Blood sugar out of control, HELP!!!!!

[AbiNip]

My 10 yr old daughter diagnosed type 1 about 1 year ago. We felt we were managing very well checking levels at meal times and bedtime. Giving insulin keeping levels down fairly well, we thought.
The past few weeks we've had constant blood monitoring which has shown levels fluctuating from hypo right up to 20 plus. We keep on altering our ratio trying to get things under control without much success.
One of the troubles we have is that insulin seems to take so long to work, sugar fly's up high after meal and only starts coming down close to the next meal. Also at bedtime we check blood, if it's good we don't give any correction but at that point levels are falling so fast that within an hour or two she is hypo.
This weeks average level is 12 which seems bad to me.

 

[Thebearcametoo]

What basal insulin is she on? It sound like that may need looking at and some adjustments may be needed if she’s having a growth spurt or having hormonal changes or if she’s ill. Your diabetes nurse should be able to look at the data from the meter and be able to advise. Are you checking ketones when she goes high too?

 

[Sally71]

It goes like that sometimes unfortunately, growth and puberty hormones are a pain in the proverbial!!
What regime is your daughter on, is she pumping or is she on injections? If the latter, what insulins is she using?

Things that jump out at me straight away are: how long before meals do you bolus/inject? If you find that the insulin takes ages to get going, could you do the dose half an hour earlier to allow the insulin to get going before she eats?

What basal insulin is she on, could you swap to a different one which could be given twice a day instead of once, so you could give her less at night. Or ask about a pump if you don't have one already, they are quite a lot of work but are much more fine tunable, you can adjust what goes on in the night without disturbing the day and so on, and they can give much more precise doses. If you are pumping already then it looks like you've got some adjusting to do, can your hospital team help?

Also, do you know how to do basal testing? Everyone's basal requirements change from time to time, and if your basal is out that mucks everything else up too, it's a pain to do but might help you find where the problems are. Good luck!

 

[AbiNip]

Basal is Levemir we currently inject 24. Key tones are fine 0.1 Nurses always say you're managing fine.

 

[AbiNip]

Bolus novarapid injecting.

 

[Sally71]

Golly, I don't think our team would be very impressed if my daughter's blood sugars were regularly going into the 20s! Well, they would recognise that you are doing your best but they would also be offering you loads of suggestions how to make it better. Levemir can be split into two doses per day, instead of giving it all at once (because it doesn't quite last the full 24 hours), and you don't have to do a 50/50 split you could give less at night if that would work better. We can't really tell you how to do it though you need to speak with a medical professional, if your team aren't very helpful could you ask for a second opinion or to be transferred elsewhere? Basically you need to look at a) basal testing, b) Levemir dosing, whether it needs adjusting and whether splitting it into two doses might help, and c) timing and dosing of Novorapid at mealtimes. Get as much help as you need on all of that, don't try to do it yourself if you don't know how (it took me well over a year to be confident in adjusting things myself!) .

I know we are lucky with our hospital team, if they had their way they would have everyone on pumps and CGMs, there isn't the money for that though of course; they are though always wanting to help you get your child's control the best you possibly can, always looking for ways to make even small improvements, and don't mind you getting in touch with them any time if you have a problem. It saddens me that not everyone is so lucky

 

[trophywench]

Has anyone spelt out for you what effect normal 'lady' hormones have every 4 weeks, on a girl's BG?

 

[Steve12]

We've got a rubbish team and we've not had any info on how to cope with my daughters hormone issues, if you have any info you can pass our way.
Many thanxs
@trophywench

 

[Sally71]

How old is your daughter @Steve12 ? Has she started her periods yet? My daughter is 13 now and we have just had all the fun of going through puberty! So we were told that puberty hormones stop insulin from working, so it's quite normal for a girl's insulin requirements to at least double during this time, and it goes on for about 3 years or so. My daughter's certainly seemed to shoot up quite suddenly and we had to increase her basal by about 30% all at once. So you have to do lots of testing and adjusting. As far as periods themselves go, I’ve heard many ladies say that they need more insulin just before and during their period, however everyone is different and my daughter seems to go the opposite way, she'll go low all the time during her period and then sky high for a couple of days afterwards. And of course just to add to the fun her cycle is not completely regular and each month seems to be different in terms of how much of an effect it has on blood sugar (some months are a disaster, some barely seem to have any effect at all) so at the moment we are just reacting to whatever happens and haven't managed to formulate any sort of definite plan to try and preempt it. Oh the joys
The only good thing seems to be that we might just be starting to come out the other side, her growth has slowed and insulin requirements are just starting to tail off a bit; when she was first diagnosed her pump would last 6 days easily between refills, during puberty it was lasting 4 days if we were lucky, and we're now just starting to go into the 5th day fairly regularly so maybe the end is in sight!

Don't know if that helps but if you have any more specific questions please ask 🙂

 

[everydayupsanddowns]

Just another nudge for bolus timing.

This makes a huge difference for me. If your doses are eventually bringing your daughter into range, but there’s a huge spike after the meal, then either you can look at the meal choices themselves do that they are less ‘spiky’, or it seems like she needs a longer gap between taking the dose and starting to eat the food. Insulin isn’t available immediately and can take a good 15-20 minutes to begin making its way from sc tissue into the bloodstream. Some cautious experimentation with leaving 5 minutes, then 10 minutes, then 15 minutes etc might really help. But bear in mind that the food doesn’t hit immediately either, of course.

So it’s a bit of fiddling to try to match the activity of the insulin with the absorption of the food. And she might find this is different at different mealtimes. Or that some meal choices (eg fattier ones like pizza or old rascals like pasta) need a different approach to pasta.

Good luck, and hope you can use the information from Libre to improve her post meal levels without too much stress.