Question about sudden bg rise

[Natt]

Hi everybody
Last night 2 hours after dinner my son (12) had a bg of 20.We've done everything as usual, the same amount of carbs and humalog dose so this came as quite a shock.After the correction it fell to 7.7 and stayed there until the morning.

Otherwise he's very well contolled and never had a bg rise above 10.Do you have any ideas why this might have happened? I checked his pen and needle to see if maybe it got stuck, but all seemed to be in order..

What would be the cause of this? We would like to prevent such things from happening again if possible.

Thanks
Nat

 

[evilclive]

The fatalistic answer is "It's diabetes, it does that sometimes". Problem with injection site - insulin hanging around rather than dispersing?

Another thought - did I read somewhere that upon adolescence, the whole thing gets very unpredictable, what with all the new hormones surging around in varying quantities, and you just have to work with it?

How to prevent it happening again? My answer is you probably can't, but you can catch it a bit easier with some form of cgm.

 

[Deleted Account]

Great answer from @evilclive (I'm beginning to think, despite his username, he has a soft spot when comes to helping out people with diabetes).
I would just add that other things like illness and stress can raise BG.
Does he have sniffles or a test coming up at school?

As our diabetes is not always predictable and there are some many things that can affect our BG, I try not to draw too many conclusions from a single unusual reading - I treat it and make a mental note if it happens again.

 

[Natt]

Hi @evilclive and thanks a lot for your thoughts. Both things you said make sense...I was also thinking about the injection site problem, but dismissed it as he has been diabetic for less than 2 years? The growth spurt can also be the reason.

@helensaramay thanks, yes, he's got tests in school this week, but I haven't noticed him being tense...which doesn't mean he isn't...

Its hard to accept that you can do everything right and still fail at this D thing...

Its just that when all is well and predictable he has a sense of control over the ilness and its important to him emotionally and mentally. And when something like that happens, he gets angry and frustrated (we all do) and tries to find a rational explanation. We have to work on acceptance and managing our expectations, its a process I guess

 

[Deleted Account]

Its hard to accept that you can do everything right and still fail at this D thing...

I read an article about language to use when talking about diabetes. It was aimed at health care professionals but I try to follow it myself. It said things like "there is no such thing as "failure" - that suggests comparison with other and we are all different. And diabetes cannot be "controlled" is it "managed". Just like when you manage a team at work, as a manager, you are never 100% in control.
I believe remembering this has helped me keep my diabetes in perspective. There is always a concern in the back of my mind about risks of complications but there is also a concern at the back of my mind about the risks of being run over when I cross the road. I would as much stop myself doing something which may affect my BG as I would stop myself crossing the road. I do both with my eyes open and try to minimise the risks but I can't stop a drunk/drug driver pulling out of a junction without looking at 100mph.

 

[evilclive]

20 correcting down to a stable 7.7 isn't a fail, that's a success! Problem seen, fix applied, problem solved.

There's plenty of people on here with many years experience, and with bodies that are theoretically older and more stable rather than the rapidly changing one of a young person, and we all get incidents like this. Some catch them earlier than others (cgm, alarm helps), but the underlying non-trend is universal - diabetes can be random and unpredictable, and we just have to cope.

It's important to not worry about it - stress isn't good. Though it's also important to keep doing all the tedious things (testing, injecting) all the time. A driving analogy - when you're driving, I hope you don't worry that you're going to swerve into the other lane head on into the lorry, but equally you make sure you're doing the things such that it's not going to happen, such as keeping your eyes open and steering

(FWIW if we're stretching that analogy, the 20 isn't even touching the cats eyes, it's just a minor pothole you had to steer for.)

 

[porl69]

20 correcting down to a stable 7.7 isn't a fail, that's a success! Problem seen, fix applied, problem solved.

There's plenty of people on here with many years experience, and with bodies that are theoretically older and more stable rather than the rapidly changing one of a young person, and we all get incidents like this. Some catch them earlier than others (cgm, alarm helps), but the underlying non-trend is universal - diabetes can be random and unpredictable, and we just have to cope.

