scary to give Riley 6 units of novolog for 1 snack. The whole correction thing keeps tripping me up mentally. She was 397 and had lunch at 12:40 so yeah way to high. I need to up her levermir tonight she as 198 and in the 200"s all night long. Before she was dropping to 82 by 4 a.m. and held there until she got up at 6. Oh wait no I have to wait and see if this is a pattern or just a weird night/day blah so much to remember. Anyhow it still seems weird to give 6 units for 1 29 carb snack. Her ratio is 1:20. Kinda sucks the pen does have a half unit. I think I have to change her ratio as well for some meals or depending on what she is having. 1:20 is fine with some meals but with others like fruity pebbles lol it doesnt come close.
Hi Jessica,
Why is it iscary? Are you afraid you will send her low by correcting?
I have to try to separate the 2 things in my mind. Bolusing for a meal or a snack and correcting for a BG. You give the insulin at the same time, but it is for 2 different reasons. So even though it seems like a lot for a snack where you would normally give her 1 or 1.5 units, it isn't to cover the snack, it is to lower the BG that is too high. What is her correction scale? Make sure you are writing it all down and looking for patterns. Glad you reminded yourself of that, it can be tempting to make a lot of changes, but if you make more than one at a time, you can muddy the waters on which change is doing what.
Which leads me to my next comment on the levemir. If she went to bed at 198 and stayed between 200-250 all night, her levemir is actually working correctly - it is keeping her BG LEVEL even though she is not eating. Levemir needs to be adjusted when the fasting level of BG is changing too much either up or down. (The rule of thumb I learned is more than 40 pts overnight). To get to good overnight numbers, you need to correct with the novolog using her correction scale. Let's just say 1 unit of the Novolog lowers her BG 50 pts and you give it at 9pm. Then at midnight you should see her BG at 148 and it should stay between 108 and 188 at 3am and 6 am if the levemir dose is right for her.
I hope some of that helps.
Don't feel scary, you're doing a great job(?) You know how to handle lows, that's the main problem and is 84 really low? I am really happy for that number LOL. For me my ratio is 2 units for every 15 carbs., but I am also an old fat (kidding, joke) man. Oh, have you figured out her correction ratio??? Mine again is 1 unit will being me down about 25.
Well that cleared a lot up for me. I am use to the NPH which had big drops in BS over night. I was just thinking because she was 84 in the mornings if I gave her any more it would drop her to low.
Its just scary because of the way we were doing it before. She hardly used any log. I think the most was 5 at dinner time.So its weird to give her 6 for a snack even tho it is because she needed a correction. Its just switching from the old way and its rules and the new way and its rules.
I need to fix her ratio's more 2 hours after eating she was at 304 and started at 115. I gave her a 1:15 instead of her 1:20 this morning. She is really stressed right now because of tests. Now a question can or should I be correcting her again when she tests two hours after eating to see where she is at or are corrections just at food times?
[quote user="Jessica "]
Kinda sucks the pen does have a half unit. I think I have to change her ratio as well for some meals or depending on what she is having. [/quote]
The half unit thing has been the only thing that's really bothered me about the flex pens. It's also a contributing factor for me really considering starting a pump soon. My doc says they're precise to the 1/10th of units, which means that they can control numbers much more precisely. I'm not sure if that's an option for you, and I didn't have to experience it when I was a kid, but my doctor has always said that it's by far the BEST option for the most control.
[quote user="Jessica "]
Well that cleared a lot up for me. I am use to the NPH which had big drops in BS over night. I was just thinking because she was 84 in the mornings if I gave her any more it would drop her to low.
Its just scary because of the way we were doing it before. She hardly used any log. I think the most was 5 at dinner time.So its weird to give her 6 for a snack even tho it is because she needed a correction. Its just switching from the old way and its rules and the new way and its rules.
I need to fix her ratio's more 2 hours after eating she was at 304 and started at 115. I gave her a 1:15 instead of her 1:20 this morning. She is really stressed right now because of tests. Now a question can or should I be correcting her again when she tests two hours after eating to see where she is at or are corrections just at food times?
