Hyperglycaemia protocols

[Redkite]

I am in the middle of updating my son's school care plan, and the hyper protocols need to be a bit more specific. At the moment it says for any BG of 14.0 or above he should inspect tubing etc., bolus a correction through the pump, then if it hasn't fallen after 1 hour, correct by pen. But there have been plenty of occasions when he has followed this and not corrected by pen because it had dropped e.g. from 14.2 to 13.8. If I'd had him at home I would not have been satisfied with such a small change, especially since with meter error it might be even higher!

So my question is, how many mmol is it reasonable to expect the BG to reduce by within 1 hour of a correction? Could I say "at least 3 mmol"?

 

[everydayupsanddowns]

Well I don't know... I guess (*sigh*) that it varies from person to person. 🙄

For myself more often than not I would expect BG to be pretty much level after 1 hour, but have dropped by 1-2mmol/L (or possibly more than this) after another 30 minutes or so*.

If mine has risen at 1hr after a correction, then I know something is up. 😱

I suspect that with your experience of how your son's BG reacts to corrections and the instinctive decisions you would take you are probably the very best placed person to define what you would want to see at 1hr.




* except in the afternoons... afternoons react much more quickly (despite all time zones being repeatedly basal tested!)

 

[Redkite]

Thanks! That's the problem, sometimes it doesn't shift at all within the first hour, other times it does. At home we can be aggressive about correcting because I will remember to keep an eye on him and not risk a sharp fall to hypo. It's very difficult to come up with hard and fast rules for him to follow at school! Also, I have in mind other contributory factors, e.g. if he was in the 4's and 5's all the previous night, he'll be quite sensitive to insulin the following day. Why can't it be simple? 🙄

 

[everydayupsanddowns]

At home we can be aggressive about correcting because I will remember to keep an eye on him and not risk a sharp fall to hypo.

I think that's it excactly - it seems wise to err on the side of caution when you know there will be less observation going on.

Even if the ultimate effect of the correction at 4-5 hours is only to bring the high down to 9, then I would cautiously suggest that might be better than risking 14 to 2 and back again over the same period.

What you want to concoct I suppose is a DKA-proof protocol. My DSN has always included ketone testing at the second result over 14. Could something like that be included to attempt to avoid over-enthusiastic/unecessary pen correcting (but still catch the nasties)?

 

[Redkite]

Yes I think I'll get a spare ketone meter to be kept in the office/medical room.

The school think they'll be getting an A4 sheet of what he needs - it's more like a short novel already!

 

[bev]

Hi Redkite,

Alex's care plan says something like if levels are higher than target range then do a correction and check again in one hour (ABCC rules) and if coming down no further action is needed - but if the same or higher then to ring parents (this is if 14mmls). I understand what your trying to do - but to be honest its a lot to expect School to understand and the problem is that if you put a specific 2mmls or 3mmls - it might make them panic too much if for example its 1.9 difference if you see what I mean. With Alex I just told him that if he didnt feel he was coming down as normal then to go back to the Medical Room for them to ring me.This has worked well for us. It also meant that Alex became very good at understanding the reasons he dropped faster/slower than normal - so a good learning curve!🙂Bev

p.s. We keep spare everything at School - including a spare ketone meter.