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Tuesday, November 30, 2010

Sending out the bat signal to the DOC

I need help. And while that's true on so many levels, right now I'm referring to help on the diabetes front. For the last week, Elise has been CRASHING after dinner, only to soar to record BG highs three hours later. I'll explain:

For her dinner, she usually gets 2 units of humalog, and 35g of carbs. The carb amount has been slowly creeping up over the last few weeks to 45g (I'd rather give her more carbs than try to measure out 1/2 units). We give her the insulin about 5 minutes before she eats at dinnertime, and her BG going into dinner ranges from 80 - 170.

About 1 hour after dinner, we start to see arrows down on the CGM. Sometimes there's a small spike, but a lot of times (like tonight) she stays even through dinner until she starts to fall. But when she starts, she falls fast. Like 100 points in less than 30 minutes.

A lot of times, we don't catch the crash until she's in the 60s (tonight we caught it at 80). We give her carbs (10-15g), then 3 hours later she's in the low to mid 300s and stays there most of the night. A few nights ago we had to correct her in the middle of the night (we've probably only done that 3 or 4 times since her dx), and last night we gave her the correction up front (because she was in the 300s) with her bedtime dose of NPH. And she STILL only came down to the mid 200s and cruised there throughout the night.

So tonight we lowered her dinnertime insulin to 1.5 and she still crashed. We gave only 7g of banana to bring her up. Right now she's out with Fred visiting a neighbour in the hospital, so I have no clue what her BG is, but she was holding steady at 103 when she left.

So what the what is going on here? The food she's eating isn't out of the ordinary. Tonight it was tortellini soup with some bread and yogurt for dessert. Last night it was sandwiches, grapes, yogurt for dessert and chocolate milk. It's almost like there's a delay in her food absorbing.

Everything else is normal as can be. I am just scratching my head over this one and would love any insight that anyone has to offer.

Edited to add: thanks everyone for the comments. If it were a food absorption issue, wouldn't it happen at every meal? Why just dinner? The food she's eating is the same as she always eats. And we haven't contacted our endo or CDE because; A) today is not the day to fax in logs, B) they won't talk to you without looking at your log, C) the CDEs are useless and I haven't talked to one in over a year and a half and, D) you have to go through a CDE first to get to the endo. Yeah, the system sucks.

Last night she was in the mid-300s all night and woke up at 242. Gotta figure this out.

14 comments:

  1. Good luck Jo! It does sound like delayed absorption. Can you bolus after her meal?...try to time it with what you have been seeing? Sounds like a good call on the decreased ratio as well.

    I hope things "sugar out" soon dear Jo! Tell the fam "Hi".

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  2. i am not familiar with NPH at all so my advice may not be worth shit. Lol sorry. But I read that normally if bgs go low that soon after eating its usually not the ic/basal for that meal but the one before. Since technically insulin can linger past 3 hours. Like I said not sure if this helps dealing with NPH but I hope u figure it out and can get some rest. Also is it only pasta meals like tortellini? If so could be as Reyna said delayed absorption...good luck girl!

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  3. Alexis - Elise gets a combo shot of NPH and Humalog in the morning. Humalog covers her breakfast, and the NPH covers her AM snack, lunch and PM snack. So there's 9 hours between shots and the NPH is gone by dinner time.

    The only time we see this delay is in her PM snack (at 2:00) and dinner. AM snack/lunch/breakfast we see a normal reaction on the CGM.


    Does anyone know why a delayed absorption happens?

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  4. Holy crap, batman!!! We've had similar problems lately. Maybe it's something in the air?!? Two nights in a row we've completely turned off all basal for after dinner hours because Robby keeps tanking (and even then we still have to feed him some juice). He does usually come up around 1am, but only to about 200, but he'll stay there the rest of the night even with corrections.

    I'm curious to learn more about delayed absorption.

    I have no input to offer, but I did think this post was so timely since I almost sent out the same plea for help from the DOC.

    Good luck!

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  5. Have her foods or beverages changed at all??? More fat in the diet? That could delay absorption.

