Sigh, dietitian

[everydayupsanddowns]

Sorry to hear of everything you have been goung through Shivles. Sounds absolutely horrific!

Have skim-read the thread and spotted that you seem to be lacking some info from your team. Wondered if these might help.

Basal testing There's a good write up here (though numbers are US so you need to divide by 18). https://mysugr.com/basal-rate-testing/ You would probably need to adapt it for someone so young... perhaps test every 2 yours if hourly is too much... perhaps use something no carb and low protein (sugar free jelly??) to make them more bearable?

Pumps in young children
This blog post (and others) might help: https://theunderstudypancreas.com/2013/02/
This forum sticky has some thoughts in it: https://forum.diabetes.org.uk/board...rents-of-newly-diagnosed-children-pt-1.23853/
You might also be able to ask for tips here https://www.t1resources.uk/resources/item/parents-of-children-with-t1-facebook-group/

 

[bilbie]

😛 Kids, ya gota love em, just when ya think it's sorted..POW

 

[Shivles]

Yeah lunch didn't go well!

 

[Northerner]

Yeah lunch didn't go well!

How long prior to eating did you give the injection? Do you expect her levels to fall back again by the time of her next meal? I used to have the same result and in my case I was able to largely overcome that post-meal spike by injecting at least 15 minutes before eating - I was getting the bolus dose correct, but it wasn't starting to peak until after the food had peaked. I appreciate, however, that injecting much before eating in one so young could be a risky proposition if she decides she's not hungry! I know that some parents inject after eating when they can be more confident of how much has been eaten, but that can obviously lead to these post meal spikes whilst the insulin gets to work. An alternative is to inject half a dose before and then the rest after eating, but that means more injections (something that a pump helps with - no extra injections, and you can set it to automatically release the bolus over an extended period if it helps). We've come a long way with these things, but it's still not easy! 🙄

 

[bilbie]

It wouldn't hurt to bring up at the meeting about splitting the levemir to before bed and when she wakes up. They may think it will help. also there seems to be a lot of bolus compared to the amount of basal? 50/50, 60/40 are targets I've seen say work everyone is different
so far today it's 1.5U basal and 3.5U bolus?

splitting is supported by Dr B, who even splits tresiba and also supported by DAFNE UK
http://www.dafne.uk.com/uploads/223/documents/PU04.009, Version 1 - September 2013 - Insulin statement.pdf

 

[Shivles]

How long prior to eating did you give the injection? Do you expect her levels to fall back again by the time of her next meal? I used to have the same result and in my case I was able to largely overcome that post-meal spike by injecting at least 15 minutes before eating - I was getting the bolus dose correct, but it wasn't starting to peak until after the food had peaked. I appreciate, however, that injecting much before eating in one so young could be a risky proposition if she decides she's not hungry! I know that some parents inject after eating when they can be more confident of how much has been eaten, but that can obviously lead to these post meal spikes whilst the insulin gets to work. An alternative is to inject half a dose before and then the rest after eating, but that means more injections (something that a pump helps with - no extra injections, and you can set it to automatically release the bolus over an extended period if it helps). We've come a long way with these things, but it's still not easy! 🙄

Since she was 4.6 I only give it 10 minutes where normally I would wait longer, didnt want her going hypo before the meal

Usually she would come down again by tea time but the way this week is going I've no idea! 🙄

Split doses might be something we will have to try

 

[Shivles]

It wouldn't hurt to bring up at the meeting about splitting the levemir to before bed and when she wakes up. They may think it will help.
This is supported by Dr B, who even splits tresiba and also supported by DAFNE UK
http://www.dafne.uk.com/uploads/223/documents/PU04.009, Version 1 - September 2013 - Insulin statement.pdf

Unless she improves by tea time I'll be giving them a ring so will mention it

 

[bilbie]

another reason to split is because of the small dose, smaller doses metabolise/absorbed into the system, quicker than larger doses, ask Dr I'm just guessing from what I've read with others
http://www.diabetes-book.com/laws-small-numbers/

 

[Northerner]

Since she was 4.6 I only give it 10 minutes where normally I would wait longer, didnt want her going hypo before the meal

Usually she would come down again by tea time but the way this week is going I've no idea! 🙄

Split doses might be something we will have to try

Just what I would have done with the bolus! 🙂 Might be tricky splitting such a tiny dose though. By the way, the basal/bolus split percentages are only rough guidelines so the fact she is quite different to the 60/40 isn't unusual - I was never anywhere near that.

