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Starting from scratch

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MeanMom

MeanMom

Well-Known Member
Relationship to Diabetes
Parent of person with diabetes
K's readings have been all over the place for no decernable reason , being mainly lower than expected, not higher which is what tends to happen due to stress, hormones or occasional cold etc. She had a hypo at school on Thursday morning, which I can't remember ever happening (mornings have been the hardest to keep in range due to increased insulin resistance) With K's anxiety issues (and lack of support and understanding again from her so called 'friends') she didn't make it to school yesterday and today hasn't gone to her (new) drama class:(

So (deep breath) I am going to try to redo all her ratios and her Levemir. Can anyone give me some advice on how to approach this with the minimal amount of testing? The ratios we currently use are really just 'think of a number' and see if it works, clinic have never worked them out for me. I adapted them from her fixed dose regime - the breakfast dose seemed correct over a week or so, I worked out what this ratio was abdxwent from there. Since then we have just gradually upped it (mostly), but this week has involved many random lows and lower than expected, need to start again me thinks:confused:

Any ideas, need to get this sorted out before I get any more grey hairs!
 
I only know the way my carb course taught me - get the basal right first, then and only then can you hope to get the bolus right too.

http://www.diabetes-support.org.uk/info/?page_id=120

Scroll down till you get to the testing bit.

Incidentally - doses are a moveable feast ..... you never know how long they may last.

Does Ragnar Hanas have any tips bearing in mind he's writing with kids in mind?
 
I know this isn't particularly encouraging, but for myself, I sometimes find that managing expectations is as important in many ways as managing situations - not just diabetes related, but all sorts of things eg employment, other health issues / appointments etc. I've just had a pleasant surprise - and overnight, basal proved too high, due to relief!

Plus, being a teenager is tough, with hormones, education / exam pressures, friendships etc - my 13 year old niece loves winding up her mother (my sister) although she doesn't wind up her grandparents (our parents) nor me (her aunt) - or perhaps we don't allow her to wind us up? As trophywench has already pointed out, ratios change with time, so just when you think you've sorted, they change.

Real shame she didn't get to drama class, though - might be worth trying to find out what's going on there, if you can, but I know it's difficult.
 
Not sure if this will work (it doesn't for everyone including me) but one way of starting to reset ratios is using some of the rules based on average figures from different Total Daily Doses.

If you have records for the last few weeks/months find K's approx average TDD.

Basal:bolus split is likely to be between 40-60%. Given that K is youngish her carb intake may be higher for her weight than it would be as an adult, so it might be nearer 40%. Take a look at the previous split (when things were working well) to see if this gives an indication - if all else fails go for 50%.

TDD x50% (or 40% or whatever) = new basal

The '500 rule' is often used to guess insulin:carb ratios.
500 divided by TDD = grams of carb per unit

The '110 rule' is often used for sensitivity
110 divided by TDD = expected fall in BG per unit of insulin

As I said these are just 'rules of thumb'. They only ever give you a starting point to test test test whether or not they are right.
 
Sorry, I can't offer any advice. We were started on 50% of the daily dose as the Lantus, then the other 50% split between 3 meals with Novorapid. Of course that was only for a few days, then we went to carb counting and were given the ratio of 1:10g carbs and have never been told to deviate from this.

Ok, things are sort of different now my son is on the mixed insulin, but he is still meant to do 1:10g carbs at evening meal time.
 
Sorry to hear you're having trouble again with K's so called friends :(

I can't give you any advice either, because how you described your adjustments, is how we do it. If high all the time, guess increase and see what happens.
Good luck and a big hug to K from me.
 
Thanks for all replies (sorry Internet down all afternoon :()

Mike - that was the sort of thing I was thinking of so thanks for that - will get the calculator out 🙂 Was being a bit lazy really as I know Ragnar Haas has stuff about this but my brain wasn't up to wading through the big orange book today :D

Reason for not going to Drama today same reason for not going school yesterday (and on many days in the Autumn term) - fear of bad hypo and no one able to help. K asked her friend for help when she went hypo at break on Thursday - 'friend' said 'In a minute' so K dealt with it on her own :( (which she can do - but this sort of thing makes her feel rejected and vulnerable, I'm afraid)

The ratios we have been using have been running her slightly high for several months - for them suddenly this week to be making her easily in range or hypo has been a shock - can't even work out whats going on with Levemir - Monday wednesday and Friday she was around 9 on waking, tuesday and Thursday about 4 or 5. Her activity does not really vary on a scoop day as she is not doing PE at the moment.

Anyway will get my thinking head on and use those formulas Mike.

And will pass hugs on Monica, thanks everyone
Xx
 
Hi MeanMon, sorry to hear of the problems you and K are having, sounds tough. |The only advice I can give re starting again is to keep a diary and record everything and look for patterns, I'm sure you're doing that already though.

K's "friend" doesn't sound very helpful - of course she should have helped if she could. I was just curious what help K was asking for and why? If she doesn't like to feel different then one way to avoid it is to always keep some sweets or sugary drink on her person so she can deal with a hypo herself. You can get a keychain or similar which will hold 4 gluco tabs, or you could have a mini bag of haribo in every pocket/bag.

Sorry, I hope I don't come across as patronising or insensitive, I'm just thinking that I don't like to feel different either and so I never ask anyone else for help with my diabetes. Often if I'm out with friends and I have a hypo I'll just eat sweets or swig Lucozade and I don't even tell them why. But I know that I can sort my hypos out so it doesn't stop me doing anything. I realise I'm 31 not 12 and there are a lot of issues at that age, I just thought maybe if you could help some of the practical issues the anxiety about them might lessen.
 
Thank you Pidgeon, that was kind🙂

K does have hypo treatment with her all the time - I think in this instance as it was break time she wanted the friend to sit quietly with her til she felt better and not just leave her on her own. Although K can and does deal with hypo's herself she likes to think her friends at least care about her welfare, and not go off and do something 'more interesting'.

Diabetes mixed with teenage insecurities = no idea :(
 
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