Nathan has given himself 6units or N/R more than he was told

[sasha1]

Glad to hear he is ok now, but must have been very worrying for you. Good move getting him picked up. Have you been able to talk to him about it yet? and understand what his reasoning was to go against your agreed dosing?

I don't know if you have said before why you aren't carb counting? maybe it would give him more freedom and confidence to adjust his own insulin doses and feel more in control.

Hi sofaraway.

Yes we had a good chat..he decided to give himself 20 because he was going to have flapjack after dinner....in his mind he was trying to do the right thing..I understand fully...I have just advised him to try just 1 or 2 units next time and said if in doubt keep to your usual dose because he/we can always correct later...and advised him not to increase any dose by a full 6 units..

Nathan is adamant he does'nt want to carb count...unfortunately at 14 anything that is suggested by others is rubbish and he knows best..its a difficult age...he is also struggling to accept his diabetes..dx 2yrs 4mths ago... I was taught how to adjust Nathan's doses in accordance with the effect foods had on his bg and the food in front of him...I believe it is called the intermediate level..I am now trying to pass this on to him

Heidi
🙂

 

[katie]

Nathan is adamant he does'nt want to carb count...unfortunately at 14 anything that is suggested by others is rubbish and he knows best..its a difficult age...he is also struggling to accept his diabetes..dx 2yrs 4mths ago... I was taught how to adjust Nathan's doses in accordance with the effect foods had on his bg and the food in front of him...I believe it is called the intermediate level..I am now trying to pass this on to him

wow. Have you told him that if he carb counted he would have been able to work out how much he needed for that flapjack and could have added it on? He will feel so much better if he carb counts! I can't believe they still arnt teaching people how to carb count as soon as they are diagnosed. I was diagnosed 5 years ago and I was taught straight away. How is Nathan's HbA1c?

 

[sasha1]

wow. Have you told him that if he carb counted he would have been able to work out how much he needed for that flapjack and could have added it on? He will feel so much better if he carb counts! I can't believe they still arnt teaching people how to carb count as soon as they are diagnosed. I was diagnosed 5 years ago and I was taught straight away. How is Nathan's HbA1c?

Hi Katie,

The hospital have offered to teach us carb counting..and we did try it for a little..nathan's levels went hay wire..carb counting one meal...Breakfast...Nathan has been told about all the benefits of carb counting...but wont have it..and ultimately at 14 we cannot make him...
His HbA1c has ranged from 7.6 to 6.8 as of apr 09

Heidi
🙂

 

[bev]

Hi Heidi, how is Nathan now? Have levels stabilised yet?

I must admit (we have spoken about this) - i dont understand how you dont carb count! I think it just goes on how you are taught from day one doesnt it? But we were carb counting within days of diagnosis - so i suppose its all we know how to do! I think it probably will make life easier for Nathan in future - because he wont want to have to rely on you to tell him his units - perhaps if you play the 'you will have more freedom' card - he may be a bit more interested in learning? To be honest in the first few days i thought i would never 'get it' - but actually its really easy and once youve learnt what a portion looks like you get quite good at 'guesstimating'! In a way, you are carb counting because you either increase or decrease depending on how big the meal is. Anyway, hope he is feeling a bit better and hope he has learnt it may be best to underestimate rather than overestimate!Bev x

 

[MarcLister]

wow. Have you told him that if he carb counted he would have been able to work out how much he needed for that flapjack and could have added it on? He will feel so much better if he carb counts! I can't believe they still arnt teaching people how to carb count as soon as they are diagnosed. I was diagnosed 5 years ago and I was taught straight away. How is Nathan's HbA1c?

Yep. Carb counting would give him more freedom. He could work out how much to take for lunch then how much to add for a bit of flapjack without any problems.

And I only learned how to carb count from this forum. My DSN didn't tell me when I was sent to hospital on my day of diagnosis. Spoke to my consultant 2-3 months ago and seemed happy I was carb counting. Happy because I was carb counting or happy I'd learned how to do it without help I don't know. 😛

 

[katie]

Hi Katie,

The hospital have offered to teach us carb counting..and we did try it for a little..nathan's levels went hay wire..carb counting one meal...Breakfast...Nathan has been told about all the benefits of carb counting...but wont have it..and ultimately at 14 we cannot make him...
His HbA1c has ranged from 7.6 to 6.8 as of apr 09

Heidi
🙂

Well at least for now his HbA1c's are good. I'm amazed that they are without carb counting! Does he have similar things to eat each day? How do you work out how much he needs? Did he have a honeymoon period where he needed less insulin?

