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advice or experience on how to manage this..

T

timu123

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2
hello,
My 17 year old daughter is 2 months since diaganosis of type 1, diagnosis was done by 2 fasting tests with results of 14 and 15 mmol/l, she was tested due to the classic symptoms - thirst, weight loss...

honeymoon period has kicked in and the insulin dose has come way down..

Current insulin regime is 0.5 unit of levemir at 6pm - bed time sugars are 6.5 mmol/l and 4.9 before breakfast.
doing 1 unit of novarapid at breakfast ( 50g carbs ) - goes to 8 after an hour, back to 5 at 2 hours.. tricks down to low 4 by lunchtime
doing 0.5 unit of novarapid at lunch ( 60g carbs) - goes to 6.5 after an hour, back to 5 by 2 hours and tricks down for th rest of the afternoon.
doing 0.5 unit of novarapid at lunch ( 60g carbs) - goes to 7 after an hour, back to 6 by 2 hours and is fairly stable till bed time.

But the big problem that is making her life miserable are the almost daily hypos, any sort of gentle exercise eg walking 100 yards will drop her sugars to < 4 no matter what they were before - we have seen 8 -> 3.4 in 10 minutes..

yesterday she had the normal 0.5 units of novarapid + big lunch + extra sandwich+ 100ml milk - sugars to 7, went to ride horse 2 hours after eating and it was 5.6, ate big banana and a white bread jam sandwich!, waited 15 minutes and then walked him for 10 minutes and sugars were 4.5 then 4.1 and dropping, drank carton of apple juice whilst still walking the horse around ( so very gentle exercise) and her sugars were 4.1 at the end, they didnt go up afterwards just drifted gently down again - but that was 140g carbs within 3 hours just to sit on a horse at walk for 20 minutes.. the same happens walking around college on the days they stay up long enough to even get there!

this morning had 1 unit of novarapid + breakfast ( 2 weetabix+ mil) , bloods to 6 after 90 minutes, started to revise - after 20 minutes, felt low tested - 3.6 !!

We are completely at our wits end as to how to stop this! dropping the novarapid doses from 1 unit to 0.5 unit has raised the peak after meal bloods by 1 mmol/l, but the peak is gone by 2 hours and then its down down down till the next meal...

I dont think its the tiny levemir dose - after an extra hour of lie in her bloods were stil at 4.9 and thats 14 hours after its injection.. we have moved it forward a few times and you cant see any change on the bloo dchart from that..

Its like the novarapid hangs around for the 5 hours dragging it down , you can just watch the sugars drop 6 -> 5-> 4 -> 3.x , i always hope it would stabilise around the 4.x mark but that doesnt happen.. 1am and 4 pm every day the sugars drop even without exercise..

We did find that if we can feed the levels till 4 or 5 hours after the novarapid that then it remains fairly constant like night time..

Any suggestions/experience/advice ? do we try low carb / no insulin? a shorter lasting insulin like apidra ?
we are asking the consultant for help again on Monday after his last suggestion of just get on with it and eat a banana before exercise.....

thanks in advance.
tim
 
Honeymoon period a right pain. With your teams guidance would suggest trying no insulin, measure blood levels frequently. Remember activity/excercise will cause dramatic drops in levels.

Sent from the Diabetes Forum App
 
During my honeymoon period managed with no basal (long acting insulin) and only using qa (novarapid) in small doses at meal times. Still needed a carby snack between meals.

Sent from the Diabetes Forum App
 
Hi

I also agree with Brett..... your daughters bg levels are a bit too low at the 2hr mark and she should to eat a small carb snack and then test at the 3hr mark to make sure that the carb snack eaten is enough to get her bg up to about 8mmol and then with any luck, by the time 4-5hrs is up, she should be back towards a normal target.
 
Hi,
I agree with Brett and IHS, it may be that she doesn't need any background insulin at all, also it may be worth asking if it's possible to get a paediatric pen that has smaller units like 0.1 or 0.2 units instead of the 0.5. I think they make them for babies and children as they need less insulin. What is the target level your daughter is aiming for? Mine is set to 5.5 so waking up in the 4's although not hypo is too low for me to be constantly sitting at. Good luck for your appointment.
 
Your poor daughter, and you! I too would say maybe she doesn't need the long lasting injection and maybe try it out with lots of bg testing! You sound like you have a great specialist team telling you to just get in with it! :(
 
many thanks for the quick replies..

I would never have thought about pediatric pens - thanks.
We tried snacks at the 2 hour mark ( and then 3, 4 hour) but what ever she eats just dissappears eg
a whole 150ml can of full sugar coke raised it 2 mmol for 30 minutes and then its back down again, ( and thats just sitting on the sofa!)
we have experimented with slower release foods as snacks and they dont even register , might slow the drop but certainly dont reverse it..

one thought is slower release carbs and no insulin and quite a lot of monitoring..

yep - one or other of the insulins needs changing..

target level in the morning of 5 - 6 would be good, but at 0.5 unit of levemir we cant go less.. ( but now i know about pediatric pens!),

thanks again.
tim
 
I can sympathise. I agree with some of the other posts that trying to stop one or other of the insulins for a while and testing may be worth it. Currently it appears your Daughter's diabetes is marginal but it may not stay that way so possibly do a trial but with enough measurements to avoid any issues. My excellent nurse suggested fruit before I go to the gym. I thought this a bit odd but exercise does cause strange sugar profiles so I guess was based on her or others experience.
 
I would strongly suggest stopping all insulin and continue testing - if normal levels are found why make her feel like ****? I've seen this happen before with someone who was on my DAFNE course. Speak to your DAFNE trained DSN ASAP
 
Hi

I would also say that its not uncommon for Novorapid to have its final fling on the last 45mins of its 4hr acting time so the bg levels that you mention is fairly typical (it affects me more or less the same way).

As your daughter is still in the honeymoon period using insulin, U100 insulin can be diluted to be weaker but a DSN would have the knowledge to advise on that. U50 insulin is also available for children too. Lastly, your daughter might be better using one of the older insulins like Lente as an example (available from Workhardt), which will release its bg lowering effect a bit more slowly and only needs to be injected just once per day or maybe twice and then its action on bg levels is regulated by eating carbohydrate at set times during the day. Must admit injecting 0.5u of basal insulin hardly seems worth doing an injection for but just goes to show how it takes all sorts of ways to control bg levels.
 
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