What Am I Missing?.

[martina]

Hello everyone, at the moment my daughters bgs are running slightly high. They are all around 10. No matter how many corrections I give they never bring her down. I have particular problems getting her bgs down during the night. Her overnight correction is 1 unit brings bg down by 3.9. Is it solely the correction factor I need to be working on to get her down. At 10pm she has been aroun 10 and by 6am she was 11.0. So her overnight basals are consistent , which is good just a little to high. She takes her insulin around 8am what basal would need to be changed to have the 8am lower? She wears an Accu- chek combo pump. I think sometimes because I look at the bgs so much there could be things I'm missin. Someone else might spot the problem straight away. Many thanks Martina

 

[tim2000s]

Can you provide a list of bg readings and food consumption over a period of 24 hours please? It's easier to determine what might be awry if all the data is presented. Have you spoke to your diabetes care team about this?

 

[novorapidboi26]

how many basal rates does your daughters pump run.....and what rate does the 8am fall under?

if she is 11.0 at 6am and then 8.0 at 8am then that would suggest that the basal rate between 6am and 8pm is a touch high....

you should ideally work in blocks of time with the basal rates.....

if by 6am she was at 5.5mmol, potentially she could have dropped low by the time 8am came along....

 

[azure]

How long has she been running high like this? Could it be the insulin or the set? How long has she been on the pump?

And what time does she eat in the evenings? I'm wondering whether her evening meal bolus is sufficient.

 

[martina]

Has been like this the last 3 days. Woke yesterday 9.3 checks at 10am and was 9.0. Lunch which is at 1pm she was 9.0. Then at 3pm she was 9.1. When she came home from school she was 5.7 and at tea she was 4.8. Supper at 7.30pm 6.4 then at 10pm 10.5. 12am 11.8., 4 am was 11.6, 6am was 10.2 and then woke this morning at 10.0. Last night I gave a bolus at 12am which obviously didn't work.
Today she was 12.4 at her 10am check and she took a bolus which brought he down to 4.1 at lunch after her recheck she was 5.9 and the pump gave 8.6 units and now when we checked she was back up at 14.5, not enough given,as yesterday lunch was 9.0 and it gave her 9.6 units although there would have been a correction involved. HAve spoke to nurse an she said to make changes to basals but no suggestion as where to start. It's driving me crazy, can't seem to win. Don't think set prob as she does come down. On her pump she has different rates for every hour but I was always told change 2/ 3 hr before one you want to change. So going by that I guess it would be the 5am that affects the 8am reading?

 

[martina]

If at lunch she was 5.9 and shot up to 14.4 two hrs later I'm I right in thinking that she would be needing more bolus with her lunch. I originally didn't think this because yesterday lunch was 9.0 and 3pm was 9.1 which would make you think it spot on . God I'm so confused as what to do.

 

[iHs]

Looking at yr msg Martina, it seems as though yr daughter's bg levels are changing from supper onwards. To me, I would change the 7pm basal first to see what effect the change has on the 9pm and 11pm bg test.. If your daughters TDD changes, then divide that into 100 to get a rough idea of what the new correction factor needs to be. Does yr daughter's bg tend to drop if she walks home from school? If so, that will explain the late afternoon drop in bg level. Also, is she eating sweets at all to cause a rise in bg which quickly drops because of the way sweets get digested and the bolus correction.

If you are not sure what is going on, then start to do some basal testing to see if the problem is basal related and if not, it could be
That food is maybe being eaten without the bolus. The weather is now getting colder too so keep that in mind.

 

[irrationalJohn]

God I'm so confused as what to do.

The first step is obviously to try to get unconfused, no?

There are a number of different factors which could result in an unexpectedly persistent rise in BG (Blood Glucose) levels. The risk I worry about is becoming so concerned about responding to the high BG that multiple corrections are administered which "stack" and then eventually take effect resulting in severe hypoglycemia. Monitor the Insulin On Board carefully so you don't stumble into this.

If you haven't already done so, you should reach out to your daughter's med team for advice & feedback. It could help to talk through suggested approaches to fix this to flush out potential problems when making a change. While it is frustrating to go slow since you want to fix whatever is wrong as soon as possible, one needs to proceed methodically to attempt to discover what the underlying problem(s) may be.

Here are some possible causes that jump to mind which may … or may not … be relevant.

• The basal and/or correction factor settings are wrong and need to be adjusted. But be very cautious about attempting this. If you just start changing things without thinking them through & tracking them, you could only confuse things even more.
• The infusion site is "bad" and the insulin administered by the pump is not being absorbed correctly.
• You daughter may be coming done with a cold or have some other disease or taken a drug which (temporarily) increases her BG.
• Something else is happening which didn't occur to me to mention.

When my corrections don't seem to work properly and I can't pin it on a change to my diet or health, the next thing I will usually do is change my infusion site in case there might be an absorption problem. Another apporach is to administer the correction with a syringe rather than via the pump. If a correction by injection "works" when one from the pump does not, it is likely an absorption problem and the site should be changed.

But as I said at the beginning, track the potential Insulin On Board and your daughters BGs closely. You want to avoid inadvertently causing a severe hypo.

Have you asked your daughter for suggestions?