It's important to not worry about it - stress isn't good. Though it's also important to keep doing all the tedious things (testing, injecting) all the time. A driving analogy - when you're driving, I hope you don't worry that you're going to swerve into the other lane head on into the lorry, but equally you make sure you're doing the things such that it's not going to happen, such as keeping your eyes open and steering

(FWIW if we're stretching that analogy, the 20 isn't even touching the cats eyes, it's just a minor pothole you had to steer for.)

Nail on the head. Brilliantly put with the driving

@Natt there isn't a type one who doesn't have blips similar to your sons. You did the exact right thing in noticing and then treating your sons high.

 

[Natt]

Its something we still have to learn and work on @helensaramay, I know, we still believe there can be some control over D... and what happened just shows us the opposite, so yes, managing not controlling...

I liked your analogy @evilclive its just that I don't drive precisely because of that. The eye opener for me is that IT still can be random and unpredictable no matter what you do, something that our endos never told us- just do what has to be done and all is supposed to be fine. That's why this forum is so great.

A month ago endo changed his insulins without much explanation especially related to basal testing (previously on actrapid/insulatard, now humalog/lantus). Ever since, we haven't been quite able to manage it as well as on previous insulins. To make things more interesting, it all happens in Spain where we moved 7 months ago, so all is new and I am still trying to "click" with the healthcare system here.

 

[Fairygodmother]

Hi @Natt, does your son take Lantus once a day or does he split the dose? I found that Lantus, for me, didn’t last the full 24 hours. I’m taking Levemir now, and finding it easier, though as helensaramay and (not so)EvilClive say, T1 sometimes throws us curve balls.
I wonder, too, if he had a honeymoon period and could it be that that’s ending, which, as well as changes in puberty, could have caused the blip?
It sounds as though you’re all doing a great job keeping his bs well controlled: he’s a lucky young man!

 

[Natt]

Hi @Natt, does your son take Lantus once a day or does he split the dose? I found that Lantus, for me, didn’t last the full 24 hours. I’m taking Levemir now, and finding it easier, though as helensaramay and (not so)EvilClive say, T1 sometimes throws us curve balls.
I wonder, too, if he had a honeymoon period and could it be that that’s ending, which, as well as changes in puberty, could have caused the blip?
It sounds as though you’re all doing a great job keeping his bs well controlled: he’s a lucky young man!

Hi and thanks @Fairygodmother. Yes he takes the whole dose of lantus with the evening meal, but what you said may have sense.I wonder why the endo didn't mention such possibility, I will ask her.

It may also be that the honeymoon is ending, as I find it more diffulct in the last few weeks, for which I blamed the transfer to new insulins.

He just came from school and told me he's been 7,7 all day today..I would probably need to adjust his basal, as we have already increased fast acting and its still high..

 

[Deleted Account]

Basal should maintain a BG. If he has been 7.7 all day, that suggests to me his basal is correct.
If his BG has risen slightly during the day, I still would not adjust anything yet - wait for a trend.
He may be coming down with a bug (a BG rise is sometimes a pre-cursor to a cold) or may have eaten something with carbs that you didn't spot or it may be the stress of the tests or his BG may just have felt like a rebellious day (although 7.7 is not that bad)!

If you do decide to adjust his dose, it may take a few days to take effect: the usual rule is adjust a little, wait 3 or 4 days and adjust a little more if necessary.
You can get insulin pens which provide 0.5 unit doses so you can tweak by small amounts.

 

[Natt]

Basal should maintain a BG. If he has been 7.7 all day, that suggests to me his basal is correct.
If his BG has risen slightly during the day, I still would not adjust anything yet - wait for a trend.
He may be coming down with a bug (a BG rise is sometimes a pre-cursor to a cold) or may have eaten something with carbs that you didn't spot or it may be the stress of the tests or his BG may just have felt like a rebellious day (although 7.7 is not that bad)!

If you do decide to adjust his dose, it may take a few days to take effect: the usual rule is adjust a little, wait 3 or 4 days and adjust a little more if necessary.
You can get insulin pens which provide 0.5 unit doses so you can tweak by small amounts.

Thanks @helensaramay for this advice, I really appreciate it. You are right, I will wait for some kind of trend to appear.We have half unit pens and we upped his bolus for the dinner for 1/2 unit so 2 hours after it's 6,7, hope it won't rise later.