Pre-dinner 18.0 last night

[Tina63]

My son's pre-dinner reading was 18.0 last night. No surprise given that he came in from school early and straight away started raiding food in the cupboards. I had just made a batch of chocolate chip muffins and 2 went when my back was turned, still hot out of the oven! Though the Humilin should have still been working then, I can guarantee he ate far more than 'just' those, he is constantly in and out of cupboards and the fridge. So I feel the 18.0 is justified, but it's way too high.

Fasting was 11.3 this morning. I have emailed his DSN with the past 4 days readings, suspecting she will tell us to adjust something (probably the Lantus initially) but also pointing out he has an exam on Friday so would rather he doens't start having violent hypos right now. No danger of them at current levels, but I know from past experience only small changes can made a big difference. We just haven't been encouraged to alter doses ourselves yet, so still look to her for guidance. I have asked if some education on correction doses can be part of next week's appointment too. If it comes from her rather than me, hopefully my son will take it all on board.

 

[novorapidboi26]

You mentioned Humulin and Lantus, what insulin's is he on?

 

[everydayupsanddowns]

Hi Tina

Not really sure what to suggest. Your son seems to be on an unusual mix of insulins. Lantus (basal) and Humulin (med-long acting). It might be that this is because your team are trying to match a constant 'grazing' approach to food, but the Humulin's profile would be less suited to a rapid splurge of carbs in a muffin than, say, a rapid acting like Humalog or NovoRapid.

It's not an easy match by any means. And of course without knowing the level to start with it's hard to see exactly what is going on.

I wonder if your clinic has a loan CGM they might be able to lend-out. A geeky affinity for technology/gadgets is a weakness in many blokes and the ability to see what is happening to glucose levels every 15 minutes might provide some encouragement to resist cakes?

 

[Northerner]

Is he taking his novorapid still with his evening meals, so he is now on all his daily injections? I must admit that if I had a couple of muffins without extra novorapid then I would probably be climbing to similar levels. Given his waking levels though, I would expect an increase in his lantus to be on the cards initially so that he has a better base to start from for his meal-related rises.

I think I would also be reluctant to alter things immediately prior to his exam, given that this is the only one for some time, partly because it might be too much, but even if any adjustments are spot on and bring his levels near-normal, he is likely to experience 'false' hypos because his levels have been so high over a period of time.

 

[seasiderdave]

You say he woke to 11 and that automaticaly makes us think his lantus needs lifting. But what was his pre-bed BG? If it was 10 then the Lantus is doing just fine. But obviously if it was around 6 then that's a good place to start.
Treating the cause of the problem is obviously better than the result but it's important to get the correct cause identified first.

Anyway, are you supplying muffins to the board? Obviously further research is needed into the carb levels and what better research group than a bunch of Ds 🙂🙂

 

[Tina63]

You mentioned Humulin and Lantus, what insulin's is he on?

Because he was refusing to inject at school, he has been put on a right old combination, Humilin M3 at breakfast, Novorapid post-school for evening meals and snacks, then Lantus at night. It was the consultants way to try and get him to inject and cover his school hours. She felt this was a compromise hopefully he would be happy with. I think it is working better (well by that I mean he is at least injecting more) but it's all about getting the doses right.

 

[Tina63]

Anyway, are you supplying muffins to the board? Obviously further research is needed into the carb levels and what better research group than a bunch of Ds 🙂🙂

Hehe! Only started making muffins after Christmas, received a very nice muffin pan as a present. I do actually carb count them, but I don't have a clue how much the chocolate would be. The whole bag is 100g, so divided by 12 that's about 8g of carbs each muffin. Anyone know the answer to that one please?

He isn't testing at bedtime at the moment, but then he wasn't testing at all a week/fortnight/month ago, so small steps! I am going to suggest he does bedtime tests for the next week though before seeing DSN. I will say that will help her interpret figures better.

 

[novorapidboi26]

Because he was refusing to inject at school, he has been put on a right old combination, Humilin M3 at breakfast, Novorapid post-school for evening meals and snacks, then Lantus at night. It was the consultants way to try and get him to inject and cover his school hours. She felt this was a compromise hopefully he would be happy with. I think it is working better (well by that I mean he is at least injecting more) but it's all about getting the doses right.

Ah I see...........that is a strange one............

Are his meals at school the same every day.........?
How long does the M3 last, 12 hours?

I used to be on that myself before MDI, but it was just that, no background insulin.........

That mix of insulin's must be really hard to get to grips with............

When do you think he will be up for injecting at school, its only one injection........

 

[Tina63]

Ah I see...........that is a strange one............

Are his meals at school the same every day.........?
How long does the M3 last, 12 hours?

I used to be on that myself before MDI, but it was just that, no background insulin.........

That mix of insulin's must be really hard to get to grips with............

When do you think he will be up for injecting at school, its only one injection........

It is a bit strange, I agree. His team came up with this plan because he wouldn't inject at school, did before the summer holidays but moved into 6th form with a new group of friends and just wouldn't test or inject anymore. This then got him into the habit of skipping more and more, so his consultant came up with it as a plan to at least meet him halfway and take away the need to inject at school. It is meant to have an 8 hour life, so injecting around 7.30am should carry him through until he gets home from school. He is then meant to carb count for Novorapid with dinner and evening snacks, and carry on with the Lantus as before.

If they get the levels right (and this is the first month trying this regime) I can see it working for him, but no, he eats different amounts each day. I think they just took an average of his old breakfast and lunch Novorapid amounts, added them up together and took that as a starting point for the Humilin. That's how it seemed to me anyway. I also suspect his honeymoon has now ended as all his levels were below 10 a few months ago, and his Lantus has been held steady at 25u since the end of about the 2nd or 3rd month.

Hopefully things settle down properly soon, but I have to tread very carefully with him, so willl wait and see what his DSN says next week. I have emailed her with the latest figures, but she hasn't got back to me yet.