WILD numbers

Parents
1

So yesterday my son John had crazy, wild, numbers.  Any thoughts on these - please reply! His target range is 100-200 and we are trying only 1.0 units of Levemir (down from 1.5 units) this week  given 1x daily and his meal ratio is 0.5 unit/20 carbs.

He was OK at breakfast, in the 100s. For whatever reason my husband didn't give him his shot, but when he was tested at daycare at 9:30 he was 326. I had her give him 0.5 unit (which is half of his usual correction bolus). Then when she tested at 11 prior to lunch he was 32. I totally freaked when she emailed me (which she does everyday). When we talked, she said she he was just playing with the other little boy - not complaining of being hungry, not pale, not shaky, not anything. Just playing cars until she said it was time for his lunch check! I'm like he could have been passed out! She is diabetic (T2) so she knows that is not good and was really unnerved by it too.

He ate a normal lunch and had her give NO insulin. (He did come right back up after eating). Well he was 376 at 3, but I still decided to wait on correcting, just to see what his body was doing. At 5:45 he was 165. Thankfully after that his numbers were better 100 at bedtime, which we usually would give him a snack, but I again decided just to wait and see - and sure enough at 10 when we tested again he was 180, and then back down to 130 this morning.

I know I will have to call the clinic - but ugh. A frustrating day. I feel like we are always going between treating for lows and highs. His doses are so small and it seems like even if I only give 8 carbs for a mild low that he will be high when we check next. At least we are starting on a pump soon and maybe that will give us more control over the tiny doses his body needs!

2

Hi,

You're doing a great job at this "guessing game" we have to play. My little Brandan has days like you described. I know how frustrating it gets when one wrong dose throws off the whole day.

Do you know if it was at least 2 hours after breakfast when he was checked at daycare? If not, that could account for the over-correction.

As for the 376 at 3:00; that was probably the rebound effect, every low results in a high later. When Brandan goes low I give him a pack of fruit chews (gummies) to bring him back up. Then if he eats a meal or snack I will cover it. This usually lowers the rebound high or prevents it. (If he eats enough to be covered.)

Brandan also goes from high to in range in a short time period. Sometimes it's because he's so active. Also, his Levemir works harder in the afternoon for some reason. His ins./carb ratio goes from 1:20 in the morning to 1:45 in the afternoon to 1:30 in the evening.

We are also looking forward to the small doses a pump allows. These little guys are SO sensitive to insulin.

3

A problem that we had at school was my son was not cleaning his finger or hands well before testing.  We got a few false high that we corrected for and then he dropped way low. 

We have crazy days like that with clean hands too.  Just when get confident in our treatment plan, the diabetes seems to remind us that it is unpredicable and ever changing.

Good Luck and I hope tomorrow is a better day.