[/quote]Novolog can last a variable time in everyone. I know a lot of teens/adults on Juvenation say they test after 2 hours, but we were taught 3 hours for kids. And some kids can have the novolog working even longer than that. To really know how long it works you have to do some 'tests' where you bolus for a meal and then test at 2 hours, 3 hours, 3. 5 hours, 4 hours, etc. Basically test until you see the BG stop dropping. If you can do it after several different meals, that is the best, you kind of get an average. (It isn't perfect and your kid has to be willing to eat free foods while you are doing it.)
So if it were me, I wouldn't correct until at least 3 hours after bolusing (and you could wait to test 3 hours after too). If you do the test for how long the insulin is working and know that her bolus wears off by 2 hours then you can go ahead and correct then. If you don't do the test, then you have the risk of her going low because she has insulin still working and then you gave more. We were taught "Don't correct until it has been at least 3 hours after a bolus".
Add up the total amounts of insulin you are giving in a day (units of Levemir and units of Novolog). It will probably be close to the same total amount of NPH and Novolog that you were giving before. Not exactly, because they all work a little differently, but it is one way to compare. I know you said the Levemir is way less than the NPH amount you were giving before. So it makes sense that you are giving more Novolog to 'make up the difference'.
the novolin jr pens do have half units. we were using them for both insulins before switching to lantus, but still use the novolin jr pen for the novorapid.
Matt she doesnt want a pump yet. She wants to wait until she is older. I want to wait until she can inject herself that way if the pump goes down she can take care of herself.
Thanks JDVsMom I was thinking the same thing. She has a good time period between carb meals at school. She eats here at 6:30 and doesnt eat lunch until 12:30 wow 6 hours so I can get a pretty good idea of her numbers she was normal by lunch yesterday but still high 2 hours after breakfast. I will have to be there one day and just test her more often.
Hello- it looks like you are doing a wonderful job! my mom used to do those midnight wake up's to check my sugar levels when I was much younger as well and found the same problem (which I still have to this day). She may just be having the dawn effect, the dawn efect is a typical case of a diabetic if you look through medical books. I know when it happens to me my sugar levels are normal when i go to bed, a little higher around midnight, lower around 3am, and between 7am-12pm my sugar levels shoot through the roof anywhere from 200-400. For me, I use lantus and I'm going to try levermir starting tonight. From what I'm told the one solution that would be a sure shot is an insulin pump (if you've ever thought of doing that). GOOD LUCK, I hope it works out!!!!
[quote user="Jessica "]
Matt she doesnt want a pump yet. She wants to wait until she is older. I want to wait until she can inject herself that way if the pump goes down she can take care of herself.
[/quote]
Gotcha. Like I said I got lucky and missed having to deal with it through my childhood so it's somewhat hard to relate with someone going through it at that age.
I wanted her on the pump the second I heard of it. Well at first but she was dead set against it. She didnt want robot parts. I got her to come around to the idea not pushing her for it or anything just mentioning it here and there when she had questions about control and such. Then I told her they have cools skins for it and she picked out a bunch and 3 different colored pumps lol. She said tho that she isnt ready for one yet maybe in a year or two when she is older. She wont let anyone near her tummy with a injection so that is a issue we have to over come before we even really consider a pump.
Yea injections in the stomach were hard for me too and still after 21 years it bothers me. I do hope it all works out for her in the mean time!
I wouldn't worry about pushing a pump on her yet. I was diagnosed when I was 4 and I didn't feel comfortable with getting a pump until I was 11. I was the same way and HATED the idea of injecting in my stomach. It is possible to put pump sites on your arms, legs, hip/butt, etc., but it is good to wait until she is completely familiar with using shots.
Jessica, you're doing great! When I was first moved to carb counting and correcting in high school, I felt like I was doing algebra w/ everything I had to remember. I still keep a calculator in my purse b/c I find my cell phone one too slow. When I have my husband calculate my dose for me, he actually takes out pen and paper b/c he does it so rarely, but it's super quick for me now.
As someone else said, it's great to change things one at a time rather than multiple things are once. So, I usually don't make any change unless it's been a pattern for 2-3 days. Then, I change one thing, and I give it 2-3 days to see what happens before making another change. (But, b/c I'm an adult, parents of younger kids might have different advice that works better for little ones.)