newly diagnosed son- can't control his sugar

[Issaqsdad]

Hi all,

I was wondering if someone can help. My six year old was diagnosed T1 in August and we're having trouble getting to grips with managing his suagr. He is on a fixed dosage of 2 unit levimir and 2/3 novorapid for meals. His morning readings are usually fine. Our problem is with his sugars during the day. In the beginning he was usually too high but he was sick recently with the stomach bug and since then a lot of hypos one as low as 1.8 which was very scary. We have just started carb counting but not giving him the recommended dosage as he would have a serious hypo with it. For example today I gave him just 1 unit of novorapid with his meal of lasagna and a banana and he had a hypo( we don't have half-unit pen). We then usually have to treat the hypo which may take several attempts with lucozade, candy choloate to bring him up as one attempt doesn't seem to work and then his numbers creep up slowly. It is just so frustrating as I feel i spend far more time managing lows than highs and give small amounts of insulin only to end up stuffing him full of sugar. I have no idea how to manage this. Any help would be appreciated.

some questions:

are there long term complications of hypos?

it seems that the fast acting may be a little too fast acting- would it be safe to give him it say half an hour after his meal rather than before/just after?

does this thing get any easier?

 

[jopar]

Pasta meals or meals that have a high fat content do slow down the asorbtion rate of carbs, it's referred to has the pizza effect.. This is why chocolate isn't a good choice for treating an hypo, the fat content slows the adsortion right down..

As to injecting after a meal if you feel that the insulin is hitting the system before the food had a chance to adsorb, no this shouldn't be a problem you can then adjust to pitch the timing you start with giving his injection after he just finished eating and work from there..

There are pens that actually do a 0.5 unit, but hard to get hold off but worth nagging clinic for.. If you finding it very difficult to match insulin to carbs eaten, ask to be changed to an insulin pump which IMHO is one of the most effective ways of handling childrens diabetes, as it can be used both proactively and reactively, as it very difficult to keep up with the ever changing needs of children...

But I must say you seem to be getting to grips with it all, susing out the insulin timing against food adsorbtion doesn't come automatically to some...

What every you decided to do, please run it past your care team before doing so..

 

[SophiaW]

Jo is right about pasta. My daughter will have a hypo about an hour after eating pasta or pizza because it takes longer for the carbs to hit the bloodstream. I give her a reduced amount of insulin with the meal and then another injection at about the 2 hour mark.

Ask your diabetic nurse for a half unit insulin pen, an absolute essential for children. There's no way we could work without halves.

As Jo also said there should be no problem with giving the insulin after the meal. It's often handy to do this with children if you're unsure how much they'll eat. Sometimes it's difficult to predict if they'll eat everything on their plate.

If you notice a pattern of hypos over a few days then it's best to have a chat with your diabetes nurse as you may need to look into adjusting insulin doses. In the first few months after diagnosis it can be tricky as he may still be in the honeymoon period (in fact those doses are very low so he probably is).

 

[Issaqsdad]

Dear Jopar,

Thanks for your response and advice. I was quite worried earlier and your message has helped calm me down a bit. I didn't know about the pizza effect and he has a lot of pasta-based meals so I will have to keep this in mind. I will try and adjust the timings so that it correlates to his absorbtion of the carbs better but will speak to the diabetes nurse before make any changes. I'll give them a ring tomorrow. The clinic have mentioned a 0.5 pen as well as the pump and said that it's likely that they will put our son on the pump but want us to get to grips with carb counting first. So I am not sure whether I should nag them for a 0.5 pen in light of that fact- I don't want to seem too pushy or ungrateful for the pump. I hope your right about the pump as I don't fancy trying to constantly figure out what his body is doing- actually who am I kidding i will probably be stuck with that pump or no pump but it hopefully will even out the playing field a little between diabetes and I as right now diabetes is winning hands down.


Dear Sophia,

Thanks for sharing your experiences with your daughter. I will try and see if something similar works for my son as this constant fluctuating is not helping him feel well at all. Half unit pens do sound handy and I really think we could do with one but as I mentioned above the clinic have made positive noises about the pump so I am hesitant to push for a half unit pen when they have plans to put him on a pump. I may just try and ride it out until the pump comes. I did speak to diabetes nurse when he got sick with the stomach flu and we had a hypofest and they were pretty insistent that I maintain regular insulin injections even when he wasn't keeping anything down. They told me to give him insulin with lucozade. I still haven't fully understood everything but I think they said that his body needs insulin for other purposes other than keeping his blood sugar level down. It didn't make much sense to me. It felt like I was just messing with him by injecting him when I knew he wasn't eating and then giving lucozade to cover the insulin. I thought the point was insulin to cover food but this seemed much more the other way around food to cover the insulin.


once again thanks to you both for your responses- v.much appreciated

 

[Jen&Khaleb]

Hi there and welcome!

As others have posted about the half unit pen I can only add that this is a must with kids.

In my experience if Khaleb has been sick and had a few high levels he will most often have some out-of-the-blue bad hypos once he is on the mend. My guess is that he is putting back some of the stores he has lost while ill? I have even not given him insulin after his meal and waited an hour or so to see if he needs it or not. Before, during and after being sick creates very different trends.

I also don't think Levemir has a flat profile like the professionals tend to tell us about. Khaleb has his Levemir split and this makes control a bit easier.

Your son doesn't seem to be on very much insulin so there is a good chance that he is still in the honeymoon stage and producing some of his own insulin. This will add to the unpredictability.

Don't doubt that you are doing a fantastic job as blood sugar levels are hard to manage even at the best of times.

As for your question about hypos causing problems long term. I've only read bits about memory loss and the risk of hypo unawareness from getting used to being so low. Not that it is good to have a lot of hypos but most parents will report 1-2 per week. Most will only just be below 4mmol but there will be times when hypos happen. The short term problems are obviously the ones to worry about. You wouldn't want to collapse in wrong place. Diabetes should come with a crystal ball. :lol:

Just read your post...

The body does need insulin all the time so even though kids are sick they still need insulin. You can reduce the dose though.

 

[Issaqsdad]

Hi Jen,

Thanks for the warm welcome and the encouragement. I don't really know much about the levemir but he is on such a low dose (2 units) that I don't know if it will make a difference or not? The diabetes nurse said she would normally suggest using reducing it if there are hypos during the day but since it was so low it wasn't worth it. I spent the day just trying to monitor his blood sugar as closely as possible- every half hour or less sometimes- just to try and get an idea of what it is doing. I know have an idea of what it is doing: it is doing crazy. Sometimes it goes up. Sometimes it goes down. Even dropping or jumping 3 or 4 points in really short spaces of time with nothing eaten inbetween. I started to think the meter was faulty or something at some points :evil:

Dear all,

just want to say thanks again for the advice and help. I did talk to the diabetes team and weren't so keen on splitting his dosage but they gave me a half-unit pen which comes with a snazzy case! They said to try a 1 and half dosage instead of the 2. Interestingly though during my Issaq experiements that were running all day. I was managing to keep him in range with 1 unit with good timing on the dosage. I was planning to split the two units but found that with good timing he stayed within the 4-10 range with just one unit. At times he dipped quite low 4.1 on just the one unit and then we creeped up to 10.3 I think when I was a little too late with a dosage. But it seems like 1 unit is his dosage for now until next week when that all changes or something :roll: