Any harm in no dinner?

[Spearmint]

Due to behaviour my daughter has ended up going to bed with no dinner tonight.
She had her normal amount of Levemir at 6:30pm which is normally done beween 5:30-6:30pm.

Is this likely to cause any problems?

 

[Osidge]

Hi Spearmint

I am not an expert on insulin but here is an extract from information about Levemir:

"Carry a reliable source of glucose (such as tablets or gel) to treat low blood sugar, which can occur if you take too much insulin, skip a meal, or exercise too much."

As it mentions skipping a meal, I guess that there may be a possibility of a hypo situation. I hope that one of our insulin users can let you know more.

Hope this helps.

Regards

Doug

 

[josie38]

Did it cause any problems. As the Levemir is a long acting one you were right to give it. Skipping a meal with Levemir may not give a hypo.

Let us know how her sugars are.

Josie

 

[leggott]

Strictly speaking the levemir if accurate should be covering your daughters back ground insulin requirements. So, skipping a meal should not make any difference. Having said that, Levemir does not always work consistently and sometimes the boluses given throughout the day make up for any shortfall that the levemir does not provide - if that makes sense! Often children have snacks throughout the day and if the fast acting insulin can take 4/5 hours to finish working, there is never a period in the day where there is only slow acting insulin working ( except overnight).

Hopefully she was ok overnight and this will help you determine whether the levemir dose is accurate. Let us know what her reading was this morning.

 

[jopar]

She should be ok if her background insulin is set correctly, but it's always wise under these circumstances to do a couple of extra checks of the BG overnight, not will it ensure she's fine but will give you some useful data to how well set the levimer is over night..

Leggot is right in many ways, but not so much that the levimer isn't consistant it our bodies that aren't consistant our liver will driblle gluose into the blood stream at verious amounts at different point of the day and injecting levimer once or twice the day it can always change to match the troughs and peaks of the basal line be cause by the liver delivering glucose in the blood stream..

 

[Spearmint]

Thanks for the replies

I promise i am not an evil mum, that is the first time they've had no dinner.

Well it was an interesting unplanned experiment which i am going to continue today by testing hourly and delaying lunch.
I thought i had got her doses and ratios sorted out but i keep getting lots of days where they just don't work so i am now wondering if her body has sort of recovered due to the high amounts of Levemir and now she needs less???
The 'bad days' tend to be when she has had more carbs for lunch or dinner which makes me wonder if the Levemir has been tackling some of the food and she needs less Levemir and more Novorapid???
She only has carb free snacks or sometimes something which is 5g.
We are staying in this week so this is a good opportunity to experiment a bit!

I will post her levels for yesterday and today, would love some opinions please.

Mon:
08:02 - 12.8
08:30 - 9L, 4+1.5NR, 41g carbs
11:00 - 13.8
13:00 - 6.1
13:15 - 4NR, 50.4g carbs
15:50 - 8.9
17:30 - 8.1
18:30 - 20L
19:30 - 5.9
22:10 - 3.9, 21g carbs (haribo and biscuits)

Tues:
02:00 - 8.3
08:00 - 5.9
08:30 - 9L, 4NR, 41g carbs
10:30 - 6.8
11:30 - 4.5, 11g carbs (haribo)
12:00 - 5.4
12:30 - 8.2

 

[leggott]

Your daughters blood sugar dropped continuously from tea time right through the night and she had not had any novorapid at tea, which indicates levemir on the high side. You gave her 21 g snack at night which is quite a large amount and it would be interesting to know how much 5g of carb takes her bs too. I know all kids are different but 21g of carb given to my daughter would increase her blood by about 13mmol.

Might be worth doing some more fasting to get a clearer picture of what is going on and speaking to your DSN before any changes are made.

 

[Spearmint]

I think punishing a diabetic by withholding food is not on.

However - if some good has come out of it (adjusted doses, etc...) then it's not all bad, eh?

Sorry but she has pushed me to the absolute limits lately, she knocked her 6 year old sisters 2 front teeth out on thursday evening - all over who was going to tidy up what in the bedroom

The reason her and her older sister got no dinner is because when it was cooked i asked the pair of them to clear up the mess they had made in the kitchen so i actually had somewhere to weigh and dish up their food, they both refused so i put the dinner back in the oven, turned it off and told them to dish their own dinner up after they had cleared their mess up.
Neither of them cleared up and neither of them put their dinner on their plates - that is why she ended up going to bed with no dinner....

 

[Spearmint]

Your daughters blood sugar dropped continuously from tea time right through the night and she had not had any novorapid at tea, which indicates levemir on the high side. You gave her 21 g snack at night which is quite a large amount and it would be interesting to know how much 5g of carb takes her bs too. I know all kids are different but 21g of carb given to my daughter would increase her blood by about 13mmol.

