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Help with changing doses please

Hhhmmm i am wondering if all of todays readings are accurate :?
at 17:00 she tested 3.5 before dinner, now given that she had sweets an hour before when she tested 4.1 i was a bit puzzled!! Did a retest on her replacement accu-chek mobile which finally came today and that put her at 5.7 not 3.5 :shock: so did another test on her spare accu-chek aviva and that put her at 5.2 so i went with the concensus that she was about 5.5 :lol:
She was most annoyed that i took away the pack of sweets she was going to eat!!
I will stick with the 2 accu-chek meters now i think :!:
 
Hhhmm, interesting evening here :roll:

17:00 - 5.5, 18L & 8.5NR: 131g
18:22 - 3.8: 15.8g (fruit puree)
18:42 - 4.8
19:10 - 3.6: 10g (fruit juice)
19:30 - 4.5: 15g (chewy sweet bar)
20:00 - 5.7: 15.8g (2 digestives)
20:50 - 3.5: 35g (apple juice & cereal bar)

Gone to bed now at 8pm, will test her at about 10pm i think

Edited to add, just got up feeling low at 8:50pm
Could be a looooong night :(

Thinking of dropping the morning Levemir from 11 to 9 tomorrow :?
 
I think the low readings from today are from the day before when she did the football all morning and then she did swimming this day. I was suggested once to add up all Khaleb's long acting insulin and on days he does extra exercise to reduce the long acting insulin by 10%. This has been fantastic for Khaleb. This way you are not spending a day treating hypos or lowering the insulin a day too late and then having high readings the next day. This has been my experience with Levemir anyway as it really does take a few days to settle whenever you change the dose. You'd have to experiment a bit with this but I've really found it fantastic. Sometimes if you don't know that it is going to be a big exercise day you might be a bit behind but having the Levemir split still makes it heaps easier. I've used this method when we've been away on camp diabetes and also going to theme parks as these have been the biggest causes of lows in Khaleb that have been troublesome. Your other choice would be to alter your carb ratios slightly with exercise on the day and the day after. Hope this helps :)
 
Thanks for that info Jen, none of that was explained to me, i was told to just give her the same snacks as usual before any activity.
I decided to lower this mornings Levemir from 11 to 9 anyway so that she can enjoy her last day at that school.

Last night took an interesting turn :shock:

20:50 - 3.5
23:00 - 16.4
03:00 - 23.5
07:20 - 14.6

I was tempted to give NR at 3am to correct that huge high but i was just too tired to go downstairs, find it and work out how much to give her and i am kind of glad that i didn't.
All i can think is that might have been a delayed sugar high??? or delayed adrenaline high from an exciting day out???
 
Just thought i'd let you know that we finally had a good day yesterday :D
Until we went out for dinner and i must have messed up the carbs :oops:

07:50 - 5.2, 9L, 3NR, 30g
12:00 - 6.6, 7NR, 84g
14:30 - 5.8
15:30 - 5.7
17:15 - 4.2, 18L, 6.5NR, 100g?
20:30 - 15.4
22:30 - 22.9

Today:
08:07 - 15.3, 9L, 3+3NR, 30g
10:30 - 5.1
11:20 - 3.3, 10g
12:00 - 5.9, 4.5NR, 53g
15:25 - 6.7
17:10 - 6.3, 18L, 5NR, 72g

I think i over corrected this mornings high

Just edited to add in more of todays readings, looking good so far i think!
 
Can i ask what you try to correct back to? I usually only try to correct back to 7-10mmol. The only times I might overdose Khaleb a little is if we are going to Maccas for morning tea and his morning NR can take some of the carbs that is over his usually morning tea allowance. This requires a little bit of timing on my part but I avoid big spikes and Khaleb gets a moment of doing something that everyone else is doing (minus the pancake syrup).

Three cheers for finding some good control. The blip in the evening isn't something to worry about but I would have been inclined to correct it so the higher level didn't remain for many hours. Again, for Khaleb I would have only corrected back to 10mmol so that he'd still last the night. Having the 8.30pm and 10.30pm checks going up would really make me correct but if there was a fair drop in those two I might be a bit more cautious. Just thoughts...
 
With corections, i try to get her down to 5-8, i usually go by 1 unit lowers by 4 but that doesn't always work in the mornings so i tried 1 unit lowers by 3 today but that was obviously too much!

