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Help with changing doses please

S

Spearmint

Well-Known Member
Messages
244
After changing to bigger needles nearly 2 weeks ago, we had 2 good days with normal levels :D
Then went back to pretty much up and down so monday i increased her evening dinner ratio of novorapid then increased the levemir doses wednesday but i am unsure what to change this week or by how much, am thinking of upping the levemir again but not sure that is right :?
DSN is still on holiday for another 2 weeks so thought i'd ask on here for opinions again :)

Breakfast is 1unit per 10g, Lunch and Dinner are 1unit per 15g, Correction doses are 1unit to lower by 4
The weeks reading and doses:

Monday
07:00 - 9.4, 10L & 3.5+1NR
10:00 - 17.4
12:00 - 14.3, 3.5+2NR
15:30 - 6.0
17:00 - 6.6, 14L & 5NR
20:00 - 16.1
22:00 - 11.4
03:00 - 7.7

Tuesday
07:00 - 9.2, 10L & 3.5+1NR
12:00 - 11.9, 3.5+1.5NR
15:30 - 12.5
17:00 - 12.4, 10L & 6+2NR
20:00 - 4.3 (ate haribo 10g)
22:00 - 9.5
03:00 - 11.7

Wednesday
07:00 - 13.4, 11L & 3.5+2NR
12:00 - 4.9, 3.5NR
15:30 - 6.3 (ate small cake)
17:00 - 9.2, 16L & 8+1NR
20:00 - 9.2
22:00 - 12.4

Thursday
07:00 - 9.9, 11L & 3.5+1NR
12:00 - 5.9, 3.5NR
15:30 - 17.7
17:00 - 14.3, 16L & 7+2NR
20:00 - 6.3
22:00 - 8.7
03:00 - 14.4

Friday
07:00 - 11.9, 11L & 3.5+1.5NR
10:00 - 10.7
12:00 - 8.4, 4+0.5NR
15:30 - 11.5
17:00 - 16.8, 16L & 5+2.5NR
20:00 - 13.9
22:00 - 10.6

Saturday
07:00, 9.2
No more results as at her dads

Thanks to anyone who can offer an opinion :)
 
Hi

If this was me, I would increase my eve dose of Levemir up by 1 or 2u and then start testing 2am to see what my bg levels pan out to be and then try and get my fasting bg level to be within 5.5-7.0mmol. Your daughter's fasting levels are a bit on the high side. Once her fasting levels are lower you can then start to adjust her breakfast carb ratio first and then adjust the lunchtime one etc.

What you've got to remember that the more insulin you use as your TDD then that will alter the sensitivity factor. At the moment I take it that daughter's TDD is around 25u so using the 100 rule makes it that 1u will drop her bg level by 4mmol?

What might also help is if you either inject the basal 12hrs apart or inject the eve basal just before going to bed. That way it will probably be easier for you to adjust the insulin to carb ratios better as you'll be using the bolus insulin to deal with the daytime bg levels and the eve basal will deal with the overnight bg levels. By doing this though, it will mean you altering the carb ratios.
 
Thanks so much for your reply :)

Yes i thought about increasing the evening levemir so will start that tomorrow and see what happens.
Is 2am a better time to test than 3am?

Oh i did not know that correction doses change :oops:
That 1 unit drops by 4 was done by trial and error 3 weeks ago!
At the moment totals are 27 units of levemir and approx 12-14 units novorapid.
How do i work out the correction doses now?
I did wonder if they were having the same effect.

She used to do the evening levemir before bed at 8pm but her levels were shooting up to 15-20 at 10pm, discussed this with her nurse and we upped the dinner novorapid ratio but she would then be low at bedtime so changed that back and moved the levemir to dinner time so that it kicked in as the novorapid wore off which has mostly stopped those 10pm highs.
 
Is she having snacks for morning tea, afternoon tea and supper in the figures you posted? Hard to really give some feedback as possibly some carb counting might not be right and you have made a few changes in a small amount of time. This is only what I would do ...

