Hi, my son is 17 and type 1. He uses novarapid and levemir. He has been diagnosed 1 year and his last Hba1c was 41 (october) and before that 39 (June). His control is fantastic, hardly any hypo's though has occational hypers when gaming in an evening. His Dr is happy to put this down to the gaming, I checked! Before bed last night he was 11.9 which is higher than normal and he was not gaming last night so unusual. Today he has woken up on a 15.7. I made him 're-wash' his hands - hes a teenager and sometimes 'forgets'. It was then 13.7. He feels well, no aches, no illnesses that I can tell. I tested keytones anyway, 0.1. He feels well and wanted to go to college so I let him on the condition he sends me his bloods on his break - they are now 15.5. I have called his diabetic team and left a message but I am very anxious since his control is usually so good. What could be happening? My anxiety is telling me to collect him from college immediately and hover over him all day until his sugars go down but he is 17 and I fear he would feel this is unacceptable!
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Sugars gone high for no reason?
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rebrascora
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It sounds like his Levemir needs adjusting. It may be down to hormones, the time of year or his honeymoon period coming to an end or any number of other things including possibly coming down with an infection or illness or even his insulin being compromised.... maybe by being left somewhere too hot like next to a radiator etc.
My basal needs stepped up quite suddenly twice as my honey moon period came to an end and last Feb they gradually almost doubled over a period of 3 months following my first Covid jab..... so lots of possible causes and I wouldn't be too concerned at this stage other than to correct with NR and find a more permanent strategy if the problem persists, but do talk to his DSN and discuss a possible increase in his Levemir doses if you/he are not confident to do such adjustments yourselves.
I think having exceptionally good/tight diabetes control in the early months of diagnosis (and those HbA1c results are exceptional) can sometimes lull you into a false sense of security and give you an unrealistic expectation. Hopefully this is just a minor wobble and with some help from his DSN he will get back on track, but it may be that he will not be able to attain such good results again and that his pancreas has been helping rather than hindering as it did for me in that first year of diagnosis.
Did he use his NovoRapid to do a correction this morning with his breakfast?
My basal needs stepped up quite suddenly twice as my honey moon period came to an end and last Feb they gradually almost doubled over a period of 3 months following my first Covid jab..... so lots of possible causes and I wouldn't be too concerned at this stage other than to correct with NR and find a more permanent strategy if the problem persists, but do talk to his DSN and discuss a possible increase in his Levemir doses if you/he are not confident to do such adjustments yourselves.
I think having exceptionally good/tight diabetes control in the early months of diagnosis (and those HbA1c results are exceptional) can sometimes lull you into a false sense of security and give you an unrealistic expectation. Hopefully this is just a minor wobble and with some help from his DSN he will get back on track, but it may be that he will not be able to attain such good results again and that his pancreas has been helping rather than hindering as it did for me in that first year of diagnosis.
Did he use his NovoRapid to do a correction this morning with his breakfast?
I was thinking about the honeymoon period too. How will the honeymoon period ending present itself - or is it different in everyone?
He did do a correction dose with his breakfast - he has an app on his phone that calculates it all for him. I realise now I probably jumped the gun by getting him to send me his bloods on his break as that had not allowed for the full 4 hours after his breakfast. He's just txt me his before lunch sugars and they are 9.7 so if it allows for another slight correction then hopefully it will be around 5 by teatime as usual.
He did do a correction dose with his breakfast - he has an app on his phone that calculates it all for him. I realise now I probably jumped the gun by getting him to send me his bloods on his break as that had not allowed for the full 4 hours after his breakfast. He's just txt me his before lunch sugars and they are 9.7 so if it allows for another slight correction then hopefully it will be around 5 by teatime as usual.
Inka
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If the correction is working, that’s great. Being high does mean corrections take longer to work, and may require more insulin. I’d keep an eye on him. I’d also look at his Levemir and possibly change to a new cartridge just in case that’s degraded and become less effective.
I am glad to read that your son's levels are now coming down.
As this is a sudden issue, my first thought would be to change his Levemir rather than end of honeymoon - my understanding is that the end is gradual rather than one or two days.
If he has reusable pens, I recommend checking the Levemir pen and, if it looks ok, change the Levemir cartridge.
If the pen looks suspicious, change that too (you should have spares).
If he is using single use Levemir pens, just change the pens.
As teh correction appears to be working, the NovoRapid is likely to be fine.
As this is a sudden issue, my first thought would be to change his Levemir rather than end of honeymoon - my understanding is that the end is gradual rather than one or two days.
If he has reusable pens, I recommend checking the Levemir pen and, if it looks ok, change the Levemir cartridge.
If the pen looks suspicious, change that too (you should have spares).
If he is using single use Levemir pens, just change the pens.
As teh correction appears to be working, the NovoRapid is likely to be fine.
rebrascora
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In my case it was a notable increase in basal needs but then I follow a low carb diet so I don't need much insulin for meals, so it was the sudden and consistent increase in waking levels and having to do corrections throughout the day which indicated that things had changed and I needed more basal insulin (Levemir).
Does your son inject the Levemir once or twice a day and if twice, is the dose split evenly? How many units is he currently using?
Has he been offered a DAFNE course or whatever your local equivalent is. This is an intensive (usually 5 day) course not just for carb counting but to give you knowledge and protocols to keep you safe and manage your diabetes well for the rest of your life in a whole host of real life situations. There was a young girl on my course who, like your son, had absolutely amazing control when the rest of us were struggling with levels yoyoing. I am not sure she gained as much from the course as the rest of us but I often wonder if she did the course too soon and may now be struggling. You learn a lot more from things being challenging than it being a fairly steady ride I think. Not that I am knocking the effort your son has put into his diabetes management, but just that some people have a much easier honeymoon than others and unfortunately it doesn't always stay that way when it comes to an end. In fact diabetes is a condition where the goal posts move quite frequently throughout your life so learning to cope with that is really important.
