Rokaab

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@CoolUserName one thing I will say is that do not expect him to be under 10 mmol/L all the time, for most of us that would be nigh on impossible, and if he is expected to be under 10mmol/l at all time, he is being set up for disappointment

T1 control can be chaotic even at the best of times, one day can be completely different to another and the teenage/puberty years are likely to be even more chaotic as hormones are running rampant (you shoudla seen my HbA1c through my A-levels years, wasn't very good)
 
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StewM

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Sure there is variability, but if you are able to understand dosing bolus and basal you are mostly stable. Understanding how insulin works and some basic physiology are the cornerstones of our treatment. This is what I understood from DAPHNE.
I don’t agree with how you’ve chosen to frame this. I based my objections to DAFNE’s assumptions based on knowledge of how Insulin works. It is precisely by following my Blood Sugars and making adjustments that I and other have come up with alternative measures which work.
 

ert

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I don’t agree with how you’ve chosen to frame this. I based my objections to DAFNE’s assumptions based on knowledge of how Insulin works. It is precisely by following my Blood Sugars and making adjustments that I and other have come up with alternative measures which work.
Alternative measures to insulin? Unfortunately, I don't have any other options but to take insulin.
 

CoolUserName

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I have similar issues. I can't tell you what to do for your son obviously (against the rules) but if I have a meal with carbs that I KNOW from previous experience is going to raise me to 9/10 in the first hour and then after 2 hours is going to drop rapidly to hypo levels, I take a unit or two less at the start of the meal. Yes, it may mean a rise to 10 but if I know that rise is only for an hour or so then that's fine, generally speaking it's the spikes that STAY up for hours on end that can cause the problems. You will NEVER get a carb/insulin ratio that is 'spot on', it is not possible. A non diabetic's pancreas releases the exact amount of insulin at the exact right time every second of every day, even using the correct amount of basal is tricky as it pops into action at any given moment. Add that to the fact your son may still be in the honeymoon period thus still producing some of his own insulin and you can see why it's difficult. Also, injected insulin can take a different path to its destination for every injection, sometimes it takes the scenic route (takes forever to work) and sometimes it gets there speedily. If I have a low carb meal of course then the initial rise does not happen or is kept very low, that's another option. One other thing re his libre, with them being 15 minutes behind, do you finger prick when it shows very low (hypo) or very high (hyper)? x

Hi, yes, he finger pricks if the Libre show hypo or hyper and sometimes the Libre is wrong, but most of the time it is correct or broadly so.

I hear what you're saying re: spikes. If he does spike up to 9 or 10 mmols it is usually for about 10 minutes at the most then it is straight back down (unless he's eaten something like fish & chips which kept it up for longer)

Last night for tea he had a meal of about 70g carbs. Pre meal his BS was 4.8, after eating his BS rose to < 6 and then he went low at about 1.5 - 2 hours after eating. We've reduced his insulin ratios to see if that helps. He snacks constantly in between meals up to about 13g carbs each time with no insulin so he doesn't go low.

Soon after he was diagnosed 4 months ago he went into a honeymoon period and he needed less insulin. This levelled off for a few weeks and now he seems to be entering honeymoon 2.0 where he needs even less insulin. I assume this is just what happens in some people??!?!
 

CoolUserName

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The fact that the OP mentioned that the problem with his son's glucose levels only began recently, makes me wonder if the rising temperatures af this time of year are making a difference to his insulin's action. My levels drop like a stone as it gets warmer. My consultant says that in warmer weather insulin 'potentiates' faster, ie it works faster and more efficiently. The result can easily be a hypo.

There are so many variables to consider that if can make our lives difficult. Some people need more insulin in warmer weather. We are not all the same.

That could be an option, thanks - although to be honest it's not particularly warm here at the moment. I will keep it in mind though.
 

KK123

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3,967
Type of diabetes
Type 1
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Insulin
Hi, yes, he finger pricks if the Libre show hypo or hyper and sometimes the Libre is wrong, but most of the time it is correct or broadly so.

I hear what you're saying re: spikes. If he does spike up to 9 or 10 mmols it is usually for about 10 minutes at the most then it is straight back down (unless he's eaten something like fish & chips which kept it up for longer)

Last night for tea he had a meal of about 70g carbs. Pre meal his BS was 4.8, after eating his BS rose to < 6 and then he went low at about 1.5 - 2 hours after eating. We've reduced his insulin ratios to see if that helps. He snacks constantly in between meals up to about 13g carbs each time with no insulin so he doesn't go low.

Soon after he was diagnosed 4 months ago he went into a honeymoon period and he needed less insulin. This levelled off for a few weeks and now he seems to be entering honeymoon 2.0 where he needs even less insulin. I assume this is just what happens in some people??!?!

