HONEYMOON PERIOD HELP

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Hi Everyone
My son has been Type 1 diagnossed for just about three months. We had really very good control of his sugar over that time with very few problems until the last few days and his Libre alarm seems barely off! I can only put it down to the honeymoon period kicking in as he keeps having low blood sugars. The low is happening after he injects his bolus meal insulin which is normally about 10 mins or so before he eats and then whilst he is beginning to eat the alarm is going off! He is then having to have some quick acting sugar, knowing that his sugars will then go up higher later as he has yet to have his meal. We have tried changing the timing to just before he eats with no wait time but that does not help. He is is also seeing a pattern of his blood sugars going up around three hours after meals quite sharply even though he has had nothing more to eat.
HIs diabetic nursing team have basically said we need to reduce the insulin but only by a unit every few days but on that basis he would be having very severe hypo's at each meal time as it is taking some time to get the sugar level back up and stable. This change literally happened overnight, one day being relatively normal and then the last three or four completely different and very unpredictable.
I just wonder if this was something others had experienced and had any helpful pointers?
Thank you.
 
How old is he and what insulins is he on? The only predictable thing about diabetes and kids is that it will constantly change so learning how to go with the changes is helpful.

If he’s going down before eating then either his basal is too high or his previous dose was still onboard —novorapid takes about 20 minutes to begin to work, peaks at about an hour and can stay in the system for 4-5 hours so if he’s had breakfast then a snack and had insulin for both that may cause a dip before lunch for instance. So your options are to reduce the basal by 10% and see how that goes or look at the previous bolus doses both timing and amount.
 
Thebearcametoo said:
How old is he and what insulins is he on? The only predictable thing about diabetes and kids is that it will constantly change so learning how to go with the changes is helpful.

If he’s going down before eating then either his basal is too high or his previous dose was still onboard —novorapid takes about 20 minutes to begin to work, peaks at about an hour and can stay in the system for 4-5 hours so if he’s had breakfast then a snack and had insulin for both that may cause a dip before lunch for instance. So your options are to reduce the basal by 10% and see how that goes or look at the previous bolus doses both timing and amount.
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Hi
Thank you for taking the time to reply.
My son is 19 and is on Lantus and Novorapid. He isn't a snacker at all so he is just having his three meals a day, which was working really well until this latest change. He leaves at least 4-5 hours between his meals and doses. We have already brought his basal down to 7 to stop the overnight lows that also began happening several times a night. I thought it was perhaps his own insulin kicking in, on the honeymoon period, that was perhaps making him go low almost as soon as he injects and begins to eat. The low is one thing but he is then getting a rise about three hours later even though he has not eaten anything further?
I know everyday is a school day with it, I was just hopeful to hear of others ideas's of things to perhaps try and so I am grateful for your comments and suggestions. Thank you.
 
Daft question...have you verified the libre reading against fingerpricks? Did the start of this coincide with a new libre?
Wonder if its a libre problem rather than a bs problem?
Also, i notice with my novorapid that sometimes it seems to have a kick in the tail at just after the 5 hours and bs fall quickly then. Could it be that? It doesn't always happen but it seems to be a thing for me and have heard others say it too
 
Yes, it is likely his honeymoon period. After the introduction of insulin which takes the strain off his remaining insulin producing beta cells they can revive a bit and start producing a bit more themselves. Sometimes in fits and starts, but it can be necessary to reduce both basal dose and bolus ratios in this early period and it is tricky. Is he going high because of the carbs he is eating to treat the hypos during his meals? The answer would be to inject either right before he eats or just after the meal and see how that works. If he still hypos during the meal, then it is likely his basal insulin which is causing it and his Lantus will need further reduction. If he hypos after the meal then it may be his bolus insulin is still too much. Unfortunately it can be really challenging during the honeymoon period and you just have to do the best you can and try to err on the side of caution ie. aim to prevent hypos rather than worry about highs. You can always correct a high at the next meal and often preventing the lows also stops the highs.
 
Don’t get hung up on the amount of basal or bolus. If he needs less basal then he needs less basal even if someone else needs 3 times what he does. I would drop the basal and inject as he eats or just after he eats and see how that goes.
 
Tdm said:
Daft question...have you verified the libre reading against fingerpricks? Did the start of this coincide with a new libre?
Wonder if its a libre problem rather than a bs problem?
Also, i notice with my novorapid that sometimes it seems to have a kick in the tail at just after the 5 hours and bs fall quickly then. Could it be that? It doesn't always happen but it seems to be a thing for me and have heard others say it too
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Not a daft question at all and thank you for your reply....it was one of the first things I asked him! The Libre and finger prick at the low levels seem to really very similar the Libre a tiny bit lower so good it is that way round. He is getting palpitations with the lows so they are definitely proper 'lows'. It would fit that the low is around 5 hours after his last Novorapid dose as this is normally when he is eating again? I guess there is no way around that one but a reason is sometimes comforting I find for some reason. It is all quite new to us so I guess the trying to find a reason for things will eventually wear off! LOL
 
Thebearcametoo said:
Don’t get hung up on the amount of basal or bolus. If he needs less basal then he needs less basal even if someone else needs 3 times what he does. I would drop the basal and inject as he eats or just after he eats and see how that goes.
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Thank you we shall try this.
 
rebrascora said:
Yes, it is likely his honeymoon period. After the introduction of insulin which takes the strain off his remaining insulin producing beta cells they can revive a bit and start producing a bit more themselves. Sometimes in fits and starts, but it can be necessary to reduce both basal dose and bolus ratios in this early period and it is tricky. Is he going high because of the carbs he is eating to treat the hypos during his meals? The answer would be to inject either right before he eats or just after the meal and see how that works. If he still hypos during the meal, then it is likely his basal insulin which is causing it and his Lantus will need further reduction. If he hypos after the meal then it may be his bolus insulin is still too much. Unfortunately it can be really challenging during the honeymoon period and you just have to do the best you can and try to err on the side of caution ie. aim to prevent hypos rather than worry about highs. You can always correct a high at the next meal and often preventing the lows also stops the highs.
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Thank you for your reply post. It is proving to be quite tricky I must agree. We had arrived at a similar point thinking that a high whilst it isnt great then it does not need immediate action like the lows so we are working on keeping on the higher side whilst we ride this wave. Thank you for you kind post
 
It would be useful to work out whether the pre meal lows are due to the bolus he takes for that meal or not.

