• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

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.
 
Oh that is brilliant news about his results :D
Yup i got told the same by a dr at the end of June that her insulin should be a 50:50 split and not the 65% Levemir : 35% Novorapid that she seems to be on, i queried that with her DSN as i felt like i already had enough to be worrying about with trying to get her levels right and she said that is more appropriate to adults and to just give her what she needs of each one to get her levels right.
She does seem to need an awful lot of Levemir compared to others but then she is an 11.5 year old girl, still growing and probably has hormones begining.
I have also been told to only correct highs at meal times!

Everytime i give her novorapid when i go to bed or at 3am it seems to have hardly any effect but then she has twice as much levemir in the evening than she does in the morning so maybe she just needs more insulin during the nightly hours.
Last night for dinner she had:
half a cheese and bacon quiche - 29.3g carbs
jacket potato - 39.8g carbs
baked beans - 7.1g carbs (told to only count the sugars not full carbs)
grated cheese - 0g
aero mouse - 11.5g carbs
Total - 87.7g - 7.5units NR
She wants exactly the same for dinner tonight and i am very tempted to try a 1:10 ratio given after eating and see how different her readings are......

Today she has been ok i think
09:26 - 8.9
12:08 - 6.7
15:33 - 7.0

From 9:30-10am she ate half a small tub of salted popcorn at the cinema but i have no idea of carbs as we left the book a home thinking we would not need it but popcorn was on offer cheap so i got them some :lol:
Didn't look like it did her any harm anyway :)

At McDonalds she had the BCO burger which was a battered chicken burger, cheese, bacon, onions in a bun, medium fries, diet coke, flake mcflurry with chocolate sauce, then walked round the shops for an hour before going home.
Burger - 57g
Fries - 42g
Ice cream - 49g
Total - 148g - 12.5units NR

I'm taking the kids to London tomorrow by train so i fully expect her levels to be all over the place :lol:
 
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.
 
Hopefully his levels will go back to normal soon then.
I don't restrict carbs at all, obviously when she was on premix i would keep them at a set level for each meal, i think growing children need carbs although i try not to have too many sugary carbs.

Well the 1:10 ratio was too much Tuesday dinnertime so went back to 1:12 yesterday due to being out in London for the day but have tried 1:11 tonight!
Although i am not sure how it is going to pan as she made some choc chip cookies this afternooon and desperately wanted one, i tried to persuade her to wait and have one after dinner but no.
She had breakfast and lunch later today so lunch insulin was still working when she had biscuit, gave 1.5units to cover the cookie which would still have been working at dinnertime so i gave a cautious 0.5unit extra on top of what she needed for her dinner and i will see what happens!!

Tues night:
19:00 - 4.9, 9.8g milk
21:00 - 3.7, 20g apple juice
22:00 - 9.8

Wed:
07:00 - 12.1, 9L, 4+1.5NR
09:30 - 3.6, 11g sweets, 15g fruit bar
12:45 - 7.1, 4.5NR, 56.8g (part guessed)
14:45 - 7.2, 3g strawberries (guessed)
17:15 - 7.2, 153.1g (part guessed)
17:45 - 19L, 13NR
20:50 - 5.0, 15g fruit bar
21:30 - 12.6
22:30 - 12.8, home at 22:15 so did not correct due to later bedtime & more active evening

Thurs:
08:52 - 9.0, 9L, 4+0.5NR
13:05 - 3.6, 10g apple juice
13:15 - 44.7g lunch
13:40 - 5.9, 3.5NR after lunch
15:46 - 8.9, 1.5NR, 16.3g cookie
18:00 - 13.7, 76.1g
18:30 - 14.9, 19L, 7+0.5NR
19:30 - 6.5
20:30 - 3.4, 10.4g apple juice (bedtime)
21:00 - 4.0, 10.4g apple juice (she got up feeling low)
21:30 - 5.4 (back to bed)


hhhmmm she had pasta tonight so i wonder if she will have a huge rise at some point
 
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.
 
SophiaW said:
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.
Click to expand...

No i did not know that, i know nothing about the different food absorption rates despite keeping asking at the hospital :(
I know that high sugary carbs are quick release and starchy carbs are more slow release but that is it!
Hhhmmm i wonder where i should start with splitting for pasta then :shock:
Thanks for the info :)
 
Jen&Khaleb said:
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.
Click to expand...

