself 2 hours after you've eaten but also after you've gone at least 5 hours since your last meal. A high BG reading can indicate that you're not on enough Lantus, where as always dipping low after 5 or 6 hours could indicate taking too much.

I didn't have to but some of the other DAFNE students were also advised to set an alarm for sometime between 2 or 4 am and test then. This can be very good indicator as to whether you're on the right amount of Lantus. Especially if you haven't eaten for a couple of hours before bed and then also slept for a good 3 to 4 hours before testing. It can be a bit of a pain to do but apparently it's well worth it in the long run.

If your lad is running high when he sleeps then his sleep won't be as good as it could be, this will have a knock on effect throughout the day as to how his body reacts to the insulin he takes.

A lot of things really made sense once I did the DAFNE course, it's worth hassling your GP/diabetes nurse etc to get on it...............................