Might be worth doing some more fasting to get a clearer picture of what is going on and speaking to your DSN before any changes are made.

That is what i was thinking too, the nightly levemir was increased to try and stop big rises in her levels from when she went to bed at 7:30-8pm and when i went to bed at 10-11pm as they then stayed high all night BUT i have recently discovered that giving novorapid after the evening meal instead of before the evening meal stops or lowers that big rise.

Well....when she first started MDI, experimenting found that 10g of carbs rasied her by 2 but this could now have changed.

Thanks for the advice, i am tempted to try a low carb dinner tonight, drop the levemir slightly and do more frequent testing overnight.

 

[iHs]

Hi Spearmint

Everything to do with MDI is trial and error. Like Leggot said, yr daughter's levels dropped a fair bit so it does look like you need to reduce the eve dose of Levemir down. I would just do this by 1 unit so instead of 20u use 19. You might need to alter the insulin to carb ratio for the eve meal if she eats tonight, but you won't know until you test her bg levels later in the evening whether your calculation has been ok.

Good luck, you are slowly getting there and learning from mistakes

 

[leggott]

The basal bolus regime is designed to mimic the pancreas so it shouldn't matter that a meal is skipped, or an extra meal / snack is consumed. This is the whole point of this regime and enables a more normal eating style.

I have three children to feed and my kids will very occasionally go without their evening meal if they don't like it. It doesn't do them any harm at all and in fact teachers them good behaviour and that they should not be fussy. Your daughters bg was fine at tea time and you had checked this before withholding her tea. So, as far as I'm concerned you did what you needed to do.

Please don't apologise, life as a diabetic parent is hard enough! Still, I'm sure there will be a cure for this in her lifetime, it's just a shame there probably won't be one for people's ignorance!

 

[josie38]

Hi,

Patch - she wasn't punishing a "diabetic" she was punishing her daughter for misbehaving.

Spearmint - I think you did the right thing. As a parent myself i know how hard it can be. Children, diabetic or not, need to learn boundaries and right and wrong. If it didnt do her any harm then you have nothing to worry about. At least it has shown now that her levemir may be too high and you can find ways to work it out.

Best of luck hun and let us know how you get on with it

Josie

 

[leggott]

Patch, I don't understand why you would want to try and make fun of this situation. Surely as a diabetic you would want to help a parent in dealing with these challenging issues.

It is not just the day to day management of a child that is tremendously hard work, but the emotions that come with dealing with the fact that your child has this condition which could affect their long term health and life expectancy.

I am here to offer advice and support and would like all other members to do the same.

 

[jopar]

spearmint

I did have a chuckle when I read your discription on why they went to bed without tea... Been their as a mum of 3 my self.. They made their choices and can't moan about not having tea :lol: :lol:

It does seem that her levimer may be out, have a look what happen's when you reduce, if you start facing high's in the morning to sort out the lows in the evening, it may be that you might fair better with a split the levimer into 2 injections, am&pm so that you can adjust better for the different period of time..

@Patch..

Spearmint didn't with hold food from either of her daughters, they chose not to dish it up their problem not Spearmint...

But if she had chosen to withhold it, she has acted totally responably as she did ensure that her daughter blood sugar levels were monitored and treated an hypo..

Kids have to have rules and bounderies, whether they are diabetic or not!

 

[Patch]

It's like taking cruthes away from a kid with a broken leg.

Cruel.

 

[Tumble]

My mum would have done the same thing to me as a kid. My understanding is that when you carb count you take the required amount of insulin for the amount of carbs consumed, so missing a meal really wouldn't be an issue. Tough love seems to be a thing of the past, well done for sticking to your guns!

 

[pianoman]

Are you a parent Patch?

Is your concern to do with withholding food from a person with diabetes -- who I assume is otherwise well controlled and still receiving adequate nutrition and insulin?

Or do you feel that this is inappropriate discipline for any child - after all surely we should not treat children with diabetes any different than their peers?

 

[Patch]

I don't feel that it is an inappropriate discipline for a non-diabetic child. I imagine it's quite a good deterent (would've worked on me...)

Surely not suitable for diabetic, though. ESPECIALLY if the insulin was still administered.

 

[RussG]

I don't think it's our place to judge the parenting approach in this instance, Patch. I seem to remember you became quite touchy yourself when people questioned some of your choices.

Spearmint asked a question about T1 insulin dosage and food and has since made it clear that it was not a case of withholding food.

 

[pianoman]

The basal insulin was administered (which is required whether a meal is taken or not) but if I read correctly there was no meal-time bolus given?