Oh i am glad that Khaleb seems to be settling down again :D
Yes, i knew that snack and injection yesterday afternoon was a really bad idea but i am just so fed up of constantly saying no to her all the time :oops:
I don't know if it was the 2 los of insulin or the pasta that caused the problems!
Since switching to MDI i have however ditched the 'brown' pasta and rice and changed back to 'white' to try and get the food and insulin rates matched better.
I did not correct this mornings high due to he previous 2 days ending up low by lunchtime but she stayed high so maybe something else was going on those 2 days so will go back to correcting tomorrow.
I also did an extra afternoon test to check her lunch ratio is right and her daytime levemir is right and one thing i noticed was how quick the novorapid seems to be in and out with her, it looked like it had no affect beyond 2 hours which is what i have noticed with the hourly evening tests as well although it seems to work slower with breakfast.
I am trying a 1:11 ratio with dinner again tonight to see what happens, have also upped her evening levemir by another unit.

Thurs night:
21:30 - 5.4
22:30 - 7.0
02:00 - 11.0

Fri:
07:55 - 9.8, 9L, 4NR
10:30 - 13.3
12:10 - 11.5, 5+1.5NR
14:30 - 5.8
15:30 - 5.8
17:15 - 5.7
17:45 - 20L, 10.5NR
18:45 - 11.8
19:05-19:35 - walking to shop and back
19:45 - 6.3
20:45 - 6.6
21:45 - 7.5

I wonder what made the difference tonight - the walk, the food, the novorapid ratio or the extra unit of levemir :lol:
 
: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:
 
Just a quick update before i go out, am in shock :shock:

02:30 - 5.8
07:43 - 6.7

I really hope this is not a one off :lol:
 
Glad you had a good day too :D
Khaleb sounds like a real sweetie putting his plate on the scales :)

Well today has not gone as well as yesterday :roll: :lol:
I am taking the kids away for the next couple of days so i am fully expecting it to all go wrong again!!!!
I am thinking it is ok for meal times to be slightly out but going to try and keep levemir at similar times if i can.

Saturday:
07:43 - 6.7, 9L, 4NR
10:00 - 12.6
12:00 - 6.7, 11NR
15:30 - 8.8
17:10 - 12.3,
17:40 - 20L, 7.5+1.5NR
19:30 - 4.7
20:12 - 3.6, 11g sweets
20:29 - 4.2, 11g sweets
20:48 - 6.4, 5g biscuit
 
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.
 
That's brilliant Jen, i hope he has continued to be more settled again for you :)

She was not too bad while we were away, the only bad reading was the morning after we ate at a chinese buffet restaurant for dinner when she woke up at 15.0

This week has been quite good, just the odd reading above 8, apart from today where she has been high all day with the lowest being 9.7 at lunch :?
To try and solve the problems after dinner when she eats certain foods i am now experimenting with split doses which did not work last night with pizza :lol:
She had sausage rolls tonight so split again but with a different ratio and we will see what happens!
 
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.
 
My starting points were 75:25 1-2hrs apart for high fat or protein or 50:50 1-2hrs apart for a mostly pasta/rice type meal
Last nights split was far more successful!!
If she has potato based carbs for dinner then giving the whole dose after eating seems to work well but anything else she dips low then spikes high, this also happens if given before eating.
I'm going to change the ratio back to 1:12 as 1:11 seems to but just too much now i am giving it after food rather than before food.

Right this is what happened with pizza and with sausage rolls!

17:45 - 9.8
Pizza - 39.4, Chips - 17.7, Yogurt - 11.9 so needed 6.5 units for the food and 0.5 units to lower to normal range
18:10 - 3.5NR, 20L
19:10 - 10.2
20:10 - 12.1, 3.5NR
21:10 - 6.6
22:10 - 5.6
23:30 - 4.6, i was worried to leave her at that level so gave smoothie - 11g, 2 biscuits - 10g
00:30 - 6.2
08:05 - 12.8

17:20 - 10.8
Mini sausage rolls - 49.7, Yogurt - 16.5 so needed 6 units for the food and 1 unit to lower to normal range
17:40 - 5NR, 4u for food and 1u to correct
18:40 - 14.1 so gave the other 2NR
19:40 - 7.0
20:40 - 5.2, was worried she might go lower so gave 1 biscuit - 5g
22:04 - 7.1
00:08 - 6.4
07:39 - 6.4

I'm not even sure she needed a split dose for the sausage rolls but i got given a list of foods and meals that cause slower absorption where a split dose might help stop the hypos followed by big spikes.
She did have veg with those 2 meals but i got told not to count those carbs.
 
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.
 
Back
Top