Advice please - cos not a good day yesterday

I haven't used Lantus because my daughter was on Levemir but these are my thoughts. He went hypo about an hour after injecting the Lantus. To my knowledge Lantus doesn't affect the blood sugars that quickly so it is more likely a problem resulting from his rapid acting insulin at supper time. What did he have for supper? Was it a slow release carbohydrate like pasta? If not then perhaps his carb ratio at supper time needs to be adjusted.

The high reading the next morning could be a result from a rebound following the low. Or, if he had pasta for supper it could be something like what my daughter experiences with pasta meals. She will go low (within 2 hours) of injecting for pasta but then after about 5 hours her readings start to climb and by the next morning a reading in the 18s would not be uncommon. Even if we avoid the hypo within the 2 hours, her readings still climb by the next morning, something to do with the slow action of carbohydrate being digested and affecting the blood. Now that she is using a pump we have a lot more control over this problem.

After he went low at 11pm and you treated the hypo, did you retest a short while later to make sure he had recovered from that hypo?

Hi

This is only my opinion....but there is no way I could have that amount of food (carbs) as my supper without having a short acting injection.

Try testing whilst lying down in bed in the mornings, and then one hour after getting up...you may find that James is experiencing larges high's naturally after actually getting up.

Have you tried just testing James for one evening what his levels are without his supper?

James at 13 is either starting or has just started pubety, where he will suffer 'raging teenage hormones' This will have an big impact on his blood glucose control making it at times difficult to maintain control...

With his present control he's not going to put on or maintain weight gains as soon as levels start increasing above 12mmol/l his body can't utilise his insulin probably and like to start burning off any available fat stores to fuel the body, so reducing his carbs in meals to make them easier to control might help him to gain rate as more stable BG's this will happen..

His night hypo is going to be difficult to determin where this may lay, Lantus actually does start to work within the hour here's it's profile www.lantus.com/hcp/comparison.aspx but you also need to determin how long his Quick acting insulin is working for as in general the profile says, it peaks at 2 hours (at this point it would have used 80% of the dose) then tails off over the next 2-3 hours, but some people do find takes longer to burn out the system. It not unheard of for it to take 6 hours!

His insulin out lasting the consider norm profile would explain why he's able to eat 70g carbs without injecting (that would land me in hospital with DKA) and the tail end combined with the Lantus kicking could have caused the hypo..

The raise in the morning, could be a rebound from the hypo the liver deciding to dump after you've treated the hypo.. But

Banana's are quite a slow carb more so if when only just ripe, so you could have had time lagg off this, or perhaps an high fat or pasta tea (pasty is classed as high fat) effecting the readings..

It would be wise to check to see if he's suffer dawn phanomnon (sp), where is blood glucose naturally rises during the early hours of the morning, easy to find out with a fasting tests..

You need to avoid foods that are low on the GI index, such as pasta/high Fat, and not wise to do it the day after football training as there could be a time lag, You start testing around about 4am in the morning, then every hour to mid morning, but be aware of the need to abort testing if hypo or hyper occurs... If he's got DP then his levels with naturally start to go up...

stoney said:

I can't believe how knowledgeable you all are and what good advice you give.

Jopar, no wonder he is not putting on weight like his piers if you say that above 12mmol/l won't let him put on any weight.

I have been going over and over yesterday in my head (whilst ironing I might add) to see if and where I went wrong and I remember when it came to tea time that my partners' grandchildren were also with us for tea. I then rememberd that when it came to dessert the young ones wanted a yoghurt and so James had the same, BUT he had already calculated his carbs for a home made gluten free fairycake so he had eaten 20g less for his tea. Would I be right in thinking that might have done something even though his BG before supper at 19.57 was 5.3 and no insulin covers his supper!!!

Click to expand...

Hi Stoney

I think what your dsn is trying to do is to use Lantus to control the carb in the supper meal that James eats and is not doing a very good job at the moment. Although Lantus is not meant to peak, many people do find that their bg levels will drop approx 4hrs after it has been injected and this is not always due to any bolus insulin still being active. It's well known for people to go hypo while they figure out the correct dose.

Personally I think the carb that James eats at supper is too high in carb and really it is best to use some bolus to cover that and then reduce the amount of Lantus that is probably going to be injected about 9 or 10pm when James goes to bed. You will need to keep in mind that some of the bolus injected at supper will still be a bit active if you chose to use it, so you would need to use trial and error and reduce the Lantus and then test bg levels so that 3-4hrs later, James's bg levels are all ok.

Another way round your situation is for James to eat more carb at teatime with the bolus and then less at supper (about 10-20g carb), and reduce the Lantus down. That way his bg levels will be better balanced and he will then start to gain some weight.

What Quick acting insulin does James use?

What sort of BG's would James normally expect, perhaps we can give more ideas to where the problems lay..

Ideally if bloods go above 12-14mmol/l you should be checking for ketones in the urine, there is a medical term for diabetic's who keep their blood glucose high to lose weight or maintain a low weight, called diablemia..

But don't beat yourself up for every hypo or high, at the end of the day diabetes is one of those things that likes to keep us on our toes, by throwing an hypo or high without any explination at all..