Sorry, so many questions lol x

 

[katie]

just noticed you answered my questions in the other thread 😉

 

[Proudspirit]

Hi Heidi,
Just to let you know that his age has a lot to do with him refusing to learn to carb count etc. My daughter refused outright to wear her splint as she just wanted to be "normal" she is 17 now and has been asking for me to put it on her again!
He will do what he needs to do when he is ready.

Good luck & so pleased he is ok, such a worry for a parent.

Julie x

 

[Patricia]

Hello Heidi

Phew! Glad all okay. You did so well in keeping it together. I would have been beside myself completely. I guess you were, really...but just to say -- phew!

Best.

 

[NiVZ]

Hello,

When Nathan had his 18 hypos in 10 days what time of day was he going low?

Does he have any hypo's through the night? And what is his usual bedtime and morning BG readings?

Sorry lots of questions.

NiVZ

 

[sasha1]

Hello,

When Nathan had his 18 hypos in 10 days what time of day was he going low?

Does he have any hypo's through the night? And what is his usual bedtime and morning BG readings?

Sorry lots of questions.

NiVZ

Hi NiVZ,

The 18 hypo's in 10 days were all at different times...some before meals, some a couple of hours after..and others with no pattern..even with adjustments to dose's at this time they were still erratic..Thats why last friday 19/06/09..I decided to drop all doses significantly right across the board from NR to Lantus...I would'nt advise anyone to do this though..as usuall stick to one dose at a time...But I felt confident and capable enough to carry this out without foreseeing any major problems...

He does have hypo's during the night...usually between 1.30-2.30 or 4.30-5.30...

His usual bedtime reading is between 4.5 - 8
'' '' morning '' '' '' 5.5 - 9

Heidi
🙂

 

[NiVZ]

Hello,

His bedtime and morning readings are really good which suggests his background insulin is fine.

I definitely think you did the right thing by cutting his fast insulin. If I ever had a lot of hypo's like that I'd cut mine too.

I think most diabetics would agree it's better have slightly higher blood sugars and work on bringing them down gradually with small increases to fast insulin than having to suffer the horrible hypo feeling all the time.

How's he doing today?

 

[sasha1]

Hello,

His bedtime and morning readings are really good which suggests his background insulin is fine.

I definitely think you did the right thing by cutting his fast insulin. If I ever had a lot of hypo's like that I'd cut mine too.

I think most diabetics would agree it's better have slightly higher blood sugars and work on bringing them down gradually with small increases to fast insulin than having to suffer the horrible hypo feeling all the time.

How's he doing today?

Hi NiVZ,

Totally agree on having higher blood sugars....and use the NR small increase gradually to bring them back down.. I do tend to try and aim for a little higher readings especially when he at school.

It a fine balance at the moment because if he has a temporary reading of over 11...he feels off colour and irritable...4 or under...feels rubbish.

I would agree with you the Lantus is bang on at the moment...fingers crossed...again if that starts to become a problem it can be increased gradually.

He again had hypo this afternoon......and took a while for him to return to normal..so in view of that..his lunch time NR will be reduced tomorrow...There is also a little question mark regarding his breakfast dose to as he only on 6...he seems to becoming reliant on a small fredo mid morning to bring him up...with that I will probably reduce that dose to 4...but have been told by DSN that is the least he must have...when I questioned her about it ages ago...so with that it may require his Lantus to be knocked down slightly.

He feeling much better on a whole today despite his hypo...Thank you for asking that means alot..as does it when all the other do to..

How are you?

Heidi
🙂

 

[Munjeeta]

There is also a little question mark regarding his breakfast dose to as he only on 6...he seems to becoming reliant on a small fredo mid morning to bring him up...with that I will probably reduce that dose to 4...but have been told by DSN that is the least he must have...when I questioned her about it ages ago...so with that it may require his Lantus to be knocked down slightly.

Hi Heidi,

I've been reading this with interest. Why is it that your DSN says Nathan shouldn't reduce his short acting dose to less than 4?!

 

[sasha1]

Hi Heidi,

I've been reading this with interest. Why is it that your DSN says Nathan shouldn't reduce his short acting dose to less than 4?!

