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Ah! OK. Great that he has Libre but by the sound of it you use a "reader" to scan it rather than an app on his smart phone. If he doesn't use his phone with the Libre then you can't use a follower app. Personally I love the Libre reader as it is so simple and reliable and whilst I have tried the phone app for several months I have just gone back to the reader because I prefer it.

Does he also have "Optium" test strips to use in the reader to double check his levels when he needs to or does he have a different BG meter for finger prick tests? Have you been advised when to do a finger prick and use the test strips?

Have you been advised how to treat a hypo and for your son to carry hypo treatments with him at ALL times. It is surprising how quickly it can happen and invariably when you least expect it, especially in the early weeks and months of diagnosis, so really important to be prepared. Exercise/activity will be most likely to cause it which might mean it happens when he is not at home, so he really needs to be prepared for that.
 
rebrascora said:
Ah! OK. Great that he has Libre but by the sound of it you use a "reader" to scan it rather than an app on his smart phone. If he doesn't use his phone with the Libre then you can't use a follower app. Personally I love the Libre reader as it is so simple and reliable and whilst I have tried the phone app for several months I have just gone back to the reader because I prefer it.

Does he also have "Optium" test strips to use in the reader to double check his levels when he needs to or does he have a different BG meter for finger prick tests? Have you been advised when to do a finger prick and use the test strips?

Have you been advised how to treat a hypo and for your son to carry hypo treatments with him at ALL times. It is surprising how quickly it can happen and invariably when you least expect it, especially in the early weeks and months of diagnosis, so really important to be prepared. Exercise/activity will be most likely to cause it which might mean it happens when he is not at home, so he really needs to be prepared for that.
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The doctor only gave the cgm and not test strips, so, right now we are only relying on the cgm. Is it important to use the test scripts and on what situation ? For the hypo, i have bought some sweets and ask that he takes it with him all the time. Is there any other ways to treat hypo ?
 
Mom of Type 1 said:
The doctor only gave the cgm and not test strips, so, right now we are only relying on the cgm. Is it important to use the test scripts and on what situation ? For the hypo, i have bought some sweets and ask that he takes it with him all the time. Is there any other ways to treat hypo ?
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You should urgently get some test strips if not for the kit you have for a blood glucose home testing monitor which they should provide with some strips. The CGM is not reliable at low or high levels and should always be confirmed with a finger prick test. If a hypo is treated then that should then be checked with a finger prick so it is vital to have the equipment to do that.
Glucose tablets, jelly babies, full sugar coke, fruit juice are all suitable hypo treatment but if they are hard sweets they are not as suitable as there is a choking risk and they may not release the glucose/sugar quickly enough.
 
Leadinglights said:
You should urgently get some test strips if not for the kit you have for a blood glucose home testing monitor which they should provide with some strips. The CGM is not reliable at low or high levels and should always be confirmed with a finger prick test. If a hypo is treated then that should then be checked with a finger prick so it is vital to have the equipment to do that.
Glucose tablets, jelly babies, full sugar coke, fruit juice are all suitable hypo treatment but if they are hard sweets they are not as suitable as there is a choking risk and they may not release the glucose/sugar quickly enough.
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Ok, will check those out...
 
My kid glucose went down to 4.9mmol during dinner and he ate a hefty dinner but we estimated the novorapid too low...now the level had risen to 18 in just 2 hrs. Did not expect it rised super fast. Is this how it is ?
 
Yes, sadly that’s how it is @Mom of Type 1 but things will improve as he gets better control. If that 18 was on the CGM, then you do need test strips to confirm it as it might well be a little lower than that.

Did you count the carbs in his meal? Have you been given an insulin to carb ratio?
 
