Hypo/ insulin use

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Linford76

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Good Evening all,
We are parents to our eldest son (18) who has recently been diagnosed with type 1 a week ago.
The reason for reaching out is based on todays levels/meals and insulin use.
This morning at 10.30 he injected his8 units of nororapid then he ate his breakfast and his levels were 6.4.
12.30pm he ate. Lunch went out for the day. Had chicken wrap and bread pudding , no injected because it was in the 4 hour window??He came home at 4.30pm with levels at 22. He injected 12 units as he feels the chart said 4 extra units if sugar levels are between 22-24 was this a mistake because he had a cheese omlette( carb free) b4 his work shift 5.30-8.30pm.He rang us at 6.15 saying his levels had dropped to 3.6 he was feeling shaking and heart beating fast! So I popped to his work place gave him sugary snack and they are now 9. So our question is at 8.30 tonight when he had main meal (spaghetti Bol) is another injection needed?
We feel the mistake was the 12 units at 4.30pm as they not required as he had an omlette and he has misunderstand the chart and felt with high levels he had to take insulin?
Any thoughts would be much appreciated?
 
If he is on fixed doses of insulin for each meal, the chart will make the assumption that he is eating carbs with each meal, hence the problem with the omelette. If he hasn’t had any insulin since 4.30, and he’s going to eat carbs at 8.30, then yes he will need insulin for those carbs. He probably doesn’t need to add any on for a correction dose, having had the hypo earlier, even if he is a bit higher than he should be.
Things will get easier when he does a carb counting course, and learns to match his insulin and carbs, depending on what and when he wants to eat.
 
As your son has only been diagnosed a very short time, I feel he needs to speak to his team asap. Yes, it looks like he mis-interpreted the chart or didn’t take into account his lack of carbs. He was very lucky his blood sugar didn’t drop any lower. Hypos can be potentially very serious. He needs to carry hypo treatments with him at all times. He could then have treated his hypo. Dextro tablets are convenient or mini Coke cans or jelly babies. It’s also a good idea to carry extra carb snacks just in case he needs them eg digestive biscuits.

Did his team tell him not to inject within 4 hours? You can inject within 4 hours but they might have told him that for safety early on.

It sounds like he’s on set units of Novorapid - 8 before each meal? That’s fine BUT he needs to make sure he eats the same amount of carbs for each meal. The 8 units will ‘cover’ a certain amount of carbs. He needs to ask his team how many carbs he should eat (it might be different amounts for each meal). He then needs to add up the carbs to reach the total he needs. Soon he’ll be taught how to adjust his Novorapid according to the carbs he’s about to eat, but for now he needs to stick to regular amounts. Fixed dose of insulin=fixed amount of carbs, very simply.

Although you can also use the Novorapid to correct a high blood sugar, often that’s discouraged early on after diagnosis for safety reasons, and because there’s a lot to take in without having to consider that too at this stage.

He’s basically really lucky he didn’t come to harm injecting that amount of Novorapid with a no carb meal.
 
Hi and welcome.

Sorry to hear about your son's diagnosis but good that you have found the forum for support.

So he had a late breakfast and was worried about injecting insulin for lunch when he already still had active insulin in his system, so he ate a rather carb rich lunch without insulin which is obviously why his levels shot up..... with hindsight, he would have been better having a carb free lunch like an omelette or a salad if he didn't want to inject more insulin. Personally if I didn't have the option of a low carb meal, then I would have injected for the lunch he had despite the 4 hour rule because that is a significant amount of carbs.... particularly bread pudding!
Am I right in thinking that his meal bolus is fixed at 8 units? So the 4 extra units were what we would call a correction to bring his levels down because they were too high. If so, the problem was caused by the fact that he injected the 8 units for his meal, when he was having a very low carb dish. The Novorapid is there to deal with the carbs in a meal. If there are no carbs you don't need it and if you inject it, it will drop your levels quite considerably because there are no carbs to mop it up. So, whilst the 4 units might have been about right to bring him down from 22, the 8 units for the meal were 8 units too much and hence the hypo.

I am a little concerned when you say that you had to go to his place of work to give him something sweet. I would very much hope that you were just going to support him whilst he was recovering but that he was carrying hypo treatment on him and had taken it himself before you arrived. Carrying hypo treatment and test kit at all times is really important because you never know when a hypo is going to hit you and you have to be prepared.

I am not sure I understand the question about the spag bol. Is he going to have another meal tonight? I suppose these teenagers eat a lot... Yes, he will need some insulin with his spag bol. Will there be a dessert afterwards? If not it might be wise to reduce the dose for the spag bol, maybe by half ie 4 units because he will be more prone to another hypo after he had one earlier.
 
Linford76 said:
So our question is at 8.30 tonight when he had main meal (spaghetti Bol) is another injection needed?
Click to expand...
Yes, because he's back to 9 so the hypo has been corrected. So he's back to normal and should take the insulin for the meal. Maybe a bit less (since having a hypo tends to make having another one a bit more likely), or maybe eat a bit more for the same insulin dose.
 
Insulin carb ratios are very individual and to be honest you need to speak to his team. its not something we on here can advise on really. Please make sure he has hypo snacks with him at all times, (small can of coke, jelly babies, glucose tabs). Hypos are scary and until he gets more used to knowing his own individual ratios are even more important (he needs to get into the habit of taking these everywhere with him though).
 
Chicken wrap and bread pudding is quite a lot of carbs to have with no additional insulin which is what caused the big rise and then correcting that lead to the hypo. It’s all learning at this point as to how much insulin he needs for carbs or correction. Did they give you a chart print out based on his weight to then work out meals and corrections?

A dose of novorapid peaks about an hour after injecting but stays in the system for around 4-5 hours in total so injecting. The breakfast dose was for the breakfast carbs and so any carbs after that even within the 4 hour window would need additional insulin but he might not need to correct any high because of the insulin still being onboard.

But yes he should have insulin with spag bol.

He should always have hypo treatment with him.

It’s very early and it’s a steep learning curve for you all. It will get easier.
 
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