Bill, thank you for your stories and experiences. I really appreciate what you and Dennis have to offer in the way of experience. My daughter’s experience may very well be like Cathy’s in a lot of ways. Multiple bags of D-10 were used to keep her afloat. It doesn’t happen every day, but it does seem to be a very similar time of day, and it has been happening multiple times in the last month. Once again, thank you for your wisdom!
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That is what I was saying Brian @bcfbrian7800, if the carb ratios and correction factor are correct, her TOTAL dose [food + correction] should have been a maximum of 5 units. My calculations:
- Food Bolus : 54 gm. divided by 15 = 3.6 units
- Correction to 120 : 191 - 120 = 71 divided by 80 = 0.9 units
- Total dose : 3.6 + 0.9 = 4.5 units
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All these comments seem to have to do with adjusting insulin. The truth of the matter is that most of us even with insulin can’t handle a lot of carbohydrates at once. Insulin just doesn’t act fast enough to keep carb doses in check unless everything is timed to a tee before and after a meal, and even then females have lots more hormonal ups and downs than males. So, it took me years to adjust my carb intake to more closely let the insulin deal with it. Eating greens with toast at breakfast allows the toast carbs to require less insulin. There is lots of juggling you can do, which is harder for children. Packing lunches would help. We only get to eat 1/2 cup of spaghetti noodles for instance, but a school lunch will probably provide a plate full of noodles, perhaps 2 cups worth? Eating fewer noodles will mean you don’t have to give so much insulin and have a lesser chance of crashing in the afternoon. If you eat half of a hamburger bun, you need less insulin. Good luck. With a few adjustments to diet and insulin, you will soon be on a more even keel.
Another point about carbs, many people don’t know this, but the US regulations for Nutrition labels allows that AL values may be wrong by + or - 10%. So the 54 gm carb you mentioned may run anywhere from 48.6 gm to 59.4 gm. That makes it hard to balance precisely with insulin because you are aiming at a target that may be in a different place than you thought.
Just another confusing factor for all diabetics. The best way to counter this problem is to reduce her carb load, which may be difficult for a youngster.
The other thought from my 63 years of T1d experience is that for SOME Type 1s a whole different approach MAY work, as it did for me. Actually it started being used when I was about the same age as your daughter 12. Mind you that was in 1962… Anyway my Endo, Dr. Dube, had tried every regimen he could come up with, and nothing worked consistently. (Urine testing didn’t help much either, but that’s a different story.)
So in desperation he tried something new and totally different. He changed my meds to 2 shots of intermediate speed insulin and 2 pills a day. Mind you these pill s were ONLY supposed to work for Type 2s. Brand name was DBI, generic Phenformin. These pills limited the liver and other tissues output of glycogen, the storage form of glucose. MY tissues apparently were dumping glycogen at various times, not necessarily on any schedule that we could determine at the time.
Once we got the regimen in good order I had only minor hypos (usually from exercise) and no highs as long as I stuck to the diet. He found that this worked for 5 other Type 1s in his practice, but not all. We all became model patients. BTW I was in the hospital at diagnosis in 1956, and haven’t been back until they introduced Human Insulins in the 80s and my Endo was skittish about me replacing it at home, and again when I trained on the insulin pump in 1993. Dr. Dube had retired by then, and his son had never trained anybody to use an insulin pump, so he played it safe with me being in the hospital.
I used that regiment from 1962 to ~1976 when Phenformin became the first drug that the FDA removed from the market for safety reasons. It has been replaced by Metformin, which was finally cleared by the FDA in the mid 90s. Since then I have heard of some T1s using Metformin with NPH or whichever intermediate speed insulin the doctor prefers.
Just an idea, which REALLY needs her endo to handle, IF he thinks it worthwhile. Of course an insulin pump is the normal answer these days.
Thank you all for your thoughts! It is great to have all of these POVs. I believe one of the main things that is impacting my daughter at the moment is the hormonal changes that she is going through. The patterns have drastically changed, and what worked even a month ago is not working now. It is just a reminder to us that we can never get truly comfortable with any one particular regimen because once we do, it could very easily change, like the recent changes. Again, all of your insights are very appreciated. I wish you all the best.
Brian, I hope that your daughter is doing much better this week. This has been a very informative discussion on many levels. I had been meaning to comment to inquire if you thought hormones are playing a role. It seems your daughter has been managing for several years and that these hypoglycemic episodes are new developments at age 12. My daughter of 14 experiences significant shifts in her need for insulin depending on her hormonal cycle. We have to increase both basal and bolus to get her numbers in range, then suddenly it is too much for her and we have to backtrack quickly to prevent lows. It requires frequent adjustment and I am hoping that in the next few years her dosage will be more stable. Best wishes to you as you manage these adolescent years!
Brian, it got a lot easier for us once we started on a pump rather than using long acting. The difference is that the pump just used short action and drips it all day long. And, you can adjust the basal throughout the day. We cary considerable as my daughter needs a higher basal in the early morning hours, then it goes down when she heads off to school. It starts to come up after lunch. Since the basal is short acting, it only has a 4 hour duration, and she’s only getting 1.0-1.5 per hour rather than a huge does once a day. There is no way to control how that long acting crystal dissolves once you administer it.