A big fast rise after a meal can sometime indicate not enough insulin or it can just be because the glucose from the food hit his blood stream before the insulin. It is important to know that NovoRapid is active for about 5 hours so there is still quite a bit of insulin in his system which may well bring those levels down again, so don't panic, just wait and see and hopefully it will be at it's peak now and coming down. The other thing is that Libre exaggerates these high levels so he may just be at 14 or 15 in reality if he was to prick his finger and double check, so please don't be too alarmed. For the first few months I was diagnosed, I used to spike up to 15 (finger prick result) almost every morning after breakfast and then come hurtling back down again to about 5. Coming back down quite fast wasn't a very nice feeling because you get hypo sensations when levels drop fast. The answer for me was to inject my NovoRapid earlier before my breakfast and I did a lot of careful experimenting to find the right timing of the insulin before my breakfast. Other meals were less of a problem but breakfast was particularly challenging and the timing needed to be longer. Eventually I changed to a faster insulin (Fiasp) because I was having to wait more than an hour after injecting to eat breakfast to prevent that spike. Now I still have to wait about 30 mins (with Fiasp) but my levels no longer rise by more than a couple of mmols which is great, although the change to a different insulin was not without other frustrations and complexities which needed to be worked through, so not necessarily something I would reccommend. Anyway, those were the timings that worked for me and my body but they would quite likely cause other people to hypo whilst they were eating so, please don't think I am suggesting your son uses these timings. He absolutely should not! What he needs to do is start carefully increasing the time between injecting and eating from whatever he does now, by a few minutes every few days until he finds the timing which works for him. So if he injected directly before eating his dinner today, then inject 5 mins before he eats it tomorrow and see how that goes and keep it like that for a few days and then if he still spikes but comes back down, increase it by another 5 mins until he is maybe just going up to about 12-13. I think that would be a reasonable level to aim for for now. Once you start learning to carb count and adjust your doses and become confident at that then you can perhaps aim a bit lower, by fine tuning the timing a bit more. The important thing is just to make one small change at a time and leave it a few days to see what happens before deciding to change it a bit more.
 
Inka said:
Yes, sadly that’s how it is @Mom of Type 1 but things will improve as he gets better control. If that 18 was on the CGM, then you do need test strips to confirm it as it might well be a little lower than that.

Did you count the carbs in his meal? Have you been given an insulin to carb ratio?
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Yes, we thought that 4.9 was a little too low, rewarded himself with some fried chicken. I guess we did not expect it was so damaging coz he ate the fried skin as well. What a bad decision of mine.
 
rebrascora said:
A big fast rise after a meal can sometime indicate not enough insulin or it can just be because the glucose from the food hit his blood stream before the insulin. It is important to know that NovoRapid is active for about 5 hours so there is still quite a bit of insulin in his system which may well bring those levels down again, so don't panic, just wait and see and hopefully it will be at it's peak now and coming down. The other thing is that Libre exaggerates these high levels so he may just be at 14 or 15 in reality if he was to prick his finger and double check, so please don't be too alarmed. For the first few months I was diagnosed, I used to spike up to 15 (finger prick result) almost every morning after breakfast and then come hurtling back down again to about 5. Coming back down quite fast wasn't a very nice feeling because you get hypo sensations when levels drop fast. The answer for me was to inject my NovoRapid earlier before my breakfast and I did a lot of careful experimenting to find the right timing of the insulin before my breakfast. Other meals were less of a problem but breakfast was particularly challenging and the timing needed to be longer. Eventually I changed to a faster insulin (Fiasp) because I was having to wait more than an hour after injecting to eat breakfast to prevent that spike. Now I still have to wait about 30 mins (with Fiasp) but my levels no longer rise by more than a couple of mmols which is great, although the change to a different insulin was not without other frustrations and complexities which needed to be worked through, so not necessarily something I would reccommend. Anyway, those were the timings that worked for me and my body but they would quite likely cause other people to hypo whilst they were eating so, please don't think I am suggesting your son uses these timings. He absolutely should not! What he needs to do is start carefully increasing the time between injecting and eating from whatever he does now, by a few minutes every few days until he finds the timing which works for him. So if he injected directly before eating his dinner today, then inject 5 mins before he eats it tomorrow and see how that goes and keep it like that for a few days and then if he still spikes but comes back down, increase it by another 5 mins until he is maybe just going up to about 12-13. I think that would be a reasonable level to aim for for now. Once you start learning to carb count and adjust your doses and become confident at that then you can perhaps aim a bit lower, by fine tuning the timing a bit more. The important thing is just to make one small change at a time and leave it a few days to see what happens before deciding to change it a bit more.
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Do you fix your basal or change it every night depending on the readings at the moment of injections ? For bolus, we should be able to change it depending on how much we eat, correct ? Yesterday, his basal Toujeo was 12 and his morning readings was good. Today, we inject 14, due to the rise...i did not dare to inject higher...
 
