utterly confused!

[bev]

ok so we went to see the dietitian today and she basically told us some interesting stuff 🙂 which cheered him up 🙂 so my son chose his dinner 🙂 lol he had

pasta in a sauce (130 carbs)
home made pizza (30.2 carbs)
sugar free jelly (0.5 carbs)
Milk shake (27 carbs)

His results so far

before meal 13.3
1 hour after 13.5
2 hours after 11.5
3 hours after 20.0

Hi Hybriduno,

Have you been taught about giving a correction dose of insulin for high levels? If 13.3 before eating you really should be waiting for the levels to come down before eating and also inject at least 15 minutes before eating to give the insulin a chance to start working. Pizza is one of the tricky foods as is pasta and milkshake so altogether you werent going to get decent levels to be honest! It would be a good idea to try just one of these on their own when levels are under 10mmls so you can get a better idea of meal spikes and how to dose for them.🙂Bev

 

[hybriduno]

Was that all in one meal? That does look like a lot of carbs - I probably only get through about 150g a day, but I'm not his age. There is quite a jump at 3 hours, so it looks like this is the spike - whether it reduces will depend on his 4 and 5 hour readings. If they are still high or incerasing then there is probably insufficient insulin.

TYpo!!! pasta was 30 not 130 😉 ill check him again in a few minutes as at 10:30 its 5 hours later 🙂

 

[Northerner]

TYpo!!! pasta was 30 not 130 😉 ill check him again in a few minutes as at 10:30 its 5 hours later 🙂

Phew! That sounds better! 🙂 Had visions of enormous amounts of spaghetti and a little 8 yo! 😱

 

[hybriduno]

Was that all in one meal? That does look like a lot of carbs - I probably only get through about 150g a day, but I'm not his age. There is quite a jump at 3 hours, so it looks like this is the spike - whether it reduces will depend on his 4 and 5 hour readings. If they are still high or incerasing then there is probably insufficient insulin.

Hi Hybriduno,

Have you been taught about giving a correction dose of insulin for high levels? If 13.3 before eating you really should be waiting for the levels to come down before eating and also inject at least 15 minutes before eating to give the insulin a chance to start working. Pizza is one of the tricky foods as is pasta and milkshake so altogether you werent going to get decent levels to be honest! It would be a good idea to try just one of these on their own when levels are under 10mmls so you can get a better idea of meal spikes and how to dose for them.🙂Bev

Thanks for your response Bev. no we havent been told jack! this is whats upsetting, we have a very basic chart ie:

bs under 4 follow hypo guide..
bs between 4-10 give 3 units
bs over 10 4 units
bs over 20 5 units

nighttime levemir 5 units

now obviously its 10:30 pm and i dont know whether to give him another unit or 2 to try and bring him down or wait till 2 am and re check him.

it's soo worrying that we have so little knowledge yet released from hospital

 

[trophywench]

Shoot! Or summat similar.


me -

1 unit of insulin deals with (negates) 10g of carb.

1 unit of insulin and no food, reduces my meter reading by 3.0


I'd be mega, stega hypo if I took 4u when my meter said 14 ........

For that meal then, I'd need 9u of insulin, plus another 2u as a conservative correction, so I'd have that in 2 jabs as it's less successful injecting more than 7u in one jab. Your HCP may disagree with that. But it isn't a hypothesis - most of us find it's true ......

I still think 90g of carb in one sitting is A LOT for an 8yo.

 

[bev]

Thanks for your response Bev. no we havent been told jack! this is whats upsetting, we have a very basic chart ie:

bs under 4 follow hypo guide..
bs between 4-10 give 3 units
bs over 10 4 units
bs over 20 5 units

nighttime levemir 5 units

now obviously its 10:30 pm and i dont know whether to give him another unit or 2 to try and bring him down or wait till 2 am and re check him.

it's soo worrying that we have so little knowledge yet released from hospital

Hi Hybriduno,

Hmm that does seem a little general! I dont understand why you would be giving a correction dose when levels are 5 for example? Your chart says between 4 and 10 give 3 units - but you wouldnt need a correction if levels are within range (i.e. between 4 and 7) so am a little puzzled. If you gave 3 units at 4 your child would be on the floor!

