First sudden plunge

(Fiora) #41

Hey Cindy,
Thanks for your reply, sorry for my delay.
No, my daughter will be 4 next month and is tiny and so reactive to carbs. We treat lows with a 1/4 graham cracker currently and if we give one too many she’s over 250 all night.
In response to this thread I haven’t bought chocolate milk yet, but I will! But I have purchased the berenstain bear juice boxes that are only 7g of carbs. We too have a dexcom and I’m just starting to experiment with stopping a drop before I have to do the rule of 15. These work great. Sometimes we need something faster acting. For example last night she had 1/4 cracker, went up, dropped, had 3 chocolate went up, dropped, I fed her 1/4 cracker as she slept, went up, dropped. As my husband and I debated about what to give her- she went up. From 80- 145 and woke up at 120.
It’s not what I was taught but the fast acting has its place here with the dexcom and I’m exploring it. Chocolate milk is next!

(Fiora) #42

If you are comfortable, I would ask your doctor about adjusting ratios on your own.
I have been doing it since about 2 weeks after diagnosis, so close to 5 months now. With full support of her nurse educator, always, if needed. The rule is 3 highs at the next mealtime, change it, and a low even once, if you know your carbs were correct, change it.
Do you have a rounding table? Ours is .25 and under, no insulin, .26- .75, half unit, .76-1.25, one unit, and so on.

(Cindy) #43

Try a teaspoon of peanut butter on the graham cracker - it’s a few more carbs (less if you use PBfit or PB2) but the protein and fat will help stabilize the BS. Good luck!

(Cathleen) #44

@Fiora. Thanks, Flora. Is your rounding table for the purpose of correcting highs? Is it for extra insulin in addition to covering the carbs at mealtime? I think it is similar to the correction table that we use for blood glucose over 150, but I wasn’t sure what the numbers “.25 , 26-.75” mean (please excuse my lack of knowledge!)

(joe) #45

@cminer Hi Cathleen,

you should probably get a set of instructions from an endo or CDE.
Many people use a “carb ratio” and a separate “sensitivity” to figure out how to bolus for carbs and how to bolus for a high blood sugar ( a correction).

an example:

if I am 165 mg/dl and I want to be 100 mg/dl, I first subtract (165 - 100 = 65) than I use my personal sensitivity of 32 mg/dl/unit, and do 65/32 = 2 units, or if you have a pump… 2.05 units of insulin as a “correction”.

I also use carb ratio - say 1 unit for 15 grams, so if I eat 30g of carbs as a snack I need 30/15 = 2 unis.

If I am 165 and want a 30 g snack because I am hungry, then I combine the correction with the food bolus for a total of 4 units.

If you pump, you can accurately give “tenths” or even less of a unit. If you are on shots - you need to round up or down because you can’t accurately give 0.10 units of insulin with a pen or syringe.

For figuring our your personal carb ratio or sensitivity, you can do certain experiments. These experiments are described in the book “Think like a pancreas”

good luck. hope this helps.

(Cathleen) #46

@joe Very interesting, Joe. I had not yet heard about the personal sensitivity calculation. Eva is using injections, so we have a straightforward carb ratio and a correction scale. Your method sounds alot more nuanced. I like also that a pump allows for much smaller increments. I will be talking with our endo next week, so I have some good new questions for him. I think he is maybe easing us in with all of the new information! Reading “Think Like a Pancreas” right now. Very helpful, thanks so much!

(Fiora) #47

Hi @cminer, yes, I agree without Joe, most definitely talk to your endo about all of this.
My daughter is approved for a pump but currently on injections, so we are restricted to a half unit.
I’m speaking about carb ratios, and how to know what amount of insulin to give if it’s on the cusp, as you mentioned previously.
Our endo gave us a scale. So for breakfast she’s on a 1:17 carb ratio and if she had 38g of carbs it would come to 2.23 units. With our scale that’s 2 units. If she had 39g of carbs it would be 2.29, and that would mean 2.5 units.
Her target glucose number is 120, and her correction factor is 300, so we would do the same math Joe mentioned, (180-120=60/300=.2) So if she was 180 before breakfast and had 38g of carbs that extra correction would get her to 2.5 units.
As I mentioned before though, we don’t correct her if she’s had a carb in the last 3 hours so never at snacktime, only mealtimes. I’ll have a lot more to learn when she gets a pump, and have the flexibility of exact units.

(Cathleen) #48

@Fiora, Thanks for the clarification, Flora. It seems like I am arriving at the same end by a different means, using a couple of tables instead of the calculations. I would like to get as sharp at the calculation method as you and Joe and will definitely be asking our endo for instruction. Best wishes and good luck with everything!

(Jay) #49

Everyone has there go to items. One of the best things I was taught by my educator was Gatorade.

Why? it last pretty much forever if not open, in hot or cold temps. Their small bottle is 23 carbs and a pretty perfect amount for me.

We have 2-3 on hand in every car glove box. A six pack in my night stand and unlike other items they just last forever.

(Jay) #50

Everyone has a sensitivity, but some endos don’t talk or bring these things up for like 6 months to 1 year into treatment.

Still a bunch of ifs and learning, they mostly want to make sure honeymoon phase is over before you start carb ratio treatment. Plus you will need to go to nutrition school, yeah!!! It’s not fun just jk. But most educators can teach you well on food calculation. In addition there are many apps out there to help.

One thing I have is my food bible in the notes on my phone. It list all restaurants I go to frequently and how many units I need. A lot of times diabetics become creatures of habit so I do often eat the same things at the restaurants I frequent and I know exactly what to do at each one because of my notes.

(Cathleen) #51

Thanks Jay! We have started a food notebook, but I like the idea of keeping it in the phone. My daughter and I are already gluten free due to celiac disease, so we eat out rarely at a couple of places and mostly cook at home. I think her endo is a “one step at a time” kind of doc, which has been good! We will probably learn about sensitivity at a later date.
Take good care!