Mom of Type 1 said:
Yes, we thought that 4.9 was a little too low, rewarded himself with some fried chicken. I guess we did not expect it was so damaging coz he ate the fried skin as well. What a bad decision of mine.
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No, not a bad decision and the skin is not bad. Keep an eye on things and I am sure his levels will come down again within that 5 hour period that the NovoRapid is active. As I said, my levels went up that high nearly every morning after breakfast which was very healthy natural yoghurt and berries. It is about learning how to adjust and time your insulin to match the food you eat, not what you eat. Of course it is not healthy to eat fried chicken with the skin and coating every day but there is no reason why your son should not have these foods as part of a reasonably balanced diet. You have not made a mistake, what happened is normal until you learn how to use the insulin you have effectively and that takes time and practice. You can't just pick up a tennis racket and be a world champion 2 days later. Diabetes is extremely complicated and takes a lot of trial and improvement and Type 1 is all about adjusting your insulin to match what you eat rather than restricting what you eat, so please don't restrict your son as otherwise he may decide to rebel against his diabetes as it would be stopping him from enjoying life. He just needs to learn how to use his insulin to deal with what he eats and trips up to 18 or 15 every day for a month or two should not cause his young body much or even any harm. It is mostly if his levels go that high and stay that high for weeks and months that you need to worry. Gradually you will learn how to manage it so that it only goes up to 15 before it comes down and then maybe just 12 or 13, but don't beat yourself up over an 18. I am 5 years down the line and very occasionally I still get it wrong and it heads into orbit. You have to just accept that you can't get it right all the time and when you are just starting you are not expected to have good results all the time, so don't put that pressure on yourself.
Out of curiosity what are his levels like now? Are they coming down. A gentle walk around the block can help or drinking plenty of water.
 
At this stage I don't think you should be adjusting his basal at all unless the hospital have told you. It was almost a year after diagnosis and after I had had a week long intensive education course on managing diabetes that I started to adjust my own. I find basal insulin much more powerful than bolus (meal time) insulin, so increasing it is not a good idea at the moment and that increase from 12-14 may well be why he went down to 4.9 during dinner. The hospital will have set his dose to try to keep him a bit above range at the moment I would have thought because it is best to bring his baseline levels down slowly into range, so you should probably not be trying to get them into range yourself straight away. Toujeo is quite a strong basal and I believe you need to leave at least 3 days before making any further adjustment but in your situation I think the safest thing to do would be to go back to the 12 units of Toujeo he was prescribed for now and leave any adjustment of that to your doctor. But no, I do not base my adjustment of my basal insulin on my morning reading or any other single reading. It is much more complex than that.
 
rebrascora said:
No, not a bad decision and the skin is not bad. Keep an eye on things and I am sure his levels will come down again within that 5 hour period that the NovoRapid is active. As I said, my levels went up that high nearly every morning after breakfast which was very healthy natural yoghurt and berries. It is about learning how to adjust and time your insulin to match the food you eat, not what you eat. Of course it is not healthy to eat fried chicken with the skin and coating every day but there is no reason why your son should not have these foods as part of a reasonably balanced diet. You have not made a mistake, what happened is normal until you learn how to use the insulin you have effectively and that takes time and practice. You can't just pick up a tennis racket and be a world champion 2 days later. Diabetes is extremely complicated and takes a lot of trial and improvement and Type 1 is all about adjusting your insulin to match what you eat rather than restricting what you eat, so please don't restrict your son as otherwise he may decide to rebel against his diabetes as it would be stopping him from enjoying life. He just needs to learn how to use his insulin to deal with what he eats and trips up to 18 or 15 every day for a month or two should not cause his young body much or even any harm. It is mostly if his levels go that high and stay that high for weeks and months that you need to worry. Gradually you will learn how to manage it so that it only goes up to 15 before it comes down and then maybe just 12 or 13, but don't beat yourself up over an 18. I am 5 years down the line and very occasionally I still get it wrong and it heads into orbit. You have to just accept that you can't get it right all the time and when you are just starting you are not expected to have good results all the time, so don't put that pressure on yourself.
Out of curiosity what are his levels like now? Are they coming down. A gentle walk around the block can help or drinking plenty of water.
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This morning, his level is 12.9 after yesterdays hoo hah of 18. Now we are adjusting again. We will try to stick to a consistent basal at night and adjust morning dose of bolus.
 
How do you know that you are having hypo while sleeping ? My son will be leaving for college soon and will be staying alone. This is something that worries me..
 
It used to worry me until I had a few and then I gained confidence and experience in dealing with them and now I know that my body will wake me up, I sleep soundly and if I do wake up hypo, I can work out how many Jelly Babies I need which are always on the bedside table, chew them and be back to sleep within a couple of minutes, which is a bit naughty because I am supposed to stay awake to 15 mins afterwards and test to make sure the Jelly Babies have worked but I very rarely manage to do that and if they haven't brought me back up or I drop low again, I wake up again and eat another JB or 2.
Obviously Libre helps if you set your alarm above 4 to enable you to treat it before it happens but if for some reason Libre doesn't work, I just wake up. Usually around 3-3.5 When lying down asleep with your eyes closed in the dark you don't notice the early warning signs like problems with your vision or wobbly legs, but you usually wake up with your heart beating faster/pounding and you might be sweaty or just feel something is not right and quite often you might wake up having a dream about being hypo..... it is clever how the mind works!