Hi there, that 'spike' of 9/10 for ten minutes is NOT a spike, it really isn't. Even a non diabetic can hit that number and the fact it is for ten minutes only means that it cannot be counted as a 'long term damage inducing' issue. I know it's hard but if your son is having to regularly eat snacks in between means he is eating to the insulin and not the other way round. I get that sometimes to do it that way is an option but it could lead to more instability and weight gain. Although they say a snack of under 15 carbs should be covered by basal everybody is different, it could be that the accumulative effect of those snacks are also contributing to everything else. You are clearly a great parent and you are helping him adjust in absolutely the right way, trial and flipping error. The honeymoon period definitely can keep ebbing & flowing, I'm still in mine 3 years later. x
 

CoolUserName

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Messages
52
@CoolUserName one thing I will say is that do not expect him to be under 10 mmol/L all the time, for most of us that would be nigh on impossible, and if he is expected to be under 10mmol/l at all time, he is being set up for disappointment

T1 control can be chaotic even at the best of times, one day can be completely different to another and the teenage/puberty years are likely to be even more chaotic as hormones are running rampant (you shoudla seen my HbA1c through my A-levels years, wasn't very good)

Hi, yes, I completely understand that his BS won't always be under 10mmols. It has very occasionally go up to 11 or even 12. The reason I used 10 is that the guidance seems to be keeping your BS between 4 and 10 if you have type 1 Diabetes and that is the target he has been set by the hospital team :)
 
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CoolUserName

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Hi there, that 'spike' of 9/10 for ten minutes is NOT a spike, it really isn't. Even a non diabetic can hit that number and the fact it is for ten minutes only means that it cannot be counted as a 'long term damage inducing' issue. I know it's hard but if your son is having to regularly eat snacks in between means he is eating to the insulin and not the other way round. I get that sometimes to do it that way is an option but it could lead to more instability and weight gain. Although they say a snack of under 15 carbs should be covered by basal everybody is different, it could be that the accumulative effect of those snacks are also contributing to everything else. You are clearly a great parent and you are helping him adjust in absolutely the right way, trial and flipping error. The honeymoon period definitely can keep ebbing & flowing, I'm still in mine 3 years later. x

Thank you that's good to hear re: the 'spikes'. I just want to help him stay as healthy as possible and fortunately he is a very sensible person and humours my clucking around him :)

Hopefully reducing his ratios will help as I agree, eating to 'feed' the insulin isn't great, no matter how thin he is and how much he enjoys snacking it implies a lack of control over the situation which worries me in case he is snackless and going low.
 

oldgreymare

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Messages
537
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Commuting, overcrowded spaces, especially after the arrival of covid-19...
The fact that the OP mentioned that the problem with his son's glucose levels only began recently, makes me wonder if the rising temperatures af this time of year are making a difference to his insulin's action. My levels drop like a stone as it gets warmer. My consultant says that in warmer weather insulin 'potentiates' faster, ie it works faster and more efficiently. The result can easily be a hypo.

There are so many variables to consider that if can make our lives difficult. Some people need more insulin in warmer weather. We are not all the same.
LOL, I typically need less insulin when temperatures rise, but not sure I think April in England this year qualifies!! :coldfeet:
 

oldgreymare

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537
Type of diabetes
Type 1
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Pump
Dislikes
Commuting, overcrowded spaces, especially after the arrival of covid-19...
Hi, yes, I completely understand that his BS won't always be under 10mmols. It has very occasionally go up to 11 or even 12. The reason I used 10 is that the guidance seems to be keeping your BS between 4 and 10 if you have type 1 Diabetes and that is the target he has been set by the hospital team :)
@CoolUserName Until recently most diabetic care focused on HbAc1 targets, but as these are 3 month weighted averages, they do not provide any insight into BG variability. With greater use of Libres and CGMs, UK targets for type 1s are slowly being adjusted to concentrating on "time in range". But controlling T1 is tough, and I understand that more than 70% TIR is considered a good first target. Thankfully the challenge of volatile puberty hormones is a long way behind me, but still my insulin ratios are massively sensitive to day to day variations in my lifestyle - did I have 1-2 days of more carbs (up to 100 g/day), did I take long walks 2 days in a row?, an intense morning of emails and black coffee, emotional stress, etc, etc, all mess up calculating any insulin ratios for a given point in time. So I I use these as a starting point. Also vary time of injection depending on how quickly I think the meal will spike me.

But because I use a CGM, I can compensate by multiple small correction doses if staying high - definitely not recommended if you do not have access to a libre or CGM. Pragmatically while I do have lows these are typically under 3% of the time, but make sure I always have glucotabs to hand. Easy enough to carry in a pocket.
 
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CoolUserName

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@CoolUserName Until recently most diabetic care focused on HbAc1 targets, but as these are 3 month weighted averages, they do not provide any insight into BG variability. With greater use of Libres and CGMs, UK targets for type 1s are slowly being adjusted to concentrating on "time in range". But controlling T1 is tough, and I understand that more than 70% TIR is considered a good first target. Thankfully the challenge of volatile puberty hormones is a long way behind me, but still my insulin ratios are massively sensitive to day to day variations in my lifestyle - did I have 1-2 days of more carbs (up to 100 g/day), did I take long walks 2 days in a row?, an intense morning of emails and black coffee, emotional stress, etc, etc, all mess up calculating any insulin ratios for a given point in time. So I I use these as a starting point. Also vary time of injection depending on how quickly I think the meal will spike me.

But because I use a CGM, I can compensate by multiple small correction doses if staying high - definitely not recommended if you do not have access to a libre or CGM. Pragmatically while I do have lows these are typically under 3% of the time, but make sure I always have glucotabs to hand. Easy enough to carry in a pocket.

Thank you that's really helpful.

I'm only just starting to appreciate how things can fluctuate from day to day, week to week etc. (sometimes with no apparent reason) and I have to say it can be frustrating, but I guess you already know that!!!