I am wary about correcting at night as i don't fully understand the whole food absorption rates at all and some nights she can drop by a lot and others not at all.

We went to a carvery for dinner last night so this is what i did:
5:15pm test - 4.2
She ate a plate full of food before injecting 2.5 units to cover 40g
Only carbs were 2 medium yorkshire puddings = 20g, 2 medium roast potatoes = 10g, 2 thin sausages = 10g - those amounts were got from the cals and carbs book with pictures in
She then went and got another plate of food but all veg which i got told not to count
Pudding came at 6:15pm which was toffee apple pie
It looked nothing like the apple pie in the book, so i looked up a slice of cheesecake the same size and used the weight of that to find apple pie of that weight and added on 10g for the toffee so guessed at about 60g carbs so she had another 4 units at 6:20pm before eating it

I thought a carvery would be quite easy to work out but i must have been out somewhere :?
 
Yeah, when we eat out it is a bit of guess work. Any dessert would be really hard to calculate as the sugar content is going to vary heaps. I do count nearly any veg that isn't green. Corn is something that can be noticeable in Khaleb.

The nights that your daughter drops from a very high figure to a much lower figure can sometimes be the bodies own mechanism of flushing out the excess glucose so if you corrected a little bit you avoid that function and get a more predictable drop overnight.

Even though our kids have lost insulin production all the othe aspects of the bodies blood sugar control are usually still intact. I think there are some people that also have an auto-immune attack on their alpha cells in the pancreas and those produce the hormone used to lift blood glucose. This is my interpretation of how someone gets brittle diabetes.

http://www.youtube.com/watch?v=BDATgiMwRNA

Have you watched the Type 1 Mum song yet?
 
Jen&Khaleb said:
The nights that your daughter drops from a very high figure to a much lower figure can sometimes be the bodies own mechanism of flushing out the excess glucose so if you corrected a little bit you avoid that function and get a more predictable drop overnight.

Even though our kids have lost insulin production all the othe aspects of the bodies blood sugar control are usually still intact. I think there are some people that also have an auto-immune attack on their alpha cells in the pancreas and those produce the hormone used to lift blood glucose. This is my interpretation of how someone gets brittle diabetes.

http://www.youtube.com/watch?v=BDATgiMwRNA

Have you watched the Type 1 Mum song yet?
Click to expand...

Oh i didn't know the body tried to get rid of glucose itself :oops:

No, never heard of it but just watched it and it is very true!!

Last nights readings were pretty similar to the previous night and i know the carbs were right!
17:10 - 6.3, 18L, 5NR, 72g
20:00 - 14.7
22:10 - 16.7
07:05 - 9.7

I had a 'lightbulb moment' whilst trying to get to sleep last night :oops: :lol:
I reduced her morning Levemir by 2 units from 11 to 9 on friday, pre-bed readings have been 5-7 apart from the last 2 nights so i wondered if that change has finally had an effect meaning that she needs more Novorapid with dinner as there is less Levemir floating around her system.
So tonight i changed the dinner ratio from 1:15 to 1:12.5 and we will see what happens tonight!!

She has been slightly high all day today but i am putting that down to her feeling nervous/anxious because we went to Great Ormond Street hospital today for some heart and artery scans for reseach.
Hopefully tomorrow she will be back to normal levels :)
 
Totally agree that changes in Levemir show up days after. You really see why they tell you to only make small changes every few days. I also find it a pain that fixing the Levemir then means changing ratios to carbs. Because Khaleb is little I don't have a lot of leeway to alter NR as it will make him hypo acting to quickly. We all walk a tight rope every day trying to keep the balance.

Poor Khaleb had his blood test on Monday. I hate having 3 people holding him down while he screams. He has to get his thyroid levels checked every 3 months and they do his hba1c at the same time. I get the results on Tuesday. He either goes high or has a hypo after this test. Yesterday morning it was an odd hypo (3.1) at 10am.
 
Oh no poor khaleb and poor you :(

It seems to be that i can get 2 days good readings and then it all seems 'out' again which is frustrating and i am not known for my patience either!
Normal day at home today and looking at todays readings i 'think' the morning levemir 'might' need to go back up but i shall see what happens tomorrow before i make any changes.
Giving more insulin at dinnertime last night meant she went to bed on a good level but didn't make much difference to the 1st thing in the morning reading :?

