4 letter words, beware

Ahhhhhhhhh!!! Is there not some kind of clinic where we can just go live with T1 ALL THE TIME? stupid doctors know nothing! Science explains nothing, going by the book solves nothing, mom instincts solve nothing.

One of the best children’s hospitals in the county and they have no answers. Why, when bg is 90, you give super fast acting glucose gel to absorb in her cheek, a regular fast acting, another super fast, a third super fast and she continues to drop down to 50.

When you tell Dr. Know nothing that every evening she is going low and that typical corrections are not working and the only thing that will bring her up is super fast gel, he says he doesn’t know why and passes right over it. So they next night you end up have to call 911. Shit this is too hard!

hi @motherphillips, I read your post fast and I was originally going to say “yes there is a clinic and it’s called the Caribbean” but then I re-read it and now it doesn’t seem as appropriate.

please don’t blame your instincts - the complexities are not always intuitive.

with our crappy tools and slow insulin, (yup I said it, our meters stink, our pumps stink, our CGMs really, really stink, and our lispro analog human dna recombinant insulin is way too slow) controlling diabetes is like trying to drive a car FORWARD by looking only in the rear view mirror. couple of curves in the road …and your crashed.

the secret to diabetes is not what is going on RIGHT NOW, it’s more of an understanding of what was going on 1-2 hours ago? such as, just had a meal, just had a bolus, just had a shot of long acting, more or less activity… so what was going on prior to this?

90 and dropping fast could be - too much basal insulin, too big of a bolus, too much activity given a bolus within 4 hours, a “stacked correction”, or and this one is freaky, a slight low prior causing her liver to dump glycogen, then the liver re-absorbing sugars to make glycogen. When it’s that, I typically drink 8-12 ounces of juice rather than chomp down 6 glucose tabs.

we’ve all had a “stubborn low” and we’ve all had to correct by eating 2X to 10X the “usual” amount of sugar to bring it back. you want understanding by a medical professional? Find and endo that HAS t1. the rest of them only know how to talk about it. don’t go too hard on yourself.

Oh Mother!!!

I hear you @motherphilips, I feel for you, I emphasize with you. Believe me, during the past 68+ years I have gone through all the trials that are hounding your daughter, and the worst are the horrible persistent and draining [physically and mentally] lows. I also agree with just about everything that @Joe has told you.

I’ve read the books, the blogs and listened to doctors and the so called “experts”. Yes, I learned from some of these sources, brought to heart what WORKS FOR ME and let the rest of the information slide to the back of my memory for possible use at a later time. What I am saying is, everyone with T1GM must be his/her own doctor and use the tools and schemes best suited to oneself; in your case, you and your daughter are her “Primary Care Physician”. Yes, this places a heave burden on you and her to learn more than just basics, closely observe her and be make day to day adjustments without waiting for a call-back from some doctor. But do stay in touch with her doctors, visit regularly and review all changes that you have made [and why you made changes] and ask if the doctor has better ideas - that is what I do.

As Joe has said, it isn’t necessarily what is happening right now but rather what has happened 1 or 2 hours ago; for me, it is also the activity in which I was engaged 12 hours ago and what I have eaten or done since then and the insulin that I have taken. I’m certain that the five miles I walked before lunch will be reflected in my pre-dinner BG reading. Each one of us is different so what is NOW working wonderfully for me may not fit your daughter’s situation.

I regret that I do not recall your daughter’s treatment plan, whether she is treating with MDI of fast acting plus a background insulin or with a pump. Whichever method, and I am NOT a medical professional, she is very probably “stacking” insulin in her body. Please take time to check the validity of her meal bolus ratios and her sensitivity factor used for corrections.

It is very hard on you and it is very easy to just give up, but I think you are really doing an extraordinary job caring for your daughter and for yourself. I’ll keep you in my thoughts and heart.

Hi motherphillips,

The input from others in this blog is right-on.

At risk of too many words I’ve cut/pasted my “list” of FACTORS TO CONSIDER" for insulin and/or corrections. I created this list a long time ago when I was trying hard to get through to medical people and to answer what seemed really dumb questions from same medical people. I think I did this on an earlier post to this blog – but can’t always keep up ;/

I think it spells out at least partially many of the complexities of our attempts to approach metabolic balance. Even then, the last item “gut feel” has often been as important as numbers of all types.

In years past, to keep my son safe from this notorious rollercoaster, I simply checked his BG a lot. On a difficult night or day, it was every 30 minutes, then every hour, every 2 hours, etc. FEW of the treatments for low BG would bring him up in any sort of linear fashion, so I/we learned to test.

When Humalog first came out with its claims of working within 15 minutes…we tested this little marketing story…and it was NOT true. One hour, sometimes two hours, for a so-called “instant” insulin. I am still very grateful for Humalog and I know it is my son’s life blood. It is far better than the old insulin products.

The other participants who responded have actually said it all but I thought I would add my 2cents !!

So, once again, here is my list - the format is not so good in this cut/paste but it’s readable:

BG = Blood Glucose
Basal = Baseline for homeostasis

  1. Time of day

  2. Current activity level

  3. Past activity level(s)

  4. Near future activity level

  5. Prior BG levels (24-48 hours)

  6. Insulin brand: humalog versus novolog

  7. Age of insulin (i.e., vial in use for 30 days or more)

  8. Most current basal dosage recommendations per MD and delivered via insulin pump

  9. Most recent outcomes of dosage adjustments to basal, bolus, correction factors, I:Carb ratio

  10. Site of injections/pump infusion set

  11. Scar tissue at injection sites

  12. Accuracy of glucose meters

  13. Ketones (pos/neg)

  14. Food intake by TYPE:
    a. Carb
    i. How many grams carb per serving?
    ii. Quick acting
    iii. Slow acting
    iv. Glycemic index of carb
    v. Fiber content of carb (subtract from grams of carb)

b. Protein intake (type and amount)

c. Fat intake and composition (amount of fat in food combo)
d. How all 3 types of food work in concert when consumed together in a meal

  1. Food intake TIME OF DAY

  2. Food intake AMOUNTS (relative proportions)

  3. Overall health

  4. Age/hormones

  5. Stress levels / “sick” days

  6. Logistics (i.e., will I be able to get help in the event of an unpredictable response to changes in insulin dosage or type)

  7. Overall BG goals - both daily and average

  8. Current weight in lbs and kg

  9. Change in body weight (Y/N)

  10. “GUT” feel or intuition