Super high highs and insulin before meals

(Flora) #1

My daughter (3.5 years old) has started having highs of over 400 after eating. Her dexcom is just reading “high” currently. This began Tuesday when she was at preschool and I had never seen it before and freaked out a bit. The school nurse took her BG and she was 434. By lunchtime she was 71 with no correction.
It’s clear to us, and her DNE is in support, that we need to give her insulin before she eats or at least during. We weren’t taught this way and are only 3 months in so I am nervous, but I understand most people with diabetes take insulin before meals, right?

(Dassy) #2

Hi Flora,
I’m relatively new to this, only about 5 1/2 months. But I was told to take my insulin before each meal, according to what my blood glucose is. The doctor gave me a scale to follow. I also take a long acting insulin every night.

(Dennis J. Dacey, pwD) #3

Hi Flora @Fiora, I agree that you, and her DNE should be concerned. But as I’m not a medical doctor and I’m not really familiar with your daughter’s insulin and meal plan I will not second guess.

I will offer a suggestion: work with her doctor and DNE to develop a “correction sensitivity factor” [among other things] so that in the future she doesn’t dive too low - I’m conservative when making corrections having learned the hard way. I validate my correction factor for different times of day by taking one unit of insulin when my BG is at least 150 mg/dl and then doing a BG check [in addition to my CGM reading] after 2, 3 and four hours and again after six hours. I will do this on days of “normal” activities. I suspect that your daughter could be in the so-called “honeymoon period” which could also cause her BG to drop fast.

(Flora) #4

@Dennis, I was hoping you would answer.
My daughter, her name is Willa, is very sensitive to both food and insulin. We usually only give insulin at meals, and correct at that time. When she was at 434 and then 71 there was no correction.
I talked to her DNE for an hour that day, we decided to stop her Lantus altogether, which they had been recommending for a while. The change in no Lantus hasn’t been significant, except for overnight, she hasn’t been dropping and needing snacks at midnight and 5am.

(Flora) #5

We actually just corrected for the first time ever, and at night, which is so frowned upon with our endo, but she is still over 400 from dinner. She doesn’t have ketones, looks like she needs a new ratio for dinner.

(Dennis J. Dacey, pwD) #6

Hi Flora, I hope that Willa has not continued her wild BG swings - I’ve not been able to respond sooner.
The wild swings, in the opinion of some ‘experts’ can cause more than a constant high - although not as high as her 434. I too think stopping the Lantus and restricting insulin to fast or rapid acting to cover meals might be safer; as she gets older and her diabetes matures - when she is beyond honeymoon - the Lantus could be resumed carefully and dose[s] timed to avoid her meal-time bolus.
I also hope that you will soon be able to “relax” and trust her Dex to let you know when to step in. Speak with her DNE about a safe target range for CGM alerts - the Dexcom default 70 to 180 may not be right for a child.

(Flora) #7

Yes, we are doing exactly that. Her nighttime numbers can’t really handle any amount of Lantus and we have adjusted all her ratios to support her better during the day. Her over 450 highs were a result of coming out of a recent honeymoon. We have started giving insulin before or at the beginning of some meals, and waiting until after if the meal has high fat content, to better match the time she spikes to the insulin kicking in. Friday night her dexcom just read “High” for hours despite 2 half unit corrections about an hour and a half apart. On a positive note I now feel comfortable as to when to give corrections.
We do trust her dexcom, but her pediatric endo office wants a BG number anytime insulin is given, they are conservative with children and I appreciate that. Your advice is consistent with theirs, we have our high alert set to 350, and the low to 70. It was 3 months yesterday that Willa was diagnosed, and in going over her dexcom reports with her DNE she said she wouldn’t have done anything differently, which is reassuring/affirming. What a crazy education this has been. This forum is so helpful, with so many like you who have had T1D for decades. Thanks for being there!

(Dennis J. Dacey, pwD) #8

You are doing well - the very best any mother [or anyone who care] could do. I admire how far you have come, and how much you have learned in just three months.
A few years ago my wife, we are in our 53rd year and I had diabetes for when we met] “convinced” me to realize that TypeOne can never be controlled, that I have some real crazy days BG wise that are NOT my fault or mismanagement, but that I generally have good management skills.
I think what she really means is that when I see my glucose levels out of range, low or high, that I take proper steps to get matters back in line. You Flora, are at that point very early with Willa. I expect that Willa will with time, with your encouragement, be managing her diabetes like a professional.