 

[Shivles]

By the way, the basal/bolus split percentages are only rough guidelines so the fact she is quite different to the 60/40 isn't unusual - I was never anywhere near that.

What does that mean?

 

[Pumper_Sue]

I'm much more relaxed talking about adults. Even though if I had a T1 kid, I wouldn't use my keto diet. I don't see the need for a T1 kid to be in ketosis, but it would be lower carb, higher proteins and fats. With what I currently think. I would have a pump and half basal dose with tresiba and half with the pump. The reason is that when just on a pump and a site fails, ketones and high BG happens so quickly. Half pump still leaves a lot of flexibility for basal rates and has a half dose long acting to minimise ketones and BG rise when site fails.
I may change my mind about pumps if anything comes from pumps causing long term problems with site damage, as opposed to injections.

You are frighteningly dangerous in your idea of pump management and insulin usage 😱

 

[Northerner]

What does that mean?

@bilbie mentioned that she takes a relatively large amount of bolus insulin compared to her basal. Usually, when people are first put on basal/bolus they are given a total daily dose which is 60% bolus and 40% basal (so 60% novorapid with meals and 40% levemir). I was more like 90% bolus and only 10% basal! 🙂

 

[bilbie]

You are frighteningly dangerous in your idea of pump management and insulin usage 😱

I guess it's lucky I don't have a t1 kid then and it was an if I did scenario🙂 There are people using both pumps and separate basal injections, it isn't unique. A half dose of basal from both seems the best of both worlds to me, for the stated reasons.

 

[Pumper_Sue]

I guess it's lucky I don't have a t1 kid then and it was an if I did scenario🙂 There are people using both pumps and separate basal injections, it isn't unique. A half dose of basal from both seems the best of both worlds to me, for the stated reasons.

As you are type 2 don't use insulin and were banned from another forum for being an authority on insulin with no knowledge why have you started touting your knowledge! on this forum?

 

[Sally71]

A half dose of basal from both seems the best of both worlds to me, for the stated reasons.

How on earth would you basal test then, you wouldn't know which one needed changing! DKA isn't a problem with a pump if you keep a close eye on your blood sugars, you can spot that something is going wrong and do something about it before you get to danger levels.

 

[bilbie]

As you are type 2 don't use insulin and were banned from another forum for being an authority on insulin with no knowledge why have you started touting your knowledge! on this forum?

you are incorrect but no matter.

obviously I'm not directing any advice about insulin to the OP because OP isn't using a pump. In the drift of the thread I gave my thoughts on a pump and basal rates

 

[bilbie]

How on earth would you basal test then, you wouldn't know which one needed changing! DKA isn't a problem with a pump if you keep a close eye on your blood sugars, you can spot that something is going wrong and do something about it before you get to danger levels.

I hope this isn't getting too OT and a separate post would be better but.
How they are doing it is a set basal injection and then adjusting the pump for basal and bolus rates, I'm not suggesting it to anyone, but is something I would look at and discuss with my Dr if I was in such a position on a pump

 

[Owen]

Unless she improves by tea time I'll be giving them a ring so will mention it

Up from my sleep now, how are you both doing. What did you have for lunch

 

[Shivles]

Up from my sleep now, how are you both doing. What did you have for lunch

I've attached the latest numbers. She had a slice of eggy bread (seeded) fried in some butter and 100g plain Greek yogurt, shot from 4.6 to 13.5. She came down within range now has gone up a bit again

 

[Owen]

Bread

I've attached the latest numbers. She had a slice of eggy bread (seeded) fried in some butter and 100g plain Greek yogurt, shot from 4.6 to 13.5. She came down within range now has gone up a bit again[/QUOTE

Bread is the culprit, the yogurt and butter probably disrupt the glucose absorption, so you may see medium term high bg. 13.5 is not the end of the world. Try some lizis granola instead of the bread, it does taste nice with yogurt