Set the Levemir at what I thought it should be based on the information I have and do not make any changes to it and give it at the same time each day and preferrably in the same body part. Continue with the Novorapid at meals and making corrections as required and then start increasing 1 dose of Levemir at a time and only increasing or decreasing every 3-4 days. I'd also only change the dose 1 unit at a time and keep notes on extra activity or the type of foods that caused figures that didn't seem the norm. It is also going to depend on whether you give Novorapid half hour before the meal, at the meal or after the meal.

I know this is going to take a longer time than hopefully plucking the right dose by accident but in the long term you'll have some good information about how Levemir is acting in your daughter and what different foods need to treated differently even if they have similar carb contents to other foods. You might also find that when the Levemir is at a good point it changes your carb ratios at some meals.

I imagine this is hard swapping from one parent to another and hope you both have a good enough relationship to be on the same page about how to keep levels in check.
 
Hi Spearmint

We too have had a time when James's BG's have not been consistent. I bit the bullet and changed his ratio to 1:8 breakfast, 1:12 for lunch and 1:8 for tea. He also had supper which at the time the DSN said not to inject for, but he was having such high BG's in the morning, that I decided to let him inject for supper with a ratio of 1:20. He then has 16 Lantus before bed. So far so good his BG's are very good with the odd blip which is not worrying me at the moment. He is also at the puberty stage of being 14 so this does not help with his BG's either. So don't forget to take into account the puberty as girls are earlier than boys.

His correction does is as follows: 1 unit; 4mmol

BG Insulin dose
8-11 1
12-15 2
16-19 3
20 and above 4

Good Luck and hope this is of some help for you.
 
Hi Spearmint,

As your daughter is 11 (and I still vaguely remember being 11, but only just!) do you know exactly what she is eating? Is she eating snacks, even fruit and healthy snacks?

Thsi may not be the answer, and you may have thought of this already, or it not the case, but thought I would ask? If she eats a snack, adn why shouldn't she, she will need to have some insulin with it.
 
sugar2 said:
Hi Spearmint,

As your daughter is 11 (and I still vaguely remember being 11, but only just!) do you know exactly what she is eating? Is she eating snacks, even fruit and healthy snacks?

Thsi may not be the answer, and you may have thought of this already, or it not the case, but thought I would ask? If she eats a snack, adn why shouldn't she, she will need to have some insulin with it.
Click to expand...

Food is something i still have a lot of control over!
Breakfast is the same thing every morning, lunch is the same thing every day unless we're eating out at the weekend/holidays, dinner is the most variable meal but everything is weighed and calculated exactly, at the moment she has no snacks as she doesn't need them but if she is hungry after school she will have some ham, cheese and cucumber.

Thanks for the replies everyone, short on time so will reply to the other posts later x
 
Hi Spearmint

I think it might take you a while to work out your exact insulin to carb ratios as at the moment they are not bringing your daughter's bg levels back to being within healthy targets within 2-3hrs.

Regarding corrections, if at the moment you are using approx 40u per day (basal + bolus) you divide that into 100, you will then get a better calculation of how much 1u of bolus will make your daughter's bg level drop by. The idea is though to only use a correction dose now and again. If you can increase the bolus insulin by using a different ratio, then you won't have to use a correction dose.

Stoney's suggestions are good and although Jame's carb ratios might be different to what your daughter needs, it won't hurt for you to experiment and then see what effect the new ratios have.
 
iHs said:
Hi Spearmint

I think it might take you a while to work out your exact insulin to carb ratios as at the moment they are not bringing your daughter's bg levels back to being within healthy targets within 2-3hrs.

Regarding corrections, if at the moment you are using approx 40u per day (basal + bolus) you divide that into 100, you will then get a better calculation of how much 1u of bolus will make your daughter's bg level drop by. The idea is though to only use a correction dose now and again. If you can increase the bolus insulin by using a different ratio, then you won't have to use a correction dose.

