Fighting the Lows- I think she's getting too much insulin


(My-daughters-my-Hero) #1

OK, since Monday Shyla keeps dropping into the 40's EVERY morning by 8:45 am. We get up and she is eatting breakfast by 6:45 so she can catch the school bus by 7:30. When she gets to school her first class is PE, so i know what her problem is (she is going straight to PE and she is burning all her carbs) Well i'm trying to explain to her doctor that she is so active in the mornings and i think we are giving her TOO MUCH insulin. Right now her carb ratio is 1 to 20 and she is eatting a very well balanced breakfast. Most the time it is oatmeal, fruit and either fat free milk or oj. Most mornings her first BG is between 100-120. So her numbers are wonderful, she is getting a good breakfast, but every single day she has had to leave PE, go to the nurse and her numbers are in the low 40's!! I'm i wrong in thinking SHE IS GETTING TOO MUCH INSULIN! I kinda feel like her Lantus that i give her at bedtime is enough to hold her over until lunch because she needs the carbs from breakfast to get her through the first part of her day. But for some reason the doctor isn't seeing my side. I understand i can't just not give her the insulin because i know her little body needs it, but i think she's just getting too much. 

Has anyone else gone through this problem and if so, how did you resolve it? I don't know if we are in the "honeymoon" period or what but i just truly feel in my gut that we aren't going to be doing her any good by continuing to give her so much insulin in the morning and trying to fight these lows every single day.  I can say once she gets over that "hump" in the morning her numbers for the rest of the day are perfect and she doesn't have any other problems throughout the day. Its only in the morning........ANY HELP OR ADVICE PLEASE.....


(Angels) #2

Ok I am going to let you know what I do when I had issues like this befire I had an insulin pump.  I know that Lantus does not peak so that should not be causing the issue unless its way too much.  I would cut back the morning Novolog (or whatever the short acting is that she uses) or adjust the carb ratio,, Try a 1 to 30  and see if that makes any difference.  It will just take trial and error to figure out what works best. Make small adjustments, every two or three days.. one day is not enough to see a pattern.

I know Doctors think they know everything.  they dont.  They can only give you their advibe for the masses.. My body works totally different than the anyone elses.  You and your daughter will know more than the doctors before you know it.  trust yourself, and you will be just fine.

I would start with the carb ratio first you may need to do a ratiio of 1 to 25 or 1 to 30 or even more.  I am always here to advice where I can.  I have been a diabetic since I was 9 so I have dealt with a lot in the past 26 years.  Some Doctors know some dont.

Good Luck


(Emmies Mom) #3

I totally agree with Angela.  We have only been diagnosed since 10/29 but one thing that has become really clear to me is that it is all about trial and error.  I would try a higher ratio and see what pattern developes.  We encounter the same problem with Emmie on Tuesdays when they have PE.  So on Tuesdays I change her ratio.  It has worked well so far.  Good luck!


(Jessica L) #4

From everything i have been reading I agree with the other two. After a week of doing this if her after PE numbers improve call her doc and then you have the proof you are right and he/she is wrong.


(tombeatson) #5

I've been taking insulin for 67 years, and I agree with what Angela says. Trial and error is what you need. If your doctor isn't willing to work with you, using trial and error to fix this problem, then I think you should be looking for another doctor. Trial and error may seem like a big step, but you sound like you are already thinking in that direction.

Tom

 


(Trisha Faye) #6

Brandan's Levemir (same thing as Lantus) actually does peak in the afternoon, or so it seems, even his endo and nurses think so. Brandan has to have Levemir in the morning and at bedtime. Have you thought about maybe giving her the Lantus in the morning instead of at bedtime to see if that makes a difference?

I can't imagine what it must feel like to have a doctor and/or nurses that don't listen! I'm always asked for my input in decisions for Brandan's care.

 


(Zemus) #7

Lantus is powerful stuff. If I take 1 or 2 units more than my regular dose, I will crash.


(kimi) #8

My daughter also has the same problem.  She is an athlete and runs very low at school.  There are many times she does not do any Novolog in the morning and she still runs in the 40's and 50's by lunch time.  I encourage her to snack during the day.

 

Kim


(Sarah Romaine) #9

I agree with everyone else, but another option would be to ADD a snack just before PE, maybe even just a juice.  On the doctor's side, if you cut back her evening dose, wouldn't that raise her morning blood sugar?  Then you may run into the problem of needing to get her blood sugar down before PE and maybe not being able to participate because of it.  I've never used Lantus, so I don't know how it works very well. I think that the answerr is more food, not less insulin, but I could be wrong. 

