Help a mother out!

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Michx

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Hello! My son (just turned 18) was diagnosed with type 1 diabetes in A&E on Monday night. He was given some insulin and we was sent home with a prescription for Metformin and a promise of a call the following morning. After no call and many hours if trying I managed to speak to the lead clinician of the diabetes team and we had an appointment with her this morning. She advised us to have 6 units of Novorapid before breakfast, lunch and dinner and 10 units of Lantus at night. She advised to check his blood sugar levels before each meal. This evening his levels were high, so am I right in thinking that he has his normal 6 units plus the amount of units needed to get him within range plus the units he needs for the carbs in his meal? I’m sorry if this sounds silly but I don’t feel equipped to deal with this, I have no idea what I am doing and I’m worried I’m getting it all wrong.
 
I am not an insulin user but i am sure one of our T1's will be long soon with ideas. In the mean time my suggestion is you do not panic. From what I have seen from forum members, getting insulin regimes sorted out takes time and the confusion you are seeing is par for the course.
 
He’s been put on a fixed dose of Novorapid of 6 units. It’s these 6 units which will cover his carbs. In addition, I’d be very wary of giving extra Novorapid as a correction dose at this stage. Were you actually told to do that? How high is his blood sugar?
 
Hi, yes the nurse went through the correction dose with us and from what I understood, because at that time his blood sugar was 17 (26 this evening) he would require 4 Units to get it back to 5 and if the meal was 30 g carbs he would require 3 units for that but im not sure if that was as well as the 6 units that he is meant to have before each meal time?
 
Sorry to post so quickly and in parts @Michx but what you were suggesting could have sent him hypo (very low blood sugar). In these early days, you’re mainly doing two things: firstly, avoiding hypos as this can happen quickly and unexpectedly. You/he must always keep glucose on him to deal with any hypos, and take hypo treatments when he goes out; and secondly, avoiding ketones.

Ketones are potentially dangerous but they don’t happen so quickly. They are usually due to very high blood sugar and he may well have had ketones at diagnosis. In large amounts, they can cause diabetic ketoacidosis, which is dangerous. You/he can test for ketones with urine dipsticks (Ketostix) or a special ketone meter. You can buy Ketostix for around £5.
 
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Michx said:
Hi, yes the nurse went through the correction dose with us and from what I understood, because at that time his blood sugar was 17 (26 this evening) he would require 4 Units to get it back to 5 and if the meal was 30 g carbs he would require 3 units for that but im not sure if that was as well as the 6 units that he is meant to have before each meal time?
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No! He must NOT have additional units to cover the carbs as they are already being covered by the 6 units @Michx
 
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Thank you for your advice, it’s all very overwhelming. The machine that we was given today tests for ketones in the blood. This morning they was 1.5 when we was at the hospital but this evening they have been lower.
 
It absolutely is overwhelming to start with @Michx It does gradually get easier, I promise.
His Lantus is a slow-acting long-lasting insulin that works away in the background to keep his blood sugar ok in the absence of food (because blood sugar can rise even if we don’t eat). It’s likely he’s been started on less Lantus than he’ll actually need, but that’s normal and that’s done for safety reasons (to avoid hypos).

The Novorapid is a fast, shorter-acting insulin whose job is to deal with the carbs in meals (and correction doses if/when needed). In time, your son will take differing doses of the Novorapid according to what he’s about to eat, but for now he’s been given a fixed dose of 6 units to take before each meal. Those 6 units are his meal/carbs insulin.

I also suggest he tests more frequently than you’ve been told, especially last thing at night and at any time he feels funny or off in some way.
 
This is the NHS guidance about ketones:

If you use a meter to test for ketones in your blood:

  • under 0.6mmol/L is normal
  • 0.6 to 1.5mmol/L is slightly high – test again in 2 hours
  • 1.6 to 3mmol/L means you're at risk of DKA and should speak to your diabetes care team for advice
  • over 3mmol/L is high and means you may have DKA and should call 999 or go to A&E
 
Here’s some information about hypos:

What is a hypo (hypoglycaemia)?

A hypo is when your blood sugar level, also called blood glucose level, drops too low. This is usually below 4mmol/l. A hypo, also called hypoglycaemia, can happen quickly. So it’s important to always have hypo treatments with you. It's also important to know what the signs are and how to treat...
www.diabetes.org.uk www.diabetes.org.uk

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Thank you so much, you have been very helpful and I will look at the links and books that you have recommended.
 
Also, I don't think you need to worry too much about ketones as long as he has some insulin on board (basal and he's bolusing too), post-exercise or if doing a keto-diet you can happily sit in the range where you should allegedly be calling an ambulance. I did start a thread about this somewhere or other, but I think the guidance is rather conservative.
 
Glad @Inka was on hand to give you some helpful pointers from an experienced T1 perspective.

Getting a diagnosis with T1 at A&E then being sent home just speaks to me of how overwhelmed the health system currently is :(

When I was diagnosed I was admitted to hospital for about 5 days, closely monitored and was seen by consultants, DSN, and dieticians before I was let loose on my own. And that was scary enough!

It will feel overwhelming now, but don’t panic. It will get easier. Soon enough it will must be part of his routine, and he’ll be able to estimate carb contents of a meal from 30 paces :D
 
everydayupsanddowns said:
When I was diagnosed I was admitted to hospital for about 5 days, closely monitored and was seen by consultants, DSN, and dieticians before I was let loose on my own. And that was scary enough!
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I think this varies depending upon how we were presented.
As I did not have DKA, I went to my GP due to general bleugh feeling plus lots of weeing. She diagnosed diabetes with a urine test) and arranged an appointment at the diabetes clinic the next day where I was introduced to insulin and test strips then sent home.
I had daily calls with the DSN for a week which went down to weekly for a month, then left on my own for 3 months, then 6 months and then a year.
I appreciate this was 20 years ago so things have probably changed a little in that time but, even then, overnight stays were not normal.
 
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