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Anxious on one week on Basal Bolus Regime

Discussion in 'Type 1 Diabetes' started by stoney, Feb 19, 2011.

  1. stoney

    stoney Parent · Well-Known Member

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    Can anyone give me advice on what I may be doing wrong.

    Yesterday, 2 hours after James having his tea/dinner his BG was 11, this was 8pm. In the past at this time of night he would always have supper, banana, cereal and toast. Never ever tested him before bed and off he went. Morning readings were nearly always good up until recently, hence the new regime. So he still wants to have his usual supper. His regime does not call for novorapid before supper but has 16 units Lantus before bed.

    He woke up at 6am and wanted to do his BG, I was shocked to see it was 18.8. He went back to bed and got up at 8.am with a reading of 14.2. He did a correction dose, plus his dose for breakfast which is always the same breakfast. His regime is 1unit/10gms carbs.

    He then went off to football. Dad could see that he was very lethargic and he did his BG again at 11.23 and his reading was 19.4. Did it again at 12.35 in readiness for lunch and it was 14.0. Did another correction dose plus lunch and am waiting to see in 2 hours from that what his reading will be then. He has just come to me now and said that he is starving, but has only just finished lunch.

    When we started the regime the diabetic nurse said we do not need to give a dose of insulin for his supper which she did say should be light. But here's the thing, he does like to have supper and quite frankly would like to put on a bit of weight so cutting back on his supper is not going to help.

    Would there be a problem during the night if he took another dose of insulin to cover his supper. I am afraid to do this and wonder what other people do. We will be going to see the nurse next week but wondered if anyone had an answer for me.

    Thanks in anticipation :?
     
  2. Dustydazzler

    Dustydazzler Type 1 · Well-Known Member

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    Hi Stoney,

    Regarding eating supper and insulin. Take the Lantus out of the equation for now. Lantus isn't supposed to be helping with food he eats, it simply helps get rid of glucose produced by the liver so if Lantus is correct it shouldn't be helping to get rid of sugar when he eats.

    I see you carb count at 1u to 10g of carbs. In my opinion I would use this carb ratio for his supper and give him a bolus for the food he eats. I don't know why your nurse would tell you not to bolus unless for example you were having lots of problems through the night with hypos or something.

    If you are worried about trying this, you could always err of the side of caution for the first time and just give him half the insulin you think he needs. Then if he was to wake up high you know it wasn't enough and then you could go for that 1:1 ratio you use in the day. Have you done the DAFNE course? This would you understand when and how much insulin he needs. It helps work out if Lantus is correct and then factors in exercise and illness etc. Would be good for you on this new flexible regime.
     
  3. donnellysdogs

    donnellysdogs Type 1 · Master

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    I agree with dustydazzler-to be quite honest, if the supper was a small snack (uner 10g carb) I wouldn't bolus , but anything above 10g of carb I would always bolus for at any time of day. I would try it. It may be that in addition you may have to alter the basal at some point, but waking to levels like you mentioned is not right.
     
  4. iHs

    iHs · Well-Known Member

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    Hi Stoney

    Looking at yr msg yr son is eating about 65g carb approx at supper with no bolus insulin to cover it so I'm afraid that you will either have to drop the supper to about 10-15g carb or do a bolus to cover 55g . You'll then have to start to test yr son's bg levels approx 4hrs after the Lantus has been injected just to see what effect the Lantus plus the bolus is having. Some consultants don't like people using bolus plus basal at bedtime because of the risk of hypo but with the amount of carb yr son is eating, then some bolus is going to be needed to cover it.

    Exactly what time is supper and also what time is evening meal as there needs to be about a 3-4hr gap between them. Also it looks as though the 1u to 10g carb is not quite correct so by you doing loads of bg tests 6 times a day, you'll be able to figure out whether you will need to alter the carb ratios from 1:10 to 1:8 so that 2hrs after yr son has eaten, bg levels will be a bit lower and then keep adjusting the ratio so that healthy bg targets can be acheived. The carb ratios unfortunately won't be the same all day long, at different times of the day they will need to adjusted and it's only by doing bg tests that you'll be able to find all this out and making adjustments.

    Have a look at this thread viewtopic.php?f=19&t=18553 It explains about carb ratios and corrections
     
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