Hi Munjeeta,

When I asked the DSN this as it puzzled me somewhat...She repiled 'That to take less than 4units as a breakfast dose would be inadequate...based on Nathan as an individual...although she would not recommend anyone to take less than 4units...as a meal dose...as its effect would not be beneficial and unable to deal with the spike from the meal'.....However if Nathan was ill at the time it would be ok...as they have informed me rather than give the usual dose...Fast acting insulin in small doses every two hours is best..Having tried that during illness, it worked for Nathan.

Heidi
🙂

 

[Munjeeta]

Hi Munjeeta,

When I asked the DSN this as it puzzled me somewhat...She repiled 'That to take less than 4units as a breakfast dose would be inadequate...based on Nathan as an individual...although she would not recommend anyone to take less than 4units...as a meal dose...as its effect would not be beneficial and unable to deal with the spike from the meal'.....However if Nathan was ill at the time it would be ok...as they have informed me rather than give the usual dose...Fast acting insulin in small doses every two hours is best..Having tried that during illness, it worked for Nathan.

Heidi
🙂

Hmmm... Interesting! I guess that's based on eating a carbohydrate-based meal?

 

[NiVZ]

Hello,

Thats good to hear he's doing a bit better. You're definitely on the right tracks with the changes you are making. Unfortunately with diabetes it's often a case of trial and error until you get yourself stable.

If he's needing chocolate mid-morning then lowering the breakfast one sounds good. I have to say I was a little surprised at the lunch and evening injections of 14 given he needs so little in the morning, although I know my cousin takes large amounts of insulin (she used to need to order the large syringes cos she took so much and she's only recently got a pen that can do her full dose in one shot) and as they say, everyone is different.

I know I touched on it earlier, but can you give us a quick run through of a typical school day for him?

For comparison, I'm 5ft 11in, 12 stone and work in an office. My daily food/insulin is as follows:

Breakfast: Cereal with whole milk - 6 units humalog
Lunch: Sandwich and crisps and chocolate biscuit - 7 units humalog + 28 units lantus
Evening: Pork chop with chips and rice and fruit salad for pudding - 8 units humalog

I'm doing fine thanks. Been a bit high lately (not as high as when on holiday at the start of the month!) but gradually bringing it back down again. I've noticed I've stuck on about a stone in the last 12-18 months and wondering if this is due to the hypo-thyroid. Be interesting to see if I can shift it now I've started on (Levo)Thyroxine.

Also interested to hear about a minimum dose of 4. Never heard that before, although on DAFNE they do say that even if you skip breakfast some people need to take a couple of units for the dawn phenomenon.

Keep us posted with your progress, hopefully he'll be hypo free soon.

NiVZ

 

[sasha1]

Hello,

Thats good to hear he's doing a bit better. You're definitely on the right tracks with the changes you are making. Unfortunately with diabetes it's often a case of trial and error until you get yourself stable.

If he's needing chocolate mid-morning then lowering the breakfast one sounds good. I have to say I was a little surprised at the lunch and evening injections of 14 given he needs so little in the morning, although I know my cousin takes large amounts of insulin (she used to need to order the large syringes cos she took so much and she's only recently got a pen that can do her full dose in one shot) and as they say, everyone is different.

I know I touched on it earlier, but can you give us a quick run through of a typical school day for him?

For comparison, I'm 5ft 11in, 12 stone and work in an office. My daily food/insulin is as follows:

Breakfast: Cereal with whole milk - 6 units humalog
Lunch: Sandwich and crisps and chocolate biscuit - 7 units humalog + 28 units lantus
Evening: Pork chop with chips and rice and fruit salad for pudding - 8 units humalog

I'm doing fine thanks. Been a bit high lately (not as high as when on holiday at the start of the month!) but gradually bringing it back down again. I've noticed I've stuck on about a stone in the last 12-18 months and wondering if this is due to the hypo-thyroid. Be interesting to see if I can shift it now I've started on (Levo)Thyroxine.

Also interested to hear about a minimum dose of 4. Never heard that before, although on DAFNE they do say that even if you skip breakfast some people need to take a couple of units for the dawn phenomenon.

Keep us posted with your progress, hopefully he'll be hypo free soon.

NiVZ

Hi NiVZ,

Sorry I'm just replying now..been having computer issues..for past couple of days.

Agree fully aspects of diabetes/insulin is very much trial and error. It has been something we have been encouraged to do since Nathan's diagnosis. The hospital are pleased with his results and we are left to kind of get on with it.

