Hi all. I seem to be having trouble lately with my daughters afternoon numbers. She currently takes Lispro/N at breakfast but lately we’ve been struggling to figure doses out (again). She was too often high at supper so I increased her N from 8.5 to 9u. But then she was too low at lunch the next two days so I lowered the Lispro from 1 to 1.5u. Today and yesterday she was good at lunch, but then when I check her before snack she is high. We opt for a carb free snack and by supper she is back in range. I am looking for suggestions to fix this after lunch high that seems to have graced us with it’s presence. We had her on a cgm for a week a month ago and she never had this spike once (of course).
I realize part of the issue is the variability of when N peaks, but it seems that the more I up the N the more lows she has a lunch… Catch 22. I cant seem to get the insulin and carbs to peak together. Also, I “can’t” switch to lantus/Lispro b/c she is 3 and her dad and I both work. She goes to a day home and preschool and I have to make this work to avoid lunch time insulin, at least until she can do her own or go on a pump. Today she was 7.0mmol before lunch and 2.5 hrs later she was 20.1mmol. HELP please!!
I'm not sure of what insulin your daughter is on (Lispro/N) but there are new, better insulins; lantus - levemir for basal, aprida, novolog, humalog for fasting acting basals, also the insulin pump, which many young, young children use.
These problems are pretty well-known with the older insulins. You say you can't switch to MDI. What about having someone to bolus for her at lunch? You will, unfortunately continue to have these problems; that's why most people are on the newer insulins.
Oh, I didn't realize "lispro" was Humalog, a bolus insulin. If you are using bolus for mealtimes, you need to use it for all meals. And you need to figure out I:C ratios, so that you are dosing for the food she eats, not just taking a set dose no matter what she eats. I really don't understand how you are combining NPH and Humalog. You are using her NPH (basal) to cover her lunch? That's going to work poorly at best. I feel like I'm sounding negative, but if you use more up to date tools in a correct MDI regimen (one or two doses of long-acting basal and an injection of Humalog before each meal based on the I:C ratio you determine) it will be sooo much easier! What you'll lose in logistics (having to either find someone to bolus for her lunch or get there yourself) you'll gain in stability of her blood sugars, which I know will reduce anxiety!
We use humalog to cover breakfast and supper. We use humulin N to cover lunch. We also were using lantus as her background but with only 1/2u she was going low during the night so our endo said to stop for now (?still honeymooning) and revisit it later. Being on all 3 insulins is a new hybrid system being used for peds cases to avoid lunch insulin. It has been working pretty well for the last 6 months, with really not much of a peak after lunch. We know her ratios. It is about 1/2u for 30 CHO, but at breakfast its 1-1.5u for the same 30 CHO. Our day home provider will not bolus for lunch nor will the preschool. There is no way that we can get there to do it for her. I fully understand switching to purely lantus/humalog, but this is a much better way for us for the time being if I can get it to work again. It’s not something I plan on doing forever, I am definitely pushing for a pump.
I apologize, Jen, I was completely in the dark about the hybrid system for children and just assumed it was outdated insulins which are, unfortunately all too common. I learned something! Not that that helps you any! Have you tried posting to the parents groups so other parents using the same regimen can share their input? I'm a big believer in learning from peers when it comes to D!
No worries Zoe! I have been an RN (on an adult unit)for 12yrs before my daughter was dx and I have never heard of someone being on 3 different insulins! But I have learned more than I ever cared to know about diabetes in past 6 months. I totally agree about old insulins and truth be told I hate using Humulin N and would love to switch to MDI at meals(or better yet a pump) 6 months in and it’s still overwhelming for our day home. I am so thankful she has taken on carb counting and checking sugars but don’t want to push too hard and lose her.
Yes Katie, we use pens. It’s like this: Humalog and humulin N injected pre breakfast. (humalog to cover breakfast, N to cover lunch). Then no insulin again until pre supper when we inject humalog again. Then at bedtime she takes lantus for her 24hr background. Its a fairly new idea but gaining popularity. By doing this you are able to avoid noon insulin in young school aged children who are unable to dose themselves. Obviously it’s not a perfect system, which is why some endos are hesitant to stand behind it. My opinion is it’s kinda a short term solution to problems with caregivers etc not willing to give insulin when parents work and cannot get to the child at lunch to give it either. I am sure this system evolved out of necessity.