18:10 - 13.9, 18L, 5+2NR, 63.1g
20:30 - 6.2 (bedtime)
22:10 - 8.3
07:17 - 10.9, 9L, 3+1NR, 29.1g
10:33 - 10.3
12:05 - 8.2, 5.5+0.5NR, 64.2g
15:00 - 5.9
17:10 - 11.5, 18L, 10.5+1.5NR, 130.1g

I haven't done a 3am reading for a week so i might set the alarm and get one tonight
 
I think you should be very happy with what you are doing. There is nothing out of whack with that lot of readings. You would get a good average and a1c with those levels. If you need to put the levemir up only do it by 1 unit or half a unit and wait a week before making more changes. If you know she's going to do heaps of exercise try taking off the 10% Levemir for that day and then put it back up. You are now only making small corrections and not having hypos makes life a lot more liveable. I don't know too many (actually any) kids on MDI that can stick completely to that 4-8mmol all day other than you fluke it occassionally. Pat yourself on the back!
 
Thanks Jen, the reading i was most unhappy with was the 17:10 as she seemed to go up a lot from the 15:00 reading, i made her rinse her hands and test again incase it was wrong!
Last nights readings were dire :shock:
I even braved a correction when i went to bed but it didn't seem to have much effect :?

20:05 - 17.5
22:38 - 19.8, 3NR (should have lowered her by 12 making her 7.8)
03:00 - 14.6
07:00 - 12.3, 9L, 3+1.5NR, 29.1g
10:30 - 9.4
 
Oh well, we all have days like that. Khaleb popped a 20mmol late this afternoon even though he was 7.7 at 2.30pm and only had a small afternoon tea. He's got a bit of the runs also which is very rare for him. I'm hoping it is only a minor tummy bug and doesn't turn into anything horrid overnight. I'm tired and got a bit of a cold so the last thing I need is a night without any sleep. His bsl is back to 8mmol now and he seems happy enough so I'm keeping my fingers crossed it was just a glitch. He had a weird 'out of the blue' hypo a couple of days ago and that is sometimes an indicator he is about to come down with some illness.

Do you have some idea what caused the higher levels?

I had a friend, and her 2 sons, over this evening for dinner. Her 3 year old has diabetes and on a pump and I'm learning the ropes so I can babysit for her on the odd occassion. I carb counted his meal, did the bolus and he had really good levels - almost exactly the same before and after. His mum gets terrible levels but doesn't carb count very well. I've treated one of his hypos before also and his mum was surprised how quickly his level came up. Apparantly she and daycare spend half to an hour to raise his level above 4. I was quite impressed with the pump and if it wasn't for Khaleb having Down's I'd be jumping to get one. If you know someone with one you and your daughter should take a look. They can be hard work - so I'm told - but from my little experience they have some distinct advantages.
 
Aaawww i will keep my fingers crossed that he is not too poorly :(
I think you do an amazing job considering he has down's as well.

I have no idea about the higher levels last night, all i can think of was it might have been a delayed food rise, she had curry, rice, naan bread, choc covered ice cream lolly for dinner.
I am confident with carb counting at home, just takeaways and meals out that i struggle with so i am 99% sure the carbs were right last night.

Had a good day level wise today but she was playing outside this afternoon which might have helped, she had a hugely high carb dinner tonight so not sure what her levels will be like overnight!

10:30 - 9.4
12:10 - 6.4, 5.5NR, 64.2g
13:10 - 15g cereal bar for playing on trampoline
15:08 - 6.2, 10g raisins for playing on bike
16:13 - 4.8, 11g sweets as needed a trip to shops
17:30 - 8.1, 18L, 16+0.5NR, 194.2g

She is not keen on doing 5 injections a day and if we eat out that turns to 6 a day as i get her to inject seperately for the main course and pudding due to the time delay which could end up being 7 in a day if i have to correct at night. She did briefly say to me that if she had a pump she wouldn't have the injections which would be better. I have not mentioned anything at clinic visits as all pump funding has been suspended at the hospital she attends. I do feel that a pump might be better for overnight control. She also seems to need a massive amount of background insulin.
 
Even without pump funding if we take out Private Health Insurance we would be given a loan pump for the 12 month waiting period and then be able to purchase a pump and just pay the gap fee. Khaleb still wouldn't qualify but after having a play and being a good carb counter I think I would settle in with one in no time. You can always contact Roche or Medisense yourself and see what they can offer. There are some disadvantages to the pump that you'd need to discuss. I had a look at a quick set insertion kit and I personally think I'd rather push the cannula in myself than have the big click and bang effect. Anyway, totally off topic.