Stoney's suggestions are good and although Jame's carb ratios might be different to what your daughter needs, it won't hurt for you to experiment and then see what effect the new ratios have.
Click to expand...

I think it is going to take ages, i had thought that 6 weeks down the line it might be sorted :oops:
Lunchtime is the meal with the least corrections so i assume breakfast might be more or less right.

What is confusing me about the corrections is that sometimes they work and sometimes they don't, some days she comes down to exact level i tried to get down to with the correction dose and other days it is like it has no effect!!
I am still not 100% sure she is injecting correctly tbh.

Well today we had a normal reading of 6.9 at lunch, waking was 14.7, after school 13.7, before dinner 13.0 BUT she had a trial day at the high school she is starting at in september so i don't know if those readings are skewed by emotions or not.
I have tonight increased the evening Levemir from 16 to 18 as it is overnight that i would like to sort out first so i will see what effect that has over the next few days.
 
Jen&Khaleb said:
Set the Levemir at what I thought it should be based on the information I have and do not make any changes to it and give it at the same time each day and preferrably in the same body part. Continue with the Novorapid at meals and making corrections as required and then start increasing 1 dose of Levemir at a time and only increasing or decreasing every 3-4 days. I'd also only change the dose 1 unit at a time and keep notes on extra activity or the type of foods that caused figures that didn't seem the norm. It is also going to depend on whether you give Novorapid half hour before the meal, at the meal or after the meal.

I imagine this is hard swapping from one parent to another and hope you both have a good enough relationship to be on the same page about how to keep levels in check.
Click to expand...

I have increased the evening Levemir only and will see what happens over the next 3 nights before i change anything else.
I have been filling out food diary sheets with all carbs listed and calculated, times of meals, times and results of tests, insulin doses and correction doses.
Novorapid is usually 5 minutes before meals.

Nope and i think this is part of the problem!
Her dad is type 1 himself but poorly controlled, has never carb counted in his life, has no idea about the different types of carbs and their effects or anything.
When she was on premix he refused to stick to her mealtimes and never reminded her to eat her snacks which caused no end of problems, he would not stick to any of the carb amounts given for her meals and snacks either.
She wanted to weigh and measure her cereal and milk like she does at home but he told her there was no need and just poured the cereal and milk into the bowl and gave her insulin for the amount of carbs listed on the box for a serving :roll:
He won't do any of the tests i ask for, i only wanted mid morning, mid afternoon, bedtime and mealtimes - i did not expect him to test at 10pm and 3am like i do but he will only do mealtimes as he doesn't see the point in the others even though i explained why.
Yesterday he dropped her off in the road 20mins and just drove off, didn't even wait around to make sure i was home and she got in ok :x
 
Oh how sad. Khaleb's dad left us when he was 10 weeks old. That was 8 weeks after getting the diagnosis he had Down syndrome. We don't speak at all and I live several hours away. I would hate to have to hand over blood sugar levels to someone else that I know wouldn't take the interest and care that I do to avoid the highs and lows. Just regurgitating everything to daycare so he can be there for 3 hours before I turn up for the lunch time insulin is bad enough.

I suppose you are lucky that your daughter is old enough to be taking some care of herself but she needs to be allowed to have the facilities to carb count and weigh food. It is so much easier getting the carbs right even though some foods will throw things out. Must say that I gave Khaleb kiwi fruit and got a HI not long ago. Don't know if my carb counting book got it wrong or some other freak of nature played a part. I repeated the experiment with a smaller amount at a different time and not had a problem.

The only time I have trouble with correction doses is that I can only correct for the figure on the meter but there is a chance he is actually still going up for whatever reason. I then go back further to see what I fed him or if he is ill I just blame that. Low Gi foods often give you a false impression that they are dropping but continue to slowly raise levels over a few hours. I find that hard at night if his supper level is in the 5/6's and he is still there at 10pm when I go to bed as I can't be sure he will be okay while he is asleep.

