BG 28 Now How much insulin?

[debbietowns]

Hi

Bg now is 28. No ketones.

My 12 year old has been recently diagnosed but hasn't had any insulin for a couple of months. The past few days he has had higher bg's so we have started some insulin as correction doses (Novorapid). He is probably in honeymoon as sometimes he doesn't need any insulin at all. Its a bit of a juggling act! Being tested for genetic mody types as he has lots of hypos even when on no insulin.

I need to know what the general rule is for deciding how much insulin to give. We seem to think 1 unit will bring it down by about 3 or 4 points. Does that seem about right? I just gave hime 2 units as i am scared of night hypo's! But probably needs some more? (Can't find my notes from a few months ago at the moment).

Also, when calculating his carbs in his meals is it one unit of insulin for 10g of carbs?

By the way he has no ketones but the sugar in his urine is very high.

Thanks
Debbie

 

[leggott]

Hi, It is difficult to say how much insulin is required to bring him down to a reasonable level as each child is different and as he is in the honeymoon period he will probably need a lot less than another child of his age. 1 unit brings my little boy down by around 7mmol but 1 unit only reduces my daughter by around 5mmol. It is going to be a bit of trial & error to start with . You may need to due a couple of test through the night to check if you have got the correction does ok. I would probably air on the side of caution for now, but keep a record of what his bg is and what dose you give. This will help you work out exactly how much he needs next time.

With regard to carb ratios, again these will differ from person to person and sometimes differ at each meal time. I would probably start at 1 unit to 20 grams of carb and adjust from there. leggott

 

[debbietowns]

Hi
thanks for your quick reply. One question.

How quick does it work?

He had 2 units 30 mins ago but his level has gone up to 29!

I think i will give him another 2 units........
Debbie
(ps. Why is it always at night that everything goes wrong!!!!!!!!!!!!

 

[leggott]

Hi, again this varies from person to person, but has usually peaked at around 2 hours, tappering off at that point but can still be working a little up to around 4 hours. I would suggest doing a blood check 2 hours from the last injection. I know it's a pain, but it sounds like you probably won't be getting much sleep tonight from all the worry!!

 

[debbietowns]

Thanks again,

Who needs sleep eh??

Out of interest how high can your bg levels go? I have not personally heard of any over 28??

Thanks for your help
Debbie

 

[leggott]

Hi, It can go over that level, but that level is very high and you do need to get it down as he may start to produce ketones. You will probably find that he is drinking a lot as his body is trying to flush out the excess sugar. Keep checking for ketones and get him to drink lots of water to help. If you can't get it down and there are ketones present, I would speak to the hospital immediately. Ketones can develop quickly and can be extremely serious especially in one so young. I hope you can get the levels down, ideally to below 10 if you can.

 

[debbietowns]

hi again,

We have just decided we will put a film on and snuggle under our quilts and test every hour. So will be extremely tired tomorrow, but i know i won't sleep so might as well stay up!

Thanks
debbie

 

[jopar]

leggots advice is pretty spot on..

Sugar levles can go very high indeed, home glucose meters tend to give a 'high' reading once the BG's reach 33mmol/l partly because above this level they can become very inadquate.. and partly because if you hit these types of BG's you really need seek medical advice..

As to the insulin duration, 2 hours is about the peak, at this point the body as used about 60% of what has been injected, the remain 40% tails of over the next 2-3 hours.. So if you given another correction Jab keep this in mind when calculating his next jab, this will help prevent 'stacking' where you get a sudden drop of BG's caused by 'stacked insulin..

This is important to remember when his levels are getting around the 12mmol/l mark, the higher the BG the resistant to insulin it can be so can need a little more, but the problem is that if you've got stacked insulin, and the resistence falls off, the BG plummets quickly..