OK, I just realized that you think that the morning dose (short acting) is too much, right?  You probably want to add a pre-PE test.  If she's under 120, she'll probably need the snack.  I drop with even mild exercise and have to eat and turn off my basal if I will be working out for any length of time.

Good luck!


(My-daughters-my-Hero) #10

THANKS for all you support, answers and ideas....i guess long story short, its just all about trial and error....well tonight we changed her dinner ratio to 1 to 20, we are going to take her Lantus down from 12 to 10 and then tomorrow morning we are going to use a ration of 1 to 30. Hopefully that will stop her from dropping in the morning. I'm also going to call the school in the morning and let them know she MUST test before she goes to PE and even if she has to test again after PE, then so be it. .... I really don't want to feed her any more than what i already am for the simple fact i feel like i'm already forcing her to eat. I seriously have to beg her at times just to finish her meal. She has never really been a big eater and now its even harder because i have to give her insulin before she eats so i have to all i can to make sure all her food is gone........

BUT, THANKS EVERYBODY!! YOU GUYS ARE THE BEST AND I'LL LET YOU KNOW HOW IT GOES.


(tombeatson) #11

One thing about trial and error that I don't think has been said is that you should only change one thing at a time. If you change more than one thing, you won't know if one of the changes didn't accomplish what you were hoping for.


(Sarah Romaine) #12

[quote user="Tom"]

One thing about trial and error that I don't think has been said is that you should only change one thing at a time. If you change more than one thing, you won't know if one of the changes didn't accomplish what you were hoping for.

[/quote]

Agreed!  If it doesn't work, then what?  You won't know what isn't working.  One thing at a time.  But the testing should happen before and after PE so you know what you are dealing with.


(sjwprod) #13

You are right, too much insulin is creating the lows when not food is eaten.

Another way to use lantus is to split the daily dose into to shots. Given the overlap of dosages you may be able to achieve a lower basal at night and a higher one during the day. This way the fight with lows at knight may be better managed. Lantus should never be used to cover meals, the Novolog (or other rapid insulin) should be used for carb coverage. If you depend on the lantus for carb coverage it will not be predictable because of the other factors that can impact the insulin effectiveness, such as exercise, stress, excitement, etc). 

The "Think like a pancreas ..." book may help you a great deal with understanding the physio processes and tools used to treat and manage D with insulin. 

Sounds like a pump may be the next trial.


(My-daughters-my-Hero) #14

Just got off the phone with the doctor and she actually agreed with me!! Changing Shyla's carb ratio to 1 to 30 seemed to work (a little ) she was still down but only to 86, which honestly is still too low for her because before she has morning snack she has recess (or course right after PE) so i knew she was going to need a snack just to get her to her snack time...Which is telling me, she is still getting too much insulin. But i also understand when the doctor says she doesn't want to make to drastic of changes too fast so she said she wants us to try the 1 to 30 carb ratio over the weekend, if she is still running low by Monday then she is going to try not giving her the morning humalog with her meal...this is really a challange, but i must say, she is being a Trooper through all of it. She is just smiling and dealing with it. these little ones are amazing. I'm just glad its me doing the worrying and not her. As long as she is smiling then i'll take care of everything else (or at least try too).....


(Brandy W.) #15

One thing no one mentioned is when you eat a snack before lots of activity, it needs to be high in protein.  The protein helps the carbs last longer.  If you eat something that doesn't have a lot of protein, then have lots of physical activity, the carbs are used up too quickly.  You might want to raise the amount of protein she is eating for breakfast and then ALSO have a protein snack before PE.  Maybe peanut butter or cheese crackers or a protein bar (south beach diet peanut butter protein bars are delicious!).  Just a thought to throw in with everything else.  It definitely helps me when I work out.  It helps maintain your bs which is the most important thing.  Good Luck.  I know it is frustrating but hang in there.


(Jessica L) #16

yeah we had to start adding a protein to Riley's carbs to balance it out.


(sarahslp) #17

[quote user="My-daughters-my-Hero"]

Just got off the phone with the doctor and she actually agreed with me!!

[/quote]

Good for you! As you get more experience with this, you'll find that you end up learning to make changes on your own and check in with the endo from time to time. If I am running high or low mutiple times over 2-3 days, I change my Lantus dose by 1 unit and then give it 1-2 days to see how it worked or if I need to raise or lower it again. If I'm high or low at a specific time (such as after breakfast!) for 3 or so days, I change my short-acting (Humalog) ratio and give it a couple of days before changing again.

I personally have found that Lantus, though marketed to last 24 hours, lasts more like 22 hours for me. If she's high at a certain time, it's something else to consider. I moved my Lantus time for that reason.

Does she have a juice box on her for PE each morning?