Our target is 6mmols - so if over that we know to give 1 unit of insulin for every 3.8mmols of BG that is higher - but Alex is on a pump so its easier to do such small increments whereas on injections you can only do half units as I remember. I am wondering whether your team are just being general because its such early days - but then if you followed the advice for correcting at 4 or 5 then not sure what would happen. Have you given a correction at these levels and if so what was the outcome?🙂Bev

p.s. Your doing great by the way - your asking all the right questions and not just sitting back and accepting things which is great given its such early days!

 

[hybriduno]

before meal 13.3
1 hour after 13.5
2 hours after 11.5
3 hours after 20.0
4 hours after 22.6
5 hours after 24.8
6.5 hrs after 21.5 <12:30 pm
morning level is 11.2 @ 7:30 am

 

[everydayupsanddowns]

Thanks for your response Bev. no we havent been told jack! this is whats upsetting, we have a very basic chart ie:

bs under 4 follow hypo guide..
bs between 4-10 give 3 units
bs over 10 4 units
bs over 20 5 units

nighttime levemir 5 units

now obviously its 10:30 pm and i dont know whether to give him another unit or 2 to try and bring him down or wait till 2 am and re check him.

it's soo worrying that we have so little knowledge yet released from hospital

OK, so here is my assumption. This chart is supposed to be for doses before meals. You haven't been told to inject at any other time. And you haven't been told about monitoring the amount of carbohydrate your son is eating, but to eat a 'normal' healthy diet and avoid sweet things except very occasional treats.

This is approximately 25% of the information that you actually need to manage diabetes successfully.

I suspect that their guess is that an 8 year old will generally eat something like 30-50g of carbs per meal, so they have conservatively estimated starting doses based on that (but crucially *not* told you that this is the suggested limit). They are probably trying not to ovewhelm you in the early stages, but as you can see this does not necessarily make for comfortable reading on the BG meter!

You might choose to adopt this 'fixed dose' approach in the early weeks - to monitor carb intake at each meal and take those suggested doses. Then use tests 4 hours after meals to work out whether the carbs eaten have been too much or too little for the dose (after 4 hours the dose will more or less have finished).

Alternatively you work out each meal on a insulin:carb ratio, and include an allowance for pre-meal readings higher or lower than target as others have suggested.

At your next appointment I would bring all this up so that your team know you are self motivated and aware of carb counting theory. In the long term this will be the most effective and flexible management strategy. And the more normal and less restricted your lad feels he is with food, the better his relationship with his D is likely to be IMO.

 

[pgcity]

I think you are doing marvellously well but there is an awful lot of experimenting to be done and info to learn.
Your team have put you on fixed doses. If you give them the carb counts for each meal and the before meal and 2 hour after meal readings they can help you work out insulin to carb ratios. These will change periodically but are the next step to getting better numbers.
Once you get the ratios you can look at the impact of the glycemic load and digestion of fats, proteins and odd foods. Everyone has a different list of foods that don't behave but we all tend to agree Chinese, pizza and pasta are tricky. I was diagnosed in 2011 and I still haven't sussed pasta.
There are all sorts of non food related things that impact too. Exercise, weather, stress and excitement tend to impact us all but whether it is to make your levels go up or down depends on the individual. I also have problems with baths and showers, lie ins, time of the month and watching man city.
I have learned so much from this forum and you will too but the best thing you can do is get a diary and start writing down blood glucose readings, food, activity and anything else you think might be making a difference. This will help you spot patterns and develop your own rules for dealing with the ups and downs and sometimes sheer randomness of the blood glucose readings you get.

 

[trophywench]

I was diagnosed in 2011 and I still haven't sussed pasta.


I have nearly 40 years start on you mate, and if I ever manage to get it right, I promise to let you know!

Less of it you eat though, the more manageable it is .... had spag for tea tonight. Utterly forgot to do a 'fancy' bolus and just lobbed it all in. 4.4 at plus 2 hours, now at just over 4 hours, 7.4 so just had 0.5u.

We'll see, normally have a huge spike about 2 hours from now ....