What is his levels like before taking his bolus for his meals? If they are already falling, it could be that his fast acting form his previous meal is still hanging around - some people find their fast acting can have an impact for 6 or 7 hours. Or, it could be that his basal dose is too high.
I find that the speed my fast acting insulin works can be very dependent on my starting blood sugars. If my levels are in the 4s, it is better for me to inject after eating to avoid a hypo.

Other things to consider are
- has he been more active recently? Exercise can make us more sensitive to insulin for up to 48 hours.
- has the change happened since the hot weather? Some of us find we need less insulin in hot weather. And some people find they need more.

As you suggest, this could just be a honeymoon thing. But there are something like 42 things which can affect our blood sugars so our doses rarely stays the same every day for years.
 
helli said:
It would be useful to work out whether the pre meal lows are due to the bolus he takes for that meal or not.

What is his levels like before taking his bolus for his meals? If they are already falling, it could be that his fast acting form his previous meal is still hanging around - some people find their fast acting can have an impact for 6 or 7 hours. Or, it could be that his basal dose is too high.
I find that the speed my fast acting insulin works can be very dependent on my starting blood sugars. If my levels are in the 4s, it is better for me to inject after eating to avoid a hypo.

Other things to consider are
- has he been more active recently? Exercise can make us more sensitive to insulin for up to 48 hours.
- has the change happened since the hot weather? Some of us find we need less insulin in hot weather. And some people find they need more.

As you suggest, this could just be a honeymoon thing. But there are something like 42 things which can affect our blood sugars so our doses rarely stays the same every day for years.
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It could be the Novorapid still hanging around as he does steadily fall rather than plateau at any point during the day. I think we will try injecting after eating and see what happens. Thank you for taking the time to reply and for your suggestions.
 
I suspect its more to do with the 'sting in the novorapid tail' more than anything. Has he tried skipping a meal/having it late to see what happens without the novorapid for the new meal being present?
What are his alarms set to? I set mine at 5 to give hypo treatments time to kick in. Drinks do have an effect quicker than glucose tablets...i resisted believing this for ages as it makes no logical sense, but its true.
I'm probably still in honeymoon and my ratios have varied over time between 1 to 5 and 1 to 27 for novorapid and only have 2 units basal. Weird, but thats t1. I find i need more insulin on a work day, and less for breakfast (!) so have 4 different pretty much constantly changing ratios.
 
I’d skip or delay the meal to try to work out the cause. Perhaps his bolus needs lowering further, or perhaps he’s continuing to drop from the previous meal. The only other thing to ask is where he’s injecting. If he’s missing the subcutaneous area, sometimes that can cause very fast drops, but from what you’ve said, other reasons seem more likely.

I hope you and he get it sorted. Diabetes is a pain like this. All you can do is try to work out the cause and make adjustments to his insulin if needed.
 
Injections in thighs are supposed to be moderate acting, bum slow, abdomen quick acting. It may be best to standardise which area is used for what...i use bum for basal, thighs normally, tummy for if i need quick action eg adjustments or if i can't prebolus
 
Sorry to hear about your son’s hypos - i can understand why you are worried.

Skipping a meal is a great suggestion by @Inka

Lantus should *just* be holding him level in the background such that his levels stay within +/- 1-2mmol/L when no bolus is active (including overnight).

You can formally create this circumstance as part of a basal test, but in general if my meal doses have stopped reacting and behaving how I would expect them to my money is often on basal insulin being wrong first, and then once I’ve tweaked that I move on to adjusting meal doses.

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How To Successfully Test Your Basal Rate

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Doses are likely to need to change through the course of the year - and even more during honeymoon!

Hope your adjustments begin to reduce the frequency of hypos soon - that many lows are exhausting!
 
I used to often see Novorapid kicking in within literally 10 minutes of bunging it in, with my meal literally immediately in front of me ready to eat, but before I could bung more than about 3 mouthfuls of it in - I'd be flipping hypo. It does actually make perfect sense that drinking something with enough sugar/glucose in it works faster than eating it since the very first place we start to absorb said sugar/glucose is through the inside of our cheeks ie whilst it's still in the mouth - so take enough liquid and let it stay in the mouth long enough to coat the sides before then swallowing it and taking another mouthful. Taking great gulps straight down of a drink of any sort does not help anything unless it tastes so vile you cannot bear the taste but you can't avoid drinking it for whatever reason. Tip - full sugar Coca Cola actually does this job OK (though at the time I had this prob we could still get full sugar plus glucose Lucozade which though I've never been that fond of the taste of I could tolerate drinking it like that when I needed to, so I did) I certainly wasn't in my honeymoon period at this time cos it was nearly 30 years since I was diagnosed and only eventually cured by changing my basal insulin from once a day Lantus to twice a day Levemir which happily, turned out to suit my body an awful lot better than Lantus ever did. But it's a bit drastic probably to consider this course of action this soon after anyone's diagnosis, so I'm not suggesting your son does it, but rather that he does go for injecting the Novorapid later as has already been suggested. Far simpler and easier right now.

Please - do let us know how he gets on with this conundrum.
 
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