A typical school day for Nathan is: 25.06.09

Breakfast 8am: Shreadwheat with handful of strawberries, raspberries and half banana with semi skimmed milk....BG.. 5.1 N/R 6 units

Walk to school and to and from lessons, played football for 20 mins at break..had Fredo

Lunch 12.30: Jacket potato with beans and cheese, and small piece chocolate cake (school dinner)....BG.. 6.6 N/R 14 units

Played football for the remainder of dinner time, then lessons, and walked home at 3.30.

Hypo 3.30....BG...3.1...2 glucotabs, and an apple, tea wont be long

Tea 4.30pm: Pork chop, seven small boiled new potatoes, unlimited veg...turnip, roasted carrot and broccolli, Yoghurt....BG.. 6.8 14 units N/R

Hypo 7.30: BG...3.5..2 glucotabs and 2 rice cakes


Supper 9pm: 2 slices of granary toast, some melon, kiwi, mago....BG.. 6.6 38 units Lantus


Glad you feeling ok..hope Thyroxine does the trick..

Heidi
🙂

 

[bev]

Hi Heidi,
Ijust thought i would give you an example of Alex's insulin etc.

Breakfast - special k = 8 units novo
lunch - sandwich , yoghurt = 4 units approx
dinner - chicken,mash, sweetcorn , small ice cream = 6 units


Alex doesnt eat small portions either - so i was just wondering if Nathans novo is a bit high? Nathans breakfast insulin is less than Alex's, and Nathans lunch insulin seems to be an awful lot for a baked potato and a cake.
Also the units for the pork chop etc seem like a lot for what is very little carbs(just potatoes and yoghurt really) - i am not being critical - i am just a bit shocked at the levels of novorapid for the food given.
I know you dont carb count - but the lunch and tea units are the same - but the food is very different - the lunch is almost all carbs - but the tea is very little carbs.

So if i gave Alex the equivolent insulin for the carbs you describe - i would almost certainly expect him to have a hypo after both the lunch and the tea.

I do understand that you work on a different regime than us - but i am just puzzled - as the way we work it out is that the amount of carbs has to equal the amount of novo that is given. (depending on the ratio i.e.1: 10 or 1:12 etc).

I think i would get very confused if i didnt carb count! lolBev x

 

[sasha1]

Hi Heidi,
Ijust thought i would give you an example of Alex's insulin etc.

Breakfast - special k = 8 units novo
lunch - sandwich , yoghurt = 4 units approx
dinner - chicken,mash, sweetcorn , small ice cream = 6 units


Alex doesnt eat small portions either - so i was just wondering if Nathans novo is a bit high? Nathans breakfast insulin is less than Alex's, and Nathans lunch insulin seems to be an awful lot for a baked potato and a cake.
Also the units for the pork chop etc seem like a lot for what is very little carbs(just potatoes and yoghurt really) - i am not being critical - i am just a bit shocked at the levels of novorapid for the food given.
I know you dont carb count - but the lunch and tea units are the same - but the food is very different - the lunch is almost all carbs - but the tea is very little carbs.

So if i gave Alex the equivolent insulin for the carbs you describe - i would almost certainly expect him to have a hypo after both the lunch and the tea.

I do understand that you work on a different regime than us - but i am just puzzled - as the way we work it out is that the amount of carbs has to equal the amount of novo that is given. (depending on the ratio i.e.1: 10 or 1:12 etc).

I think i would get very confused if i didnt carb count! lolBev x

Hi bev,

No I understand you not being critical hun🙂
Other diabetics/carers are a little bit shocked by the amount of insulin Nathan takes...But what I say is that he is 14...hormones in full swing..and he no longer in honeymoon...A teenage diabetic can take or require more than 3 times more than an adult...Also if nathan has to little insulin to cover these years..growth can be affected...Some teenagers can go from needing for example 15 units Long Acting to 30 units in less than 2 weeks.. Also weight influences doseages at this time...there is a passage in the Dr Hanas book which gives rough ratios to this.

If I give Nathan less insulin he spikes up into the high teen's, and subsequent readings are up there for a few days..so at the moment I'm just trying to find the right balance....yes would agree the lunch and tea need slight adjustments..but it just over a week since I dropped 10 units off Lantus.. and between 2 and 4 units off N/R, on all doses....in the same day..

Regarding the Baked potato, he has beans and cheese which are carb and the cake is both slow and fast carb....The potato at home have butter on them also the turnip is mashed in butter etc, he also has a slice of bread.
But also Nathan has the option of having something else if he requires..

Heidi xxx
🙂