My 15 yr old T1D, dx 9 weeks ago, had only 1-2 lows total for the first 7 weeks, then has had at least one low per day for the last week and a half.
Usually they occur when he is about 4 hours from his last meal and decided not to snack. Turns out that for the first 7 weeks, he was so famished from rebuilding his body from DKA, that he'd been sneaking "less than 15 carbs so I don't have to bolus" tidbits here and there, but now he's not hungry so he's stopped sneaking snacks.
Is having a low if he skips a snack normal? Does he absolutely need carbs every 3 hours? Or is his Lantus too high?
My "impression" of basal insulin is that it should keep him in the OK zone 24/7, if he were to have NO carbs at all, hypothetically, and that his bolus should completely cover his carbs, so theoretically if he had no carbs at all, the Lantus should keep him between 70 and 150. But his pediatrician said he actually wants to raise his Lantus because of his dawn phenomenon readings, usually over 180. He doesn't seem to be going low overnight, we check him at 2am every other day and it's usually over 150 at that point. Why would he only go low during the day?
He's afraid to exercise for fear of going low, now.
What am I missing here?
Waiting on word from the endo, but it could be a few days, as he's not local.... long long story, we live in a remote location...
One freaked out mom here. Lows are scary.
Love the analogy :)
Thanks MrsBaloo, It might be you are taking in more information than I did in the beginning. I mean I read the Pink panther book and "Type 1 for Dummies" those first few months. We did exactly what his Endo suggested. Like-he rarely has a snack without bolusing for it now, they said it was OK to have a uncovered 15 carb snack as long as he was under 120. Then he starting eat them at 125 then 130...It really messed him up later. Now with the pump, he doesn't have to eat a snack unless he's hungry and if he is, bolusing for a little snack is easy. Hang in there, it will get more routine. :)
Hey, that was just the question I was about to ask. Son has figured, "well, if it's a 1:15 ratio, if I sneak less than 15 carbs, it must be free!" (I didn't know about this until I heard him admitting it to the pediatrician over the phone on Friday night, btw!) I was curious if he was correct or not...!
I wouldn't describe it as "free", as the snack is actually preventing an impending low. If he chooses to use this method it can work very well, just don't forget the snack. I have actually started doing this frequently since I have gotten my Dexcom, the extra insulin at the start helps reduce the post meal spike and when I see the numbers starting to drop I have a little snack and it keeps me running very flat. Without a CGM I would not recomend this, but it can work, it just is a bit more effort.
I agree with Acidrocks earlier suggestion that 1:15 is a bit too strong and 1:30 is a bit too weak, give 1:20 a try and just keep making small changes until you get it right.
If you are able to get a Dexcom I would highly recomend it, after using it for a while you start seeing the patterns and you are able to learn how things affect the BG values and are able to better adjust and anticipate BG patterns. It also makes basal evaluation a lot easier. Good luck!
Neat idea. I am certain that my daughter would **kill** me were I to post a video of me discussing her anywhere...
Nathan too. Really. Thats why the video is going to consist of stills. Illustrations or whiteboard, pictures of food, devices pictured on his body, etc... but not his face, he wouldn't go for that. :)
I'm not even allowed to post a still of my daughter. AND she won't friend me on FB LOL
Ouch! :) Ya got us!
The doctors agreed (endo and peads) i’m likely inside the honeymoon period and i was told that it would be crazy. What i would like to ask though is, is it natural for the pancreas to decide to "take a day off”? for example, yesterday when i looked over the numbers my body had been running at a 1-15 ratio when i’d been giving a 1-30 as directed by the doctor. but then this morning when i was going to try a 1-20 (within the doctor’s range) i miss calculated and gave a 1-30 and ended up with a low. at leas i was able to correct my 9:30 snack from 1-20 by looking at the numbers trying to figure out why i was low.
Is there an easier way to navigate the honeymoon period than just correcting off of your last number?
(oh forgott to mention, i’m the spoken of 15 year old)
Sometimes it isn't just a honeymoon. Sometimes it is just "the day." You may have been more active or stressed, or it may just be the gremlins That being said, what you descirbe seems to suggest that you are a honeymooner and you pancreatically up and down days.
From what you are saying, you may actually need very little insulin (for now). If your doctor gave you an I:C ratio of 1:30 for meals, then you would get a small dose of insulin. If you actually needed a 1:15 for a meal, you would have generally gone high after the meal. You used a 1:30 this morning (even tho you planned on using 1:20) which should have given you a small conservative dose of insulin. Despite this smaller dose, you still went low. If today your pancreas sputtered back to life a bit, you would not only need less external insulin for your meal, but you might not need as much basal. Your regular basal may have contributed to your low. Sometimes, you just have to be prepared to go with the flow.
If you are in a honeymoon, it is safest to use a ratio like 1:30, accept that it is a smaller dose than you may need most of the time. And then correct if needed when you are still high. When things settle down, then you can tighten up on the I:C ratio. Unless you are experiencing significant highs (many over 200 and higher), then it is easier and safer to err on the side of caution. A low you need to take immediate action, but a high is less of an emergency (but I'm not talking in the 300s)..
so in summary, i shouldn’t try to match what my pancreas did between the last meal and this one but stick to 1:30, and be ready to go with the flow?
I make changes slowly. Just because my last bolus was off, I won't make changes right away and I am "stable." You are likely to have more ups and downs, not just from a honeymoon, but you are a teenager, your life is active and varied, your hormones are ragin and you are growing and eating. I would just go with the flow.