Because you give the injection just before the meal try to wait 2.5 hours to see what the post meal figure is when you can. I still find Novorapid works for 3-4 hours so if I tested at the 2 hour mark I would expect Khaleb to be around 8-10mmol. If I gave the injection half hour before food I would check at the 2 hour mark but I rarely do that.

Hope you have a not too worrying time.
 
Thanks Jen, you have been such a great help to me lately :D

I am thinking of changing her lunch ratio tomorrow, not sure i want to go from 1:15 straight to 1:10 though so going to try 1:12 and see if that brings down her after school levels, the change in Levemir didn't seem to have much effect last night so will see what happens tonight.

This week so far:
Monday
07:00 - 14.7, 11L & 3.5+2NR
10:00 - 12.9
12:30 - 6.9, 3.5NR
15:00 - 13.7
17:10 - 13.0, 18L & 8+2NR
20:00 - 6.3 (bedtime)
21:45 - 13.3
03:00 - 12.8

Tuesday
07:40 - 15.0, 11L & 3.5+2.5NR
12:00 - 8.2, 3.5NR
15:30 - 14.4
17:00 - 13.8, 18L & 5+2NR
19:30 - 7.4 (bedtime)

20:45 - 6.3
Just edited to add the above result as she just got out of bed complaining of tummy ache, she also thinks she might have done the Levemir in her tummy instead of her leg like normal - wonder if that will make a difference to the night readings
 
Here is most of a day in the life of Khaleb's blood sugar...

10pm - 10.3 mmol
4.30am - 16.4 mmol Correction NR 1.5 units
7am - 7.1 mmol NR 2.5 units and Lev 8 units (increased from 7.5 yesterday) 30 gm carbs
10am - 9.6 mmol Morning Tea 25gm carbs
12pm - 8.9 mmol NR 2 units Lunch 35 gm carbs
2pm - 5.3 mmol Afternoon tea 20 gm carbs
4.30pm - 4.2 mmol Dinner 45 gm carbs and delayed NR by half an hour 2.5 units

I am in the process of making basal adjustments as I was getting double figures late in the afternoon and now just have to get rid of the early morning double figure. It has crept up on me a bit as I thought the odd highs were just him being a bit ill. I put him on the scales and measured him to find he has had a big growth spurt in the last few months since our last clinic visit. We are nearly back on track but I'll just have to watch out if he starts having some hypos.

Khaleb eats rolled oats for breakfast with yogurt and milk. Morning tea might be fruit and custard type stuff. Lunch is meat and veg and fruit. Afternoon tea might be 10 grams of twisties or ritz crackers plus a fruit or yogurt or custard. Dinner is mostly meat and veg but he'll eat pizza night and a few other things with dessert of sago mixed with either fruit or yogurt. Khaleb barely drinks so most of his food has a fair amount of liquid and they are all fairly small portions. Khaleb has been asking for food a lot lately so I've really had to increase his meals/insulin a bit but that is just his growth.

Anyway, just thought this might give you a bit of an example of another kid on Lev/NR.
 
Thanks Jen, appreciate the info there :)

Well i decided to change lunch ratio from 1:15 to 1:13 and will see if that brings down the after school readings, it is difficult to get readings 2-2.5 hours after eating while she is at school cos she forgets to do a test at lesson changeover but school finishes friday so i should be able to get more useful readings from saturday onwards. She has an activity day at school today and a school trip tomorrow so not sure how much to trust those days readings!

She is fairly sure that she did last nights levemir in her tummy instead of her leg, i normally sit with her while she does her injections but last night i could not weigh and work out her carbs until the dinner was cooked so i left her injecting while i dished the rest up before it went cold!
Slightly different pattern in her readings though:

19:30 - 7.4
20:45 - 6.3
22:10 - 5.4
03:00 - 8.3
07:00 - 10.8

I am wondering if she would be better off not injecting into her legs now but i am sure i read something that said background insulin should not be injected into the tummy :?

