So Confused!

Hello! My daughter is 5 and was diagnosed in May of this year, My sitter came to see me at work today because my daughters meter said Hi. She did tell me that she tested for ketones and they came back negative. I noticed this morning that she woke up at 324 BS. So I changed her insulin pen thinking it was going bad already, and I also know she is battling a cold that she got from me. Three hours later, my sitter came to see me. I took off and called the doctor. I was told we weren’t a priority because she didn’t have any ketone, and they would call me back.I waited an hour and was freaking out a lot. So I called a family member whose daughter was diagnosed 10 years ago. She told me to correct and I did. My daughter’s blood sugar finally started to come down. The office called 3 hours later. I was told never to correct except at meal time because she could go to low. The reason I’m confused is because I thought you corrected highs. Starting to think I need to go back to class because obviously I feel as though I’m overreacting. And I know hubby feels that way. Did I miss something? Still very new to this and don’t feel as though I’m being given much support.

Hello, my 6 year old was diagnosed in March. As far as coverage in between meals, I believe it depends on the type of insulin she is prescribed. They should tell you how many hours to wait before correcting to avoid “stacking” insulin. For instance the insulin we use, the doctor told us to wait at least 3 hours after the last insulin given to correct if she is still high. I can’t tell you exactly how long in between for you because that has to come from your doctor. There is a lot to learn at first so it’s no surprise if you missed something. I know I did. But the doctor should be able to answer that.

Hi Katie. Don’t worry! You will get the hang of this! :blush: If she is high, you need to correct. Her blood sugar won’t come down on its own. Her long acting insulin is what takes care of her blood sugar not counting her food. Her fast acting Is what takes care of her food. If she is high you will need to know how many units of insulin will bring her down by how many points. Your doctor should give you that information. Once you know that, things will become more manageable.


So you can correct without a meal? I thought you only give insulin with meals.

@kpowe24 @Bookiesm0m

If your children are using fast acting insulin and not “mixed” insulin you can do a correction without a meal, if you know how much “insulin on board” The reason the pediatrician are conservative is because insulin Is dangerous.

Example I eat take out Chinese food and bolus for it but check my blood sugar at 2 hours after a meal and I’m high. I may not do a correction because my fast acting takes 4 hours and I still have half my meal bolus on board. Injecting again is called stacking and it can get you into trouble/ low if you are not aware. Talk strategy with her endocrinologist. Good luck

Hi Katie @kpowe24, you are doing SO much right and learning. Do you need to go ‘back to school’? - probably no but TypeOne diabetes is a continue learning experience - living with diabetes into my 62nd year has been constantly a learning experience; your daughter will in time be her own principal physician - you are now filling that role. Unless the professional doctor your daughter has TypeOne diabetes her/himself, within a year or two you will know more about balancing activity, food and insulin than many of the professionals.

From my experience living with diabetes - I am not a medical doctor - I’ll offer some suggestions and guidance on your “today” concerns:

  • A correction bolus: yes, if you know what you are doing a correction can be administered at other than with a meal. But be careful about “stacking” insulin - I very rarely administer a correction within four [4] hours of a previous bolus. To do this SAFELY, you must know three factors; insulin sensitivity for that time of day, target range and current BG. The simple arithmetic is (BG - Target) / Sensitivity. Message or email me if you want some detailed assistance.
  • Any sickness, including a cold, or stress can cause significant increase in BG readings. I suggest that you speak with your daughter’s medical care team about “Sick Day Rules”; I have been really surprised how much additional insulin is needed.
  • Your daughter could have sustained BG readings [a couple of days] around 500 mg/dl and not have ketones - this does not mean she is not in duress. I was hospitalized with a hidden infection and BG above 500 and never tested positive for ketones - but I WAS sick.

My best wishes for you, your daughter and your hubby; don’t hesitate to post questions here or message me with concerns.

Thank you Dennis! She does have a cold. So I will call again tomorrow to ask if I need to add insulin. Yesterday the nurse practitioner said if she was consistently up then add 1 unit to her basaglar. I didn’t tonight because she was at 110 after school. But now before bed she is at 423. So thank you for the advice!

You are very welcome Katie.
I don’t know the insulin regimen - types of insulin and timing so I’ll not be able to recommend any questions that you could ask the NP or doctor.
But, I will say the advice given you by the NP sounds correct. Based on what you wrote, going from 110 to 423 suggests that her dinner insulin was not sufficient - either that or a mis-questimate of the carb count. Even when her before meal BG is 110, [unless you suspect that her BG id falling very fast] she will still need insulin ‘to cover’ what she eats.
A thought, I know children and adults both do not always clean the plate, so it might be wise, especially when her BG is near that 110 to delay her meal insulin until she finishes eating - that way you have the option to either deduct or add to her dose. Insulin calculations, carb counting, insulin sensitivities are not carved in stone, but rather a moving target. For me, I can eat exactly the same breakfast day after day and take insulin at the same dosage and even though I’m at 106 before every meal, three hours later my BG could be anywhere between 70 and 250; it may have been my sleep pattern, but more accurately it was the “Diabetes Mystery” fairy.