    Reyna might be onto something. Maybe try giving her the Humalog after she eats, instead of before.

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  6. My advice did no good. :( I would do the shot after dinner as well. Since she usually takes awhile to eat (from what I remember)...and then tanks an hour after dinner...that means she is half way into her humalog and tanking would make sense. Grabbing at straws here...

    Could it be that she is coming out of a growth spurt and just needs less insulin right now? What ever it is...I KNOW you will figure it out! And once you do, everything will change. Man, I totally suck at pep talks! Love you!

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  7. That happens to us too...then we treat the low and he sky rockets!
    Probably absorption as said...if she was on a pump, I would say combo bolus but since you don't want to give her more shots than necessary, try the after eating (or midway through)
    Who knows why D does what it does. And once you figure it out, it will change. Ugh, stupid D!

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  8. Not familiar enough with NPH to comment.... we got off NPH right away after one month on it would not bring her down below the mid 200s... ever. Delayed absorption of food, I would consider possible celiac. If celiac, this problem will be ongoing and it takes a while usually to get a positive celiac diagnosis. I would decrease ICR, since she is dropping. The rise in blood sugars where she stays high later on in the evening, more than a few hours, I would attribute to a need for increased basals, but only the evening ones. Not sure how to handle that on MDI, how to handle variable basals. The variable basals our child has, really can best be addressed by a pump. Maybe she is coming down with a stomach virus or something? You would see delayed absorption in that case.

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  9. Scratching my head along with you Joanne. I was only thinking that she is crashing cause she is at he peak of her dose, so if you backed up the dose to either 15-20 minutes before she ate that might cause the peak not to happen then. Again, straws, grasping, sorry.
    I was also thinking growth spurt and hormones in her system cause wonky things to happen.
    Hope you get it figured out. Has your CDE been any help or your endo?

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  10. We have been having this problem for a couple months now. It happens to us after lunch and sometimes after dinner. Since Lovebug is on the pump we have been doing a combo bolus for lunch, but it doesn't always work. Good luck figuring out what it is. ((hugs))

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  11. We had a similar problem not too long ago. Since we are on the pump, we decreased the basal rate a little before and a little after dinner time and that worked like a charm. I wish I had some good NPH info for you Jo! It just seems like if she is not eating any differently than normal it may be that her bodies insulin needs are changing and you will have to just tweak until you figure out what works. Good luck!

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  12. Well....we've had the same issue with Matthew for about 5 months.

    After dinner, he's fine. Sometimes low, but a good number. Then he spikes. Anywhere from 180 to 300.

    It's not the food....we've looked at that. AND he's very consistent. It happens everynight.

    For us....we finally split the Lantus. More is given in the morning and that has helped at night.

    BUT....he still spikes then. Just not as much (usually right at 200) and comes down on his own.

    I think it's a hormone thing with him.

    We're hoping the pump will help. We start that in 2 weeks.

    It's so frustrating when his numbers are good all day and then jump up for no apparent reason. Grrr!!!

    Don't know if this helps, but I hope so. You know you can always e-mail or call me. : )

    I'll pray God gives you wisdom.

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  13. we have a very similar issue with Isaac at dinner, I think its more of an insulin sensitivity during that period of the day and growth hormones. Morning times he's a bit more resistant and I think this is due to his being inactive all night. However, for late afternoon and dinnertime his I:C is double what it is at breakfast and we can't prebolus him at all. We also figured out that between 9-12am he has been having a spike of growth hormones for the past two weeks causing his insulin needs to be huge during that time and we've adjusted it with a higher basal two hours before.
    So, I'm not sure how that translates to MDI, but maybe Wilf on the CWD board forums could help he's pretty stellar with MDI management including fast acting and NPH.

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  14. I just recently found your blog (after searching my Dexcom error code). I am 36yo and been a type I diabetic since I was 12. I've been reading the comments and I split my Lantus because I was having MANY lows at night. So now I take 1/2 at 6AM and 1/2 at 6PM. Great blog! I feel for you all. Dealing with it myself is easier than dealing with your little one.

    Crista

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