Type 1 Help with T1 insulin dose

[harreni]

Hello Everyone,

My daughter is 11 years old and weighed 46 KG and diagnosed diabetes T1.

Currently, she is taking Levimer 32 units (divided into two shots 5 AM and 5 PM) and Novorapid 32 units (divided into three shots with meals).

I switched from Lantus to Levemir 1 month back because of uncontrolled sugar readings and last HBA1C test was 9.0 and


My questions are:

1 - Are the insulin doses reasonable? What are the maximum dose of Levemir and Novorabid at my daughter's age and weight?

2 - After 2 hours from the meal the blood sugar is less than less than 8 mmol but it start rising up after the meal within 3 hours and sometimes need Novorapid correction dose (especially after lunch and dinner), so where is the issue and what is the solution?

3. Is it possible that insulin pump is will be the best solution for my daughter's to stabilize diabetes?

Sorry for my bad English and thanks a lot in advance.
Harreni

 

[GrantGam]

Hello Everyone,

My daughter is 11 years old and weighed 46 KG and diagnosed diabetes T1.

Currently, she is taking Levimer 32 units (divided into two shots 5 AM and 5 PM) and Novorapid 32 units (divided into three shots with meals).

I switched from Lantus to Levemir 1 month back because of uncontrolled sugar readings and last HBA1C test was 9.0 and


My questions are:

1 - Are the insulin doses reasonable? What are the maximum dose of Levemir and Novorabid at my daughter's age and weight?

2 - After 2 hours from the meal the blood sugar is less than less than 8 mmol but it start rising up after the meal within 3 hours and sometimes need Novorapid correction dose (especially after lunch and dinner), so where is the issue and what is the solution?

3. Is it possible that insulin pump is will be the best solution for my daughter's to stabilize diabetes?

Sorry for my bad English and thanks a lot in advance.
Harreni

Hello @harreni

1. There is no maximum or minimum dose when it comes to basal and bolus insulins; within reason of course. Huge doses would suggest that the insulins, for whatever reason, may not working correctly. There are instances where some insulins don't work well for certain people and a switch is required; but that is a decision that would be made by a diabetic specialist doctor. What matters most is that the insulin doses are correctly set and are working to keep BG's within range.

We are all different with regards to how much insulin we need, and children even more so - especially considering growth spurts, hormones, etc.

Are your daughter's before bed and first thing in the morning BG's fairly similar? That can be a good indication of a correctly set evening basal dose, but of course - you can't see what's actually happening to the BG overnight - unless you do random overnight testing or use a CGM or the like.

2. This can be caused by many reasons. One possibility is that there may be too much fat in the meal. I personally find that if I eat a lot of fat, my BG is fine 2 hours after eating but can continue to climb for some hours after; even though I've counted the carbs correctly.

Another reason may be a lack of day time basal insulin; so no not enough taken in the 5AM dose. You could look at basal rate testing to see if the morning dose (and evening dose) is correct or not:

https://mysugr.com/basal-rate-testing/

There is also the possible effects of stress, exercise and illness that can cause BG to creep up.

We all need to correct from time to time, because carb counting is notoriously difficult. Are you carb counting on behalf of your daughter, and if so, how is your carb counting - have you had some form of training? Also, 32u of Novorapid between three meals is a very specific amount; does your daughter eat exactly the same amount of carbs for every meal all the time? Also, are you aware if her insulin to carb ratio is correctly set?

Looking at the doses you've provided - they are extremely 'textbook like'. An exact 50/50 split between both basal and bolus insulins is a typical starting point upon diagnosis, but something which needs fine tuning in order to give the best results. Have these been adjusted any at all since her diagnosis?

3. I'm not a pumper so I'm in no place to really comment. However, evidence does show that pump therapy can be very beneficial for T1D's, especially younger diabetics. I'm actually in pursuit of one myself, because of the positives I've heard and read regarding their effectiveness.

Sorry for the lengthy post but I've tried to answer as comprehensively as possible

 

[Jaylee]

Hi @harreni ,

Your English is great!

To question 1. Only your daghter's doctor can prescribe a dose & give instruction on such matters.
To question 2. Do you or your daughter count/measure/weigh the carbohydrates in her meals? Different types of carbohydrate digest at different speeds too. So injection timing is crucial.
To question 3. A pump can help. However an understanding of how carbohydrates & proteins work is essential or you can have the same issues with a new insulin regime.

 

[harreni]

Hello @harreni

1. There is no maximum or minimum dose when it comes to basal and bolus insulins; within reason of course. Huge doses would suggest that the insulins, for whatever reason, may not working correctly. There are instances where some insulins don't work well for certain people and a switch is required; but that is a decision that would be made by a diabetic specialist doctor. What matters most is that the insulin doses are correctly set and are working to keep BG's within range.

We are all different with regards to how much insulin we need, and children even more so - especially considering growth spurts, hormones, etc.

Are your daughter's before bed and first thing in the morning BG's fairly similar? That can be a good indication of a correctly set evening basal dose, but of course - you can't see what's actually happening to the BG overnight - unless you do random overnight testing or use a CGM or the like.

2. This can be caused by many reasons. One possibility is that there may be too much fat in the meal. I personally find that if I eat a lot of fat, my BG is fine 2 hours after eating but can continue to climb for some hours after; even though I've counted the carbs correctly.

Another reason may be a lack of day time basal insulin; so no not enough taken in the 5AM dose. You could look at basal rate testing to see if the morning dose (and evening dose) is correct or not:

https://mysugr.com/basal-rate-testing/

There is also the possible effects of stress, exercise and illness that can cause BG to creep up.

We all need to correct from time to time, because carb counting is notoriously difficult. Are you carb counting on behalf of your daughter, and if so, how is your carb counting - have you had some form of training? Also, 32u of Novorapid between three meals is a very specific amount; does your daughter eat exactly the same amount of carbs for every meal all the time? Also, are you aware if her insulin to carb ratio is correctly set?

Looking at the doses you've provided - they are extremely 'textbook like'. An exact 50/50 split between both basal and bolus insulins is a typical starting point upon diagnosis, but something which needs fine tuning in order to give the best results. Have these been adjusted any at all since her diagnosis?

3. I'm not a pumper so I'm in no place to really comment. However, evidence does show that pump therapy can be very beneficial for T1D's, especially younger diabetics. I'm actually in pursuit of one myself, because of the positives I've heard and read regarding their effectiveness.

Sorry for the lengthy post but I've tried to answer as comprehensively as possible

Excellent explanations, thanks a lot GrantGam for your prompt help

 

[harreni]

Hi @harreni ,

Your English is great!

To question 1. Only your daghter's doctor can prescribe a dose & give instruction on such matters.
To question 2. Do you or your daughter count/measure/weigh the carbohydrates in her meals? Different types of carbohydrate digest at different speeds too. So injection timing is crucial.
To question 3. A pump can help. However an understanding of how carbohydrates & proteins work is essential or you can have the same issues with a new insulin regime.

To the point, thanks a lot Jaylee for your help .

 

[GrantGam]

Excellent explanations, thanks a lot GrantGam for your prompt help

No problem, I hope that some of it may help