Thanks for the replies. I had a call back from his DSN. From looking at his levels over the last few weeks, it looks like it is his tea/supper novarapid ratio that is the issue so we are trying that first tonight then will look at his levemir next if this does not work.
His levemir is 15 units before bed.
He has a box with all his equipment in it when he is home and hypo treatments spread through the house. Insulin pens are always in a cool place away from radiators as I get paranoid about this. As we have an old victorian house that doesnt heat well though so this is easier than you think. He has reuseable pens (and spares). When he is out of the house, he carries his equipment in his 'anti-death bag' (yes, thats what he calls it), keeps it away from heaters and obviously leaves the levemir at home. I will check both his novarapid and levemir cartridges when he gets home just to be safe.
His levemir is 15 units before bed.
He has a box with all his equipment in it when he is home and hypo treatments spread through the house. Insulin pens are always in a cool place away from radiators as I get paranoid about this. As we have an old victorian house that doesnt heat well though so this is easier than you think. He has reuseable pens (and spares). When he is out of the house, he carries his equipment in his 'anti-death bag' (yes, thats what he calls it), keeps it away from heaters and obviously leaves the levemir at home. I will check both his novarapid and levemir cartridges when he gets home just to be safe.
rebrascora
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Good to hear you have had input from his DSN. Hope her suggestion resolves the problem.
Quite surprised that he is only on one Levemir injection a day still after a year. It is designed to be split into 2 doses, morning and night and then allows much more flexibility in adjusting it to suit an individual's body. That said, his excellent HbA1c results suggest that the single dose has been working well for him until now.
Libre is brilliant and I am sure he will benefit from it enormously as well as find it a fun new toy.... Many of us were a bit obsessive about playing with it when we first got it.... It is just a really neat bit of kit, but it does have limitations and it is important to learn how it works and when you need to use finger pricks to double check it. There is a Libre Academy on the Abbott website which you can work through at your own pace and completion of that used to be a condition of getting it prescribed.
Quite surprised that he is only on one Levemir injection a day still after a year. It is designed to be split into 2 doses, morning and night and then allows much more flexibility in adjusting it to suit an individual's body. That said, his excellent HbA1c results suggest that the single dose has been working well for him until now.
Libre is brilliant and I am sure he will benefit from it enormously as well as find it a fun new toy.... Many of us were a bit obsessive about playing with it when we first got it.... It is just a really neat bit of kit, but it does have limitations and it is important to learn how it works and when you need to use finger pricks to double check it. There is a Libre Academy on the Abbott website which you can work through at your own pace and completion of that used to be a condition of getting it prescribed.
Inka
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I’ve never done a DAFNE course and have managed fine. Personally, I’d think it would be the last thing I wanted to do as a teen. There’s an online version called BERTIE, if you and he would like a look.
Another voice in favour of twice-daily Levemir - that’s what it’s designed for, and it also gives more flexibility.
I’d change both his cartridges just in case anyway.
Thebearcametoo
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We didn’t do a DAFNE course as the paediatric team have a dietician and cover everything so it’s likely that would have been the case even when diagnosed at his age. Once he hits adult care he may not get quite the same support and it may be worth him doing another course in a few years as a refresh.
In terms of high numbers: if we see patterns of all numbers rising over the course of a week or so, especially the first morning reading (if bedtime reading was in target) then we put the basal up. Otherwise we check we did the right carbs for the meal and look at changing the rations for that particular meal. He will still be growing and may well be coming to the end of his honeymoon period so changes are likely to be needed. The team will be able to spot trends when they look at the data but you may also spot them too. When we need to change things with a growth spurt we increase the basal by 10% and let it settle. Then if needed change breakfast ratio and see how that impacts the rest of the readings and so on with each meal. We take advisement on correction values from the team.
Even with a few weeks of higher numbers his HBA1C will be good enough. You’ve been getting great numbers so far but there will be times where it’s higher and that’s normal. You’re looking for long term management not being perfect every time.
If he feels fine and his ketone are normal then the correction factor should take care of anything too high and if necessary you can add in an ‘illness’ correction too of another 10% - I presume your team have set him some values for things like illness, stress or for reducing the dose for exercise etc. You only need to keep him home if his ketones are high (over 1.0) or if he feels rough from being high.
In terms of high numbers: if we see patterns of all numbers rising over the course of a week or so, especially the first morning reading (if bedtime reading was in target) then we put the basal up. Otherwise we check we did the right carbs for the meal and look at changing the rations for that particular meal. He will still be growing and may well be coming to the end of his honeymoon period so changes are likely to be needed. The team will be able to spot trends when they look at the data but you may also spot them too. When we need to change things with a growth spurt we increase the basal by 10% and let it settle. Then if needed change breakfast ratio and see how that impacts the rest of the readings and so on with each meal. We take advisement on correction values from the team.
Even with a few weeks of higher numbers his HBA1C will be good enough. You’ve been getting great numbers so far but there will be times where it’s higher and that’s normal. You’re looking for long term management not being perfect every time.
If he feels fine and his ketone are normal then the correction factor should take care of anything too high and if necessary you can add in an ‘illness’ correction too of another 10% - I presume your team have set him some values for things like illness, stress or for reducing the dose for exercise etc. You only need to keep him home if his ketones are high (over 1.0) or if he feels rough from being high.
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