Breakfast is nearly always cereal but sometimes toast at the weekends, she has been having 40g shreddies, 30g chopped strawberries with 100ml of milk which totals 35.4g carbs.
Lunch is always a sandwich and crisps unless we are eating out or gone out for the day.
Dinner could be anything, rice, pasta, jacket potato, mash, chips, it is the most variable meal.
No morning snack, after school she has ham/chicken and cucumber, before bed she sometimes has a hot chocolate made with just water and 1 teaspoon of options which is 1g of carbs.
 
Hi Spearmint

The latest bg readings are one hell of a lot better :) . It's possible that Levemir being injected into the tummy will work a tiny bit faster than if it's injected in the legs or backside but if bg levels improve, then carry on.
 
I don't use Khaleb's tummy at all. It is just too hard and that is the only reason. He gets Levemir in his butt and NR goes in his legs or hip fat. I've been doing this for 4 years and never had a site problem so pretty happy. I use 5mm needles but I personally haven't seen any difference if I use 4mm or 6mm. Looks like you had a good night so you must be edging closer to finding a dose that suits. It is always nice to see single numbers (above 4 of course). I'm happy even if the meter says 9.9 :)

Khaleb will have had diabetes 4 years next month. Oh how I miss sleep.
 
Thanks both but i am sure the better figures are due to her using her tummy by mistake!

With her thighs she tends to favour the top of them but i think this is causing problems, i am going to bribe her to try the outside of her thighs as i think it will work better there and it is softer and more fat there.
Only 2 hours to wait to find out how the change in lunch dose went :D
 
Just a quick update with todays readings, so much better but she was playing football nearly all morning at school so that might have something to do with it, she had a carton of apple juice to cover the activity, although she was sat watching a film all afternoon so who knows!

07:00 - 10.8, 11L & 4+1NR, 38.7g carbs
12:00 - 5.9, 4.5NR, 51.6g carbs
15:30 - 5.5
17:00 - 5.7, 18L & 4.5NR, 68.3g carbs
19:00 - 4.9

She went off to the school disco at 7pm, drank a carton of juice and ate a cereal bar on the way, told her to do a test at 8pm just incase and if she is normal range to have some sweets as it goes on til 9pm..
 
Wow, what a huge difference. Hope you had a good night after all the activity aswell. Just getting that basal level right makes everything fall into place. I always find it easier when the day starts with a good level. You only needed to make the one small correction so that is great.

With that half a unit I put Khaleb's Levemir up yesterday he has been really stable and had good levels. Continuing on from yesterday his levels were...

6.30pm - 5.2
9.45pm - 10.5
2.30am - 9.1
7.00am - 7.3
9.30am - 7.7
11.30am - 4.9
1.30pm - 5.2
3.00pm - 5.9

I'm very glad to have gotten rid of the highs in the wee hours of the morning. There was once a point in the fist year of Khaleb's diagnosis that I thought the DN was lying to me that it was possible to keep levels within a few boundaries. It wasn't expected when he was little and it has been nice over the last couple of years to see that it is possible. If Khaleb has a couple of days like this last 24 hours I'll go back to sleeping at night.
 
Oh that is a brilliant day Jen :D
Lets hope it continues so you can get some more sleep!
The lack of sleep is really catching up on me now, today i went looking for the hoover in the fridge :shock: :lol:

Well she went high overnight, i was tempted to correct at 3am but glad i didn't as she dropped by quite a bit, she has been low during the day today while out on a school trip so i am thinking adrenaline as that happened when i took them out for the day a couple of weeks ago!

21:30 - 13.8 (bed after disco)
03:00 - 16.0
07:00 - 11.4, 11L & 4+1NR: 38.7g (breakfast)
09:44 - 2.2: 37.1g (felt low on bus)
10:22 - 8.7: 20g (pre swimming)
11:13 - 5.9 (during swimming)
11:56 - 3.1: 21g (post swimming)
12:00 - 7NR: 83g (lunch)
13:17 - 3.6: 34g
15:30 - 4.1: 15.2g (after school)
 
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