There is a bit of a "fail safe" or safety net if you like, in that your body will release adrenaline when levels get very low and that will usually trigger your liver to release extra glucose from it's stores to help raise your levels, but if you have depleted your glucose stores, perhaps after running a marathon or something which would really drain your reserves, then that might not be able overcome the excess insulin which is causing you to drop low. This is very, very rare, but can lead to seizures/having a fit and possible unconsciousness, so it is better to have alarms set and manage it before it gets that low anyway. Usually in the early days of diagnosis, you have pretty strong hypo warnings because your body has been used to being very high for a while, so unless your son had been drinking a lot of alcohol which can mean that the liver is too busy trying to remove the toxic alcohol from the blood to rebalance glucose levels, then it should naturally kick in.
 
rebrascora said:
It used to worry me until I had a few and then I gained confidence and experience in dealing with them and now I know that my body will wake me up, I sleep soundly and if I do wake up hypo, I can work out how many Jelly Babies I need which are always on the bedside table, chew them and be back to sleep within a couple of minutes, which is a bit naughty because I am supposed to stay awake to 15 mins afterwards and test to make sure the Jelly Babies have worked but I very rarely manage to do that and if they haven't brought me back up or I drop low again, I wake up again and eat another JB or 2.
Obviously Libre helps if you set your alarm above 4 to enable you to treat it before it happens but if for some reason Libre doesn't work, I just wake up. Usually around 3-3.5 When lying down asleep with your eyes closed in the dark you don't notice the early warning signs like problems with your vision or wobbly legs, but you usually wake up with your heart beating faster/pounding and you might be sweaty or just feel something is not right and quite often you might wake up having a dream about being hypo..... it is clever how the mind works!

There is a bit of a "fail safe" or safety net if you like, in that your body will release adrenaline when levels get very low and that will usually trigger your liver to release extra glucose from it's stores to help raise your levels, but if you have depleted your glucose stores, perhaps after running a marathon or something which would really drain your reserves, then that might not be able overcome the excess insulin which is causing you to drop low. This is very, very rare, but can lead to seizures/having a fit and possible unconsciousness, so it is better to have alarms set and manage it before it gets that low anyway. Usually in the early days of diagnosis, you have pretty strong hypo warnings because your body has been used to being very high for a while, so unless your son had been drinking a lot of alcohol which can mean that the liver is too busy trying to remove the toxic alcohol from the blood to rebalance glucose levels, then it should naturally kick in.
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Ok. Got it. Thank you very much.
 
In the early days after diagnosis and before I had Libre, I used to really worry about this and I would wake up several times a night almost every night to check that I was OK. If I was on my own this meant putting the light on and pricking my finger but if my partner was with me I would get up and go into a different room to test so as not to disturb him. It was very tiring and obviously playing on my mind.
Then I had a week of nocturnal hypos almost every night about 10 months after diagnosis and I woke up every time without any problem and that pretty much cured me of the fear of them and now I actually find dealing with nocturnal hypos easier and less stressful (in fact not stressful at all) than daytime ones, probably because during the day I am busy doing something and want to get it finished or need to be somewhere or whatever, so it is a nuisance. I hope your son doesn't have any for a long time but when he does, I hope he also finds comfort in knowing that his body will wake him. Often the fear can be far more debilitating than the reality and it robbed me of a lot of sleep worrying about it before I found out by experience that my body woke me up just fine and they were easy to treat. It is important to be prepared though and have Libre and test kit and hypo treatments close to the bed, so that you don't have to stumble about half asleep and hypo trying to find something.
 
Mom of Type 1 said:
How do you know that you are having hypo while sleeping ? My son will be leaving for college soon and will be staying alone. This is something that worries me..
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Usually you wake up, but not always. This is why having a CGM like the Dexcom or Libre is so helpful. Set the Low alarm at 5 or above and he’ll be woken in time to ward off any hypos.

Although the liver can pump out glucose, that’s not fast enough to rescue people from bad hypos. That’s why we treat hypos with external glucose sweets or drinks. Hypos are not something to underestimate. Seizures are rarer now because we have CGMs but you certainly don’t have to do extreme exercise to have one. They can just be bad luck; overestimating carbs in a meal; illness affecting digestion; catching a blood vessel or muscle when injecting - any number of things.

For students, the risk is alcohol as mentioned above, missing meals or being cavalier with carb-counting so as to not draw attention to oneself when amongst friends, unexpected exercise; late takeaway meals where it’s hard to estimate the carbs, but alcohol is a big risk.
 
Unfortunately, in my country, the cgm libre is still behind. We still need to use scanner to get the readings and it is not linked to smartphone. So, I dont think can set an alarm..
 
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