Blood sugars never under 10

[Fiona30ni]

Hi
My 12 year old daughter has type 1 just diagnosed 6 maths ago. Her bm has been up and down and they have adjusted insulin regularly. She is on 15 long release and 1/5 breakfast 1/10 lunch, tea and supper. At tea time tonight she was 9.4 so give her insulin for tea but did not eat it all. Then at supper time wanted toast so checked her bloods and they were sky high 23.4 any one any ideas what's going on as I'm baffled.

Thanks

 

[mrman]

Need more ready results to really know could be basal running out or not enough bolus . Whats her levels before bed and in the morning this will give an idea to how base is working. should be lower than 8. Then 2 hours after breakfast should be below 10, b4 lunch less than 7.5. If not more qa needs to be given before breakfast. Again 2 hours after lunch below 10, and by tea below 7.5. If not more qa at lunch. Same routine after tea. Not below 8 before bed. Basically test,test,test to get a profile. Also note amount of carbs for each meal and note ratios given. If at breakfast u did 1/5, and before lunch level was 10. Try 1/4 for breakfast Next time. Same applies to lunch and tea. There is a downloadable chart on here to note ratios/carbs and levels very helpful to do. once you have got consistent levels you can work to get them lower if needed. Hope this helps.

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[Fiona30ni]

She gets her lantus at 6pm every night her sugars were 13.8 on waking this morning and at break in school which is 1hr 45 mins after breakfast where 15.3 then lunch 16.6 afternoon 9.4 before tea 18.0 and supper 23.3. Correction doses where given at bloods over 10. Correction is 1/3

 

[mrman]

Waking on 13 + would definately indicate more basal. However that would only apply if last meal was tea and no supper without qa insulin. Eg if she had supper at 1/10 ratio which might not have been enough she would natuarally be high in the morning. Check basal by giving tea one night with usual qa insulin. Then no supper. Before bed Blood should be around 8 ish. This way you know if basal is working properly and on waking should be 6 to 8. If she is higher than 8 before bed try next day using a higher ratio for tea. If basal is wrong she will be playing catchup all day. I find if I eat late before bed I require more qa than I would at tea as afterwards I'm just lying down sleeping. Once you got morning levels stable you can work better on meal ratios.

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[Karmamel]

Hi my daughter is the same age as your diagnosed a year ago. Meg also has up and down readings similar to your daughter . Last few days levels have improved but still has a daily high reading. This evening before tea she was 17 then after shot up to 24 then before her night time insulin she was 9 . Meg is on nova rapid and levimer .

There are concerns that she isn't having her insulin whilst at school but could just be due to hormonal changes. She is having a probe put in next month to find out what's going on hopefully. It's a worrying time! I hope your daughter's levels improve as I know how rotten it can make them feel and how stressful it is for us parents x


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[mrman]

Be carefull when adjusting base, usually adjust by 2 units, and wait 3 days as it can take that long to kick in 100%. Also when base is working properly qa ratios can need to go up as well as down.

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[donnellysdogs]

Be aware as well.. Not saying this is the case.. But kids naturally can and will if given chance to snack on way hime from school.. Feiwnss have sweets, chocs, crisps etc..

Not saying that all children will do rhis, but am aware what I was like in my school bus home...

I even somehow managed to sneak and buy glass
bottled coke from the tuck shop at dinner times..

Know nowadays more kids get picked up etc.. But do please be aware that kids are VERY aware that as soon as they get home they are expected to monitor, inject, eat etc and COMPLY.. And some may fall by the wayside for a while...

If it is a case of a child constantly being high at 4 and 6pm doses.. Me I would talk to my dsn to find out how to reconcile what is going on.... A 2pm or 4pm quick acting shot may be needed but there may be a way to play around with the background insulin instead.

The other way to perhaps consider is whether this occurs on days withOUT PE perhaps or compare to weekends..... Do your children get better results at 4 or 6pm at weekends...

I would love to think that we all do everything perfectly..children included... But there is pretty much an 80/20 ratio about all us humans in everything we do... 80% of D kids complying and 20% wont....or itmay well be 20% comply.. 80% don't... I only know that from my teenage years... I would have been placed in the non compliance... Despite loving my mum and dad so much.. I did love my treats too.. The treats always won....