Hi Katie,
We are always learning when it comes to type 1. My daughter was diagnosed at 10 and we will celebrate 10 years in October. I don’t know what kind of support doctor wise. I hardly talk to her doctor, we usually dealt with the diabetes educator. She laterally saved my sanity millions of times!! She is the one that taught us just about everything.
I don’t know if you have access to one or not, but I highly recommend you look into it.

Give yourself a break, there is a lot to learn you are doing a great job!!

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If you’re doctor takes 3 hours to call you back, I’d change doctors. You absolutely can and should bolus outside of meals. Pump technologies make appropriate bolusing much easier to calculate, but I have an iphone app called RapidCalc which I use when our pump is not working. I’d also recommend reading one of Steven Ponder’s books on Sugar Surfing.

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You have to manage it yourself!, its really what you have to do it there is any way you can afford a cgm blood checker it is on her 24hours a day but it checks her sugar every 5 minutes and it tells you if your going up ,down or level , it is very important! I’ve have had diabetes for 40 years without one side effect ! Listen to me not a nurse that don’t know shit

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You will get the hang of this! IN the beginning we only corrected at melas and at bedtime, and I always checked on my daughter at 2:00am if I did a bedtime correction. I read the book, Think Like a Pancreas and realized, I can do this! It becomes more of an art than a hard and fast formula. My daughter is now on a pump which is a new learning curve but much much easier than initial shots and carb counting. The book is super super helpful!

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Katie, have to say I agree with Dennis, and every one else. I have been a type 1 for 64+ years and during this time, the rules for insulin correction have gone back an forth, but I always correct a High, because any kind of illness will affect a blood sugar, Had a kidney stone and my BS was at 780 but I couldn’t get my BS to drop no matter how much Insulin I took, had to get the infection stopped and stone removed then my BS went back to normal. The longer you wait to correct the more dangerous it can become. Some of us pay no attention to Ketones, never had to… Just my opinion, but if I were you I may find another doctor, High BS are dangerous especially that high. If you had gone to the ER they would not have hesitated… Hope all this info helps. Bye jan

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Thank you all for your information! We are one week into school and still battling highs , sometimes up to 500, and lows, sometimes down to 80. We have called the doctors office several times and always the same response. If your daughter doesn’t have moderate to large ketones there is nothing we can do, just push fluids. Thankfully, I have a great nurse at school. She was ever concerned and tried calling the doctor yesterday morning, and never got a call back. We are trying to figure out what is going on, and eliminating one thing at a time. We just started with oatmeal and gave her an extra unit of insulin to see if it has any effect. We go to see a new Endo on September 4th and are looking forward to it. I just wanted to say thank you for your support and letting me know that I am not crazy.

Hi Katie, it all can be very confusing… even years later. Just remember you are doing the best you can do for your child. School is tough (highs and lows) then it seems after school numbers seems to level out. Then the next day it starts all over again. What I have learned in the past 3 years that my child has been diagnosed is: every day if different and you will learn something new- so take a breath and don’t be so hard on yourself. 2. Ketones (as Denise had said) does not mean that your child is not sick. A simple cold/ flu means your child NEEDS EXTRA insulin to fight off of the virus or bacteria. Go with your gut feeling, nobody knows your daughter better than you do. 3. Having a good support team from your Endo/ CDE is honestly important. If the office your working with now says it’s not “urgent” knowing that “high” numbers can turn into Ketones, I would find another team. Your Endo/CDE should be people you can turn to. It sounds like you are already doing a great job, and you know deep down what your child needs. Best wishes.

You should correct a high blood sugar value as soon as possible.

To calculate a correction bolus dosage, use this formula…

Bolus Units = (High Blood Glucose - 100)/(Insulin Sensitivity Factor)

Your doctor should have told you your daughter’s insulin sensitivity factor.

Things can get tricky when you are sick. I usually have to take lots of extra correction boluses (every few hours) when I am sick. Be sure your daughter gets a flu shot every year.

I would not call 80 mg/dL low. Is your daughter having symptoms of hypoglycemia at this level? (Sweating, slurred speech, shaking, loss of balance, acting silly)

Teach your daughter to recognize the symptoms of a low, and make sure she has some glucose tablets, or other carb snacks with her at all times. Saltine crackers have a very high glycemic index and work almost as well as glucose tabs for getting your blood sugar back up to normal quickly.