Khaleb had an excellent night and woke with bsl 7 this AM. I think he must have just had a 12 hour bug. He had a whinge at daycare yesterday which is unlike him and also had a sleep. At least it hasn't turned into something else. I still checked him at 1.30am but he stayed in single figures all night.

Hope you didn't have another bad night. If Khaleb had a really high carb meal, especially pizza or some other take away, I'd be giving him 2 injections also. Giving one big bolus just sends him hypo and after treating that he then goes high hours later. Sometimes I still end up with the same problem if the injections are too close together and I get the stacking effect. The joys of diabetes, hey!
 
Hi Jen, has Khaleb still been ok?

All was ok when i went to bed Thursday night but something must have happened after that as she woke quite high but i don't know what happened or when cos i slept through the 3am alarm :oops:
That seemed to have a knock on effect til afer lunch Friday and i gave a correction dose Friday night when i went to bed, she has gone to her dads for the weekend now but i am seriously considering trialling the dinnertime novorapid after she has eaten to see if it improves her nightly and morning readings - i did that 1 night a couple of weeks ago and although she was 16 when she went to bed, she was 9 when i went to bed, 7 at 3am and 9 on waking so worth trying i think.

Thurs:
20:00 - 4.9
21:50 - 7.0

Fri:
07:35 - 16.4
08:07 - 16.8, 9L, 3+2.5NR, 33g
12:10 - 13.0, 5+2NR, 59.4g
15:05 - 6.8
17:00 - 6.6, 19L, 11.5NR, 137.9g
20:00 - 6.8
22:30 - 14.5, 1.5NR to lower to 8.5
03:00 - 9.2
07:45 - 9.5
 
I think the daytime is more or less ok now but these highs at night are doing my head in now!!
I gave a correction at 11pm last night which had hardly any effect on her levels :?
Last night she did her injections after eating and the same tonight and will carry on doing that this week to see if that makes any difference as i wonder if it is the bigger evening meal that is causing part of the problem!
I'm also going to test hourly this evening to see when she is creeping up and when she is dipping down to try and work out what needs doing differently.
Also thinking of one night when we are not doing much the next day of testing 2 hourly right through the night to get a clearer picture of what is going on.

Sunday:
17:15 - 12.7, 151.8g
17:45 - 19L, 13+1.5NR
20:00 - 9.1
22:58 - 15.7, 2.5NR

Monday:
03:00 - 12.7
08:04 - 12.8, 9L, 4+1.5NR, 41.1g
10:33 - 12.3, 15g fruit bar for park
11:53 - 8.7, 5NR, 60g
14:50 - 6.0
17:00 - 5.3, 87.7g
17:30 - 7.9, 19L, 7.5NR
18:30 - 12.6
19:30 - 11.2
20:30 - 11.9
21:30 - 11.7

hhhmmm so far that looks like she needs more novorapid with dinner in the evening, when i have done that in the past she has been hypo at bedtime so looks like the key is to give it after food for this time of day.
i will next test her at 22:30 then go to bed myself, if she has not come down at all i will give a correction dose of novorapid and then test at 3am.
 
I've had some not so great nights also. Khaleb has been high some nights at 10pm and needing a correction and then last night he was 2.8 at 10pm. I rechecked him a bit later and he was 7.0 so I went to bed and checked him again at 2.30am and he was 2.6. He then woke up this morning at 12.5 grrr. We go to clinic shortly so I will find out if these problems are due to his thyroid condition or just diabetes being a pain. Will get back later.
 
Oh no :shock:
I wonder what caused those lows?
Good Luck at clinic :)

Just popped online quickly to update the rest of the night before i get dressed and go out, will be having McDonalds for lunch so i think i'll do that injection after she's eaten as it might be slower than her usual sandwich.

22:30 - 10.1, gave 1NR which should have lowered her to 6.1
02:30 - 8.1, i guess it has less of an effect at night!!!!
06:46 - 8.0, i guess the Levemir is right???

I will do the same tests tonight to see if they reveal the same pattern and if they do i will change the dinner ratio from 1:12.5 to 1:10 and give after she has eaten.
 
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