Lows ALL day (3+ hours after every meal). HELP

My son has been sick with mono and since his #s have been off. I thought we had them (better) under control and then he also got the flu. Since, his #'s have been high (250 2 hours post meal) and then drop/plumets down to 70/80's within 3-4 hours after the meal. We are correcting with anywhere from 25-40 carbs to keep him around 100. Do we have too much Lantus?? HELP!

Being sick can really mess with things. For most people, being sick brings higher blood sugars and insulin resistance. But for kids it may be even more complicated. If your son is normally running around, but is now sitting on the couch playing video games, that may also mess with his insulin absorption. Being high after meals suggests either more insulin resistance or slower absorption. You might try advancing his meal boluses and see what happens. As to the Lantus, the best way to see if there is an issue with Lantus is to see whether he consistenly drops during fasting between meals.

ps. If you mistime your bolus, you can go high (> 180 mg/dl), dump blood sugar into your urine and then go low as your bolus becomes active and misses the glucose load. Think about bolusing an hour after your meal.

When he has been sick before we usually battle high BS #'s. I don't know what is going on. Also, he isn't on a pump. :( I'm afraid to increase the pre-meal insulin as he drops so much after ... but then my thinking is it's too much Lantus. We did try decreasing the Lantus for a few nights and then he wakes up at 200+. This is crazy!

** Also, what would be the cause for insulin resistance ... being sick? Does the insulin just "kick in" all at once? And, what would be the cause for slower absorption? We have an appt. with his endo. on Monday (she has been on vacation) and am going crazy with this. I'm afraid he's going to pass out with this crazy lows.

Are you pumping? Either way, maybe try to pre-bolus a little more. If he's going to eat at one, take the bolus at 12:30 or 12:40. That way the insulin spike is meeting the food spike.

Also, tbh I aim for 70/80's 4 hours after a meal :D Though the 250 isn't all that fun.

Often humans respond to being sick with increased liver production of glucose. For most adults, this raises our fasting blood sugar and raises our basal insulin needs. And being sick also is about inflammation. Our bodies naturally respond to inflammation with increased insulin resistance. As to why, that is complicated, but many people think it is a result of increased stress hormones (like cortisol) and possibly the effect of macrophages (the bodies cells that fight infection). Although most adults have to markedly increase their basal and bolus, kids are more complicated.

Insulin does not kick in all at once, it is absorbed. For a modern rapid insulin this happens over perhaps 5 hours. And absorption is increased with activity due to improved blood flow and increased metabolism.

Since you found that decreased Lantus caused morning highs, then to a first degree you know that (at least overnight) your Lantus is at a reasonable level. Since you are really concerned, perhaps you should both advance the meal boluses and increase the ICR. If your son is using an ICR of of 20 grams/unit, then increase that to 25 or 30 and see if that reduces the after meal lows.

ps. I am assuming your son is not on medication.
pps. If your son has had digestion problems that can make it more complicated.

Yes, I understand that insulin doesn't kick in all at once (max at 1-2 hours and then some 3-4 hours after injection). I meant if you are insulin resistant what happens to the insulin? Why doesn't it bring down your BS #'s? When I lowered his Lantus & he was at 250 in the morning I gave him 2 units (during the day would only need 1 unit) to bring it down & it did nothing. So, what happens to the insulin? I know it sounds like a silly question but you sound like you really understand all of this. THANKS! :)

No, we aren't pumping (which I think would help with morning #'s). He is only 14 and is to shoot for 120 after meals and coast along at that #. But, like I said he is dropping to 70/80 and a 30-40 carb snack only brings him up to 100. Typically 6 carbs (when he isn't sick) would raise him 30-40. I'm just SO nervous as to why we are having such low #'s. I think I like battling highs better IMHO.

There are a number of mechanisms that can cause insulin resistance (IR). The insulin is still there it just isn't as effective. In most cases, IR happens because of a downregulation of glucose uptake, like a reduction in GLUT4 transporters. But just having a high blood sugar induces IR as your cells resist taking up too much glucose.

And the morning is the worst for me. I suffer from Darn Phenomenon (DP) and often awake high. This is because of a natural process that releases cortisol and other hormones to wake you up. And hence, I am more insulin resistant in the morning as are many others. So when you add up all that, I am not surprised that your son needed a much higher correction in the morning to deal with the 250 mg/dl.

Brian, do you pump or do you use Lantus? My son doesn't want a pump, but I think it would help so much with the highs and lows we have throughtout the day. Thanks again for all your help.

I use Levemir rather than Lantus. A pump can certainly help with things like DP and it makes correcting really easy. But I'm doing fine with MDI and I like not having something sticking on my body just waiting to get ripped out from my clumsy actions.

Mono often hits the liver. So anything the liver normally does such as pouring glucose into the blood stream can be affected. It should straighten out in a few weeks. Not that that's any help to you while you go through this.

Just fyi, it may feel or sound lower because he's not used to it but 70/80 is a pretty perfect blood sugar. You don't really need to correct that number blood sugar.

He has a CGM and a 90 with a down arrow is scary enough - can't wait until it hits 70 or 80 or we won't be able to correct fast enough. Also, he starts feeling funny (shaky) at 80. So, we do need to keep him around 100 just to be safe and so he feels good.

He was diagnosed with mono at Thanksgiving, so we've been dealing with this for 6 weeks now. We seem to have his breakfast and lunch #'s a lot more under control and his dinner #'s are a little better (not much). It's just the over night drops. I heard that mono can last up to 10 weeks! YIKES!

Actually you don't. He is feeling funny at 80 because he is used to being higher. He needs to get used to being at a number like 80 because it's a perfect number. You actually correct (with carbs) at 90? That's totally unnecessary - you don't want to take insulin you don't need or not enable the process of getting used to normal numbers. My guess is it's you that doesn't feel safe at 80. It takes awhile until you get a bit more relaxed. If you use glucose tablets which are the quickest method to raise a low, he should be fine in 15 minutes to 1/2 hour. If you are using food it takes longer.Relax, mom, you and Kyle are doing great!

We didn't correct at 90 before he was sick because he didn't plumet. We have been correcting since he's had mono because we have been giving so much more insulin at meals (we think the mono has made him a bit insulin resistant - and the fact that he is so tired and not moving around as much). We see the endo. tomorrow morning (finally) & hope she can offer some good advice.

Oh, I see; I didn't realize this is an attempt to deal with the unusual situation. What is he starting at before the meals? If he starts at 90 and ends up back at 90 3-4 hours later the insulin is doing its job, just doing it slowly. I agree with the others who said to bolus a bit sooner so the insulin hits quicker to deal with the carbs and then the tail doesn't hang around to lower him too much. If you increase the I:C by a point or so and take it a bit earlier you may catch the spike without going too low later. As an adult I rarely get sick but it does sound like being sick messes with your D management and I think you're doing the best you can to ride it out.

Mono is no fun under ordinary circumstances; I had it when I was 19 and I still remember feeling pretty ok but then as soon as I tried to do anything I was wiped out. Mine lasted most of a summer. But of course I didn't have D to complicate things. Hang in there!

Even with Kyle being sick for over a month his A1c was 6.6. YAY!