Help with changing doses please

I think my sister caused the lows. She gets Khaleb so stirred up and he exhibits some behaviour that I would prefer to discourage. She usually only visits for a short time but she was here all afternoon. I've reduced his Levemir a bit tonight anyway, just in case. Sometimes Khaleb has these weird lows a few days before he comes down with an illness. He's been fine all day today and no unusual bsl's, high or low.

Khaleb's hba1c was 6.2 and his thyroid levels were fine so I'll just keep going the way I am. The stupid doctor thought his control was wonderful but then went on to say he should have a 50:50 split of his total Levemir and Novorapid and also thought I shouldn't correct some of the high's and should only correct them at meals. I don't really think I could please him on either of these points especially if I left him high overnight. If I took him to daycare with a big correction going through his system and he was still highish at 10am they might consider not giving him all of his morning tea and they would be in for a big hypo. Some of the things doctors suggest aren't practical out in the real world.

Don't beat yourself up too much trying to achieve really good levels. No sooner do you get it right and then something changes and not every day will ever be the same anyway. I've met adults who ate the same thing, at the same time every day and still their levels had fluctuations. Sometimes I find Levemir a bit annoying that it hasn't really got a flat profile so you have to allow for its ebb and flow.

Where you wrote that "NR has less effect at night" do you think the dinner was low GI and maybe she was still going up at that point? I actually find Maccas to be high GI (I think there is quite a lot of sugar in the buns) and give early NR but it might depend on what you order and some trial and error. I will say one thing for Maccas and that is that their nutritional panel seems to be the most accurate of take away food places. Other places are really hit and miss. Will love to hear how you got on.

Well Khaleb was a bit high last night after lowering the Levemir so I'll just go back to doing what works and be more careful when my sister turns my son feral.

I asked the other parents of our local group what their kids were on in the way of long/short acting insulin and plenty were on 60:40 like Khaleb and not a single one had a 50:50 split. :lol:

The other complaint at clinic was that Khaleb is on high amounts of insulin but I put this down to his sudden growth and the Winter colds he lives with at this time of year. I could say it will be reduced in Summer but that could depend on whether he has grown more. At the moment he is on 1.3 units per kilo but he has always been on the higher end of the scale (1 to 1.2 units per kilo). He isn't nearly as active as kids without a disability and he can't chew hard foods still so a lot of his food is carb based in some way although I try to keep it balanced within the rest of his diet. I have taken to making sago and polenta as fillers for some of his food and also use them as thickeners so that food sticks on his spoon so he can self feed (well try to self feed). Just one of the many challenges I face during the day.

Well, I already replied to this once and lost it due to my internet connection. It has been a bit dodgy but it might be because of the Census on here last night.

It can be such a gamble sometimes deciding on an insulin dose when something different is going on either with food or activity. I think something I would have done differently with your Thursday afternoon is to not have given the correction dose at 6.30pm because of the previous insulin dose at 4pm. I find insulin stacking has the effect that you experienced of causing hypos that you treat and then you have to wait and see if they go up and up later on. Hopefully she did stay steady overnight. You might look at changing your correction ration in the morning also even though the carb ration must be quite good.

Khaleb is settling back to normal now and was 8.3 this morning and I did not check him during the night. When he wanted more food before bed I only gave him some sugar free jelly with a spoonful of yogurt. It has been really off putting when he wants to eat before bed as by the time I check him at 10pm I can't tell if he is going up still or down. Most frustrating for me getting sleep.

Well, better get on with the day. So much to do and so little time. My garden is getting very weedy with Winter coming to an end and if I don't get on top of it soon it will end up a BIG job.

I haven't been reading the whole thread but wanted to say incase you didn't already know that pasta usually sends most people low within 2 hours of eating if Novorapid is injected as normal. If I deliver all of Jess' insulin as one dose at meal time for pasta I can guarantee a low within 2 hours of eating and the low will be a difficult one to correct for another hour after that. With injections you can try splitting the dose taking some insulin at meal time and then another injection an hour or two later. How much you split and how long apart all depends on the person so you'll need to experiment. Pizza and rice dishes like risotto or paella are similar to pasta with their effect on BG.

:lol: :lol:

I often wonder what makes the difference sometimes too. Can put it down to a blue moon and a unicorn some of the time.

I find NR works for 3-5 hours but certainly by 2 hours it has made the biggest dent it is going to. Same with Khaleb in the morning. It seems to take longer and he needs a greater amount.

I don't have much trouble with pasta but it is mixed with a fair amount of other food so isn't exactly a 'pasta dish'. I got a 6.1 after Khaleb having homemade pizza last night. He gets 30gm carb in the 100gm of pizza and then I give him 15gm carb in a fruit puree so he doesn't hypo and I don't need to give him 2 needles. I gave him a little yogurt before bed so I didn't need to get up and check him in the night. He woke with bsl 10mmol so he would have been fine without what I gave him but it was so nice to sleep.

I can still do badly with hot chips from any of the take away joints except maccas. Sometimes it works out and other times it is just a mess. It would be better if he had it for lunch than dinner.