There are ways no matter what.. But I suspect a dsn will recommend increasing insulin.. And ther are a number of ways around this, but it does depend upon whether your child and school can fit in an extra dosage, whether it will be done longterm, whether your dsn suggest long or quick acting to be adjusted. Some of which may depend on what time the long acting given..

I dont like to think 'down' onany child with diabetes.. I know though what I have been kike as a chikd and adult, and although **** good managerial jobs most of my working life... I was not the goody two shoes child at school that my parents thought I was...

 

[donnellysdogs]

Take heart that although levels are too high that certainly the morning ones are consistent.. No big swings before or after eating...that is good..

Swings from highs to lows make kt harder to manage.
I don't know how you get on with dsn's etc, but I would ask to see them with the monitoring diary..
I would personally if me.. Have raised the basal dosage initially... And given it 2/3 days before increasing again.

Do you know how much quick acting insulin on an average that your daughter has each day in total?

There is a way to get lower results, but again, I would try your long acting insulin first.. I certainly wouldnt try altering bolus and basal together... As if things hiccup you wont know which one responsible.

 

[Fiona30ni]

Thanks everyone for all your advice. Think ill up her lantus from 15 to 17 and wait for 3-4 days to see if it makes a difference. She was on 13 before and I rang diabetic nurse as on waking her bloods where between 15-17 and increasing it to 15 has helped a bit but still feel they are a bit on high side. On average she gets between 35-50 units depending on correction but lately a correction is needed every meal time x

 

[mrman]

Good idea to get base right first and then concentrate on meal time doses. Try to get waking level between 6 and eight of poss. Good luck and let us know how u get on

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[Fiona30ni]

Ok thanks Brett will keep u updated

 

[AMBrennan]

Be aware as well.. Not saying this is the case.. But kids naturally can and will if given chance to snack on way hime from school.. Feiwnss have sweets, chocs, crisps etc..

So, she must be sneaking out a night as well? Until such a time that you have the insulin doses sorted out (morning fasting at least), I think it would be highly premature to jump to conclusion and blame her for (sorry) the parents not using the right insulin doses.

Edit to add: very useful document by GGC Children's Diabetes Service on insulin dose adjustment.

 

[Fiona30ni]

Hi
Spoke to diabetic nurse and she advised to up her lantus (24hr) insulin then after 2-3 days do a 3am check to see what's happening during night x

 

[mrman]

Good, glad you got some advice. The 3 am check is advised as that is supposed to be the time that blood levels are at their lowest through the night. With that you can then compare with the morning result to get a good idea what the basal is doing

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[elainechi]

thats why my daughter hypos at 3 every night..trouble is shes on bd insulin....humilin m3....and at 10pm 20 !!!!!!! x

 

[donnellysdogs]

Dont get me wrong ref kids having an extra sometime unkown to parents... I did suggestvraising basals.. And do realise night-times were high too.. And no .. Dont think that children sneak down during the night to raid the fridge..Just read on most forums and know from my own childhood that sometimes kids do want to be same as others in tuckshop queues, or popping into shops on their way home with their friends who sometimes may get sweets etc. I certainly didnt mean to imply that all kids do it, but just a prewarning...

However, really just as a 'beware' really when levels do become more stable during days and nights, dont be alarmed if you get an odd day of highs at odd times which 'could' be down to an undiclosed snack. Just dont rush in to changing things on an odd day of highs in the future.... Not necessarily now...

The other thing I was thinking about, I read somewhere ( cant recall where) that childrens levels tend to raise from 9pm-12midnight. I know from a fellow pump user child, that her levels certainly do as her bassls have had to be raised so much to cope with these times...I hate the idea of suggesting extra tests.. But personally I would consider doing 11pm and 3ams for a few nights... As 11pm will probably be one of the highest bgs and agree that 3am will prob be one of lowest. It may give a clearer idea what actions to take for alterations to get levels lower and to have less deviations in the bg readings.

Hope that you will have improvements soon, glad you saw your dsn..you'll get there, takes time unfortunately...
Best wishes..