A couple of things to watch for that might identify he's struggling and requires medical attention, if he becomes pale, or unresponsive (hard I know at night when he should be asleep) if he complains of stomach pains, feel sick or is sick, his breathing becomes shallow, rapid pulse, is breath smells best discribed as smelling sweet, pear drops, damp straw sort of smell these are the different signs that he may be going into DKA, he could have several or only one... But any concern or doubts, either call the doctor, take him to A&E or get the paramedics out to you..

I hope all goes well, I would give his diabetic team a bell first thing in the morning as he may need more close monitoring, as this could be a sign that his honeymoon period is drawing to an end, and might have to start looking at how you may deal with introducing a different/new regime..

Take care

Jo

 

[debbietowns]

Hi, Thanks for your reply,

His bg has dropped to 7 and feels like its dropping fast so now he is eating a carb snack to get it up again! So he has gone from 28 to 7 in 2 hours on 4 units.

Its ridiculous! I have set my alarm to check every hour now, so i think we have experienced what you described as 'stacking'.

This is so hard. I am sure that he was heading for hypo bgs so now i definately can't go to sleep/

Oh dear,
ZZZZZzzzzzzzzzzzzz

 

[Jen&Khaleb]

Hi Debbie,

Doesn't sound like your having a very nice night.

You'll feel really good when you can correct without bouncing from high to low. It takes time and sometimes patience. As parents we all want a crystal ball so we know exactly how to keep control, but alas, we just find out 3 hours later (or sooner) whether we did the right or wrong thing. After having many a sleepless night when bsl's aren't great I now only do a small correction of an evening, 10pm bsl (before I go to bed), 1-2am check to either do a small correct or give small carb, get up 5-6am. I hate getting up more than once a night and only do it when I have no other choice. Long term broken sleep becomes a real problem. Altering bsl's slowly is considered okay rather than dropping it suddenly.

As to how high bsl's can get, Khaleb's was 86mmol on diagnosis and barely conscious. He was fine 2.5 days before going to hospital. I know another little boy who had a bsl of 106mmol on diagnosis. The hospital had turned his parents away 3 times saying he had a virus. :shock:

Hope your night hasn't been too bad and the you start well in the morning. Lots of coffee!!!

 

[NeedleMagnet]

hopefully helpful (but maybe just reference):

You may inject but you cant expect fast results soon after a carbo intake as that will still be there, he's eaten food he'll be rising BG for a couple of hours depending on the food and the insulin will only stem the rise, to reduce the rise and bring it down would require another injection.

It is also important to inject the right kind of insulin, you want to give him shots of ACTRAPID which is a single fast acting dose rather than mixtard or any long acting insulin. Acrapid will work quickly (new variants within 10 minutes) and will tail off within an hour. If you've only been given a standardised insulin type for your regieme you need to ask the diabetic team to give you a SHORT-ACTING pen which will contain insulin you can give to limit high sugar readings.

You can tell if he's high without doing blood tests by keeping track of when and how often he drinks and urinated. High blood, above 20 or so will cause ALOT of drinking and ALOT of pissing, this is the way many people like myself where diagnosed by wetting the bed from a high of BG!! So if he's pissing alot in the night (every 10 mins to every 40 mins or so) then he's still got alot of ketones and sugars to expel from the blood. This is partly why high BG is to be avoided as this will damage the kidneys if its too regular. Anyhow, for quick proof check his urine, it will become paler and paler the more sugar is in it.

Hope this helps a little, add some background info to your armoury.

 

[Jen&Khaleb]

Monitoring of urine has become quite antiquated with the glucose meters also being able to test for blood ketones. I haven't collected urine at home a single time since Khaleb's diagnosis. I also don't find that urine in kids gets lighter the more sugar is in it. Children get dehydrated really quickly and this tends to make urine darker.

I also don't find Khaleb to have symptoms of a hyper even when his bsl's are in the 20's. They would have to stay that way for many, many hours before symptoms would appear. He would generally be sick for this to happen which would cloud some symptoms of illness with blood sugar issues.

Sorry to disagree with you Needlemagnet but times have really changed.