It is really great that you are not the food police. I also let Khaleb eat just about anything that he is capable even if it isn't always at suitable times. If he sits and shares crisps with my other so in the afternoon I just add the carbs to his dinner because we eat fairly early (5pm about). Khaleb makes me laugh though, he goes and gets a plate out the cupboard and sits in on the scales for me to get him food. :lol:

We've had a good day too!

Hope you have a good time away and don't see anything too 'out there' on the meter. Khaleb's still on best behaviour. He's been steadily going down until about 3am and then going up slightly by the time we get up so I've gone back to getting some sleep. This is about as good as it gets for us on MDI as to avoid hypos I will see Khaleb's morning bsl around 8-10mmol even though he has been 5-6mmol for much of the night. His daytime levels have been good also. I was a bit tentative doing his bsl before dinner as I expected he might be a bit high but got a 6.2 .

Take care.

For pizza last Khaleb had his usual fruit dessert and had a good night even though I did get up and check him at about 1.30am. I find it hard to get to sleep when his blood sugar is on the lower end of the scale even if I know the carbs are there and he will be ok. I get really tempted to give him an extra snack but if I do that I just end up having to correct him later. I know the food is just low GI and higher in fat and I should just wait and see. Lucky most of our other meals are a bit easier to manage.

Glad you had a nice time away. What happened with your split dose for the pizza? Did the insulin stacking just cause lows or did you end up too high because the first dose wasn't enough?

If it's any help Jess has a 30% 70% split for pizza. 30% straight away and the remaining 70% delivered over 3 hours. Your daughter doesn't have a pump so it's a bit more difficult to deliver the remaining insulin over a period of hours but perhaps try the remaining portion of the insulin an hour later. Keep a record of her readings and then tweak each time until it seems to work for her. It does take a long time and a lot of testing. Jess got her pump in Jan and we're still trying to nail down pasta so that it works best. It's a lot of trial and error.

I might be a bit lazy and not inclined to do split doses so sometimes if he Khaleb is in a good place before the meal I just delay the insulin for 1/2 hour after the meal for the fatty chips and the like. I always find I get in all sorts of trouble stacking insulin and even though splitting is the right dose for the carbs I still end up with 2 lots of NR peaking for a short time that is just a bit dangerous for Khaleb being so little. The pump certainly has it's advantages when it comes to fine tuning.

You're next trial will hopefully prove more successful. Getting sleep is as important as good levels and safety overnight.

I do wonder why you are told not to count all carbs. I understand some veg are so low it isn't worth it but by the time a plate is 1/2 to 3/4 veg they soon add up. I count all the carbs but may round up or down depending on the day. If I count 37gm carb and Khaleb's bsl was 5mmol I'd count it as 35gm and if his bsl was 9mmol I'd count it as 40gm. This isn't practical for pumps but works well for Khaleb.

SophiaW - Do you count all carbs for the pump or leave out the veg other than potato, pumpkin?

I count absolutely every gram of carbs but this is something I've done since we started carb counting on injections. I think because I struggled so much to get consistent readings with Jess when she was on injections I didn't dare guess anything when it came to carbs (apart from those rare occasions when we eat out and I have no other option). Even broccoli which is 1.8g of carbs per 100g I still count and add that in, it's a habit now and not going to do any harm. I agree with what you say about having a plate full of veg, Jen, it soon adds up and with Jess even just 4g of carbs can make a difference in BG readings. Jess has a lot of vegetables on her plate so it can often be as much as 8g of carbs, that could be a difference in BG of 6 mmol/l.

When we split a dose of insulin for pasta or pizza, we only split the insulin needed for the pasta or pizza, not the rest of the meal. So for example if Jess is having pizza with a salad and some orange juice, we'll split the insulin for the pizza but deliver the insulin for the orange juice and salad as a full dose all at once. A pudding afterwards would have all the insulin delivered at once too, not split unless it's a type of pudding that needs splitting. Also, if the BG reading needs correcting, we deliver the insulin required for that all at once rather than including it in the split.

The other thing I want to mention is that with pasta we've struggled to get a split dose to work well, even with the pump. I have recently had better success now that I'm using a different amount of carbs per 100g of cooked pasta. In the past I used 30g per 100g of cooked pasta, that's what most of the books and internet sites suggest. I've now changed that to 25g per 100g and this week we had much more success. I don't serve her more than 200g max of cooked pasta in one serving. That extra 10g of carbs meant more insulin which was making her go hypo. Now that we've reduced the carb value of pasta we had our first pasta meal without a hypo at some point whilst the insulin is active, hooray!

Totally agree! That 4 or 5 gms of carbs in the veg can make the difference between staying in range or out. Depending on the meal I might be looking at another 1/2u insulin.

Do you find the lables on your pasta give an amount per 100gm for cooked pasta or raw? I have found both here but the most accurate was one that had raw pasta values. After I cooked the pasta I then re-weighed and worked out the carbs/gram and got 22gm carbs/100gm. I think I cook pasta a bit more than most so it has a higher amount of water. I worked out the carbs for a child with a pump coming for dinner and he had exactly the same bsl before the meal as 2 hours after. I was quite proud and confident to look after the child the following weekend.