Help with lows

Need a few suggestions of what I should do for my daughter . Here are her numbers
Wednesday:Breakfast : 122 ( gave 1.5 Humalog)
Lunch: 250 ( 1.5 humalog)
Dinner : 78

Thursday: breakfast : 144 (1.5 humalog)
Lunch: 250 (1.5 humalog)
Dinner:62 ( no insulin)

Friday: breakfast : 162 no humalog I thought it may help the low but it didnt
Lunch 317 ( 1.5 humalog)
Dinner: 44, 97 67 no insulin
Shes on 4 units of tresiba . She just switched but this low night numbers were happening on lantus as well so I know that’s not why. I dont understand the low at all!!!

Hi, @stixxs512, and I’m so sorry you’re having to deal with this. Can you tell us a little more about what’s going on? What had your daughter’s routine looked like before, and what’s changed now? What has the doctor or nurse educator said? (If you haven’t asked one of them yet, then by all means do that now. I’m not a medical professional — I’m just a mom to a daughter with T1D — so while I’m happy to tell you about our experiences, I can’t give medical advice.)

Hang in there!

Shes been virtual learning since march and after lunch is when she goes low. It doesnt happen on days that she doesnt have virtual . She has PE some days and I notice she goes low on those days or when she has PE assignments and no class. Her doctor just always tries to adjust insulin that’s as deep as it goes. Can a PE class make her go low and stay low for hours ??? It didnt happen that way when she was in person learning

A few initial thoughts - I’m not a medical professional and you will want to discuss with your medical team what’s going on but:
She might need a little more Humalog with breakfast, and less with lunch. - it’s not unusual to need different rates for meals at different times of day. I’ve found that a small change can make a big difference. You and your daughter will come to a point where you can make adjustments on your own, but until then check with doctor regarding how much to change. You will need to wait a few days to see how the change “settles in” unless hey numbers are unsafe.
A snack between meals can help with the lows.
Exercise can have an effect on glucose even hours later, and it might depend on the type of. There is some trial and error involved in figuring out how to adjust insulin and food around exercise.
You might talk your nutritionist if you haven’t before or get some updates based on what’s happening now. They can recommend snacks and meals that can tide her over when she exercises.
Our body’s needs change over time and with circumstances. It doesn’t mean anyone is doing anything wrong - just that things are different and need to be handled a different way.

@stixxs512 , I feel for what both you and your daughter are experiencing with her diabetes. Knowing that she has been living with diabetes for close to 2 years, my first thought is that it is apparent that her body, and its insulin needs, has changed significantly and a physician’s testing and adjustment is now imperative. @srozelle , who is an observant and “diabetes aware” mother offered advice that I would also suggest; Dori offered some good practical thought too. A major fact you’ve omitted, is what your daughter actually is eating - how many carbohydrates she consumes at different meals.

From what you have posted, it appears that her physician has begun her on a MDI [Multiple Daily Injection] insulin regimen consisting of a Background [or basal] Insulin [Lantus and now Tresiba] which is designed, or intended, to maintain as close to possible a level body glucose level around the clock. In addition to the background insulin, Mealtime Bolus Insulin [her RAPID-acting Humalog] is used to counteract the normal and expected body glucose rise caused by carbohydrate eaten. The fact that she has been prescribed 1.5 units of Bolus Insulin for every meal would indicate that ALL her meals have exactly the same number of carbohydrates AND that her insulin sensitivity doesn’t change over the time of day - both conditions extremely rare with TypeOne Diabetes.

The above paragraph is just a quick summary of the theory behind MDI, a concept in which I was involved in development in the 1970s. Also, keep in mind that insulin needs for our bodies will change over time - sometimes rapidly. Personally, my total daily insulin need [basal + bolus] has decreased about 25% since August, even though right now I’m actually eating more - consuming additional carbohydrates.

Shes had diabetes almost 6 years. I make majority of everything and replace flour with either coconut or almond flour. Whether it be fried chicken, pancakes, bread etc… she also eats a lower carb of noodles. We have never eaten pork or beef before diagnosis so meats we eat are fish , chicken, and Turkey. Mainly dairy free due to sensitivity of the stomach. Shes not on 1.5 all the time she ranges between .5-2 per meal and goes higher for humalog mainly when we eat out which barely happens due to covid.

What Dorie and Dennis said. :slightly_smiling_face:

Share your log with your endo or nurse educator, and ask about more insulin with breakfast and less with lunch. Can you tell us more about how you know how much to give with each meal?

As for exercise, we had our daughter check her sugar before PE (or other exercise), and have a snack if it was below, say, 150 (you’ll learn what number is right for your daughter with trial and error — it might be higher or lower than this). And then check again after, and have another snack if needed. Exercise drops our daughter’s sugar fast, and yes, absolutely keeps her lower for hours afterward.

Depending on when PE happens, she could also bolus less (if at all) at lunch. Again, it’s trial and error, but less insulin can help keep her numbers up with exercise, too, either instead of or in addition to having a snack.

Right now every 20 carbs is 1 unit of humalog sometimes its every 30 carbs being that she still produces insulin.sometimes endo says 1 unit if over 200. And 1 unit if over 200 , 2 if over 300 etc. To correct the high
I do notice with PE she goes low and stays low. All of these changes have started since covid being that shes in virtual. During in person classes she was pretty much regulated after her 1st morning dosage and rarely every dropped low. PE drops her so quickly its scary, I’m going to start back up giving her juice boxes to prevent her lows before PE after she checks her sugar. I already can tell from her trend she needs more for breakfast now

Agreed it sounds like she needs more at breakfast. The endo can guide you on how much to change her morning ratio — a small change, maybe 1:18 instead of 1:20, for example, and give it a few days before changing anything else to see how it goes.

I wish we could blame virtual school, but unfortunately, that’s probably just a coincidence. Like Dorie and Dennis said, her needs are going to change over time, and it’s going to be extra-super-bonus frustrating as long as she’s still sometimes unpredictably making her own insulin.

But, yeah, get her in the habit of checking before and after exercise, and having those carbs handy so she can catch herself before she drops too low.

And maybe consider less insulin on PE days, depending on timing. Now that our daughter’s on a pump, we actually turn her basal off while she’s exercising, she doesn’t bolus at all for the food she eats during the exertion, and she keeps her basal lower for hours after, too.

When she was on shots, obviously we couldn’t turn her basal off, but she would take a little less of her long-acting insulin on days we knew she would be more active, and that worked pretty well.

She also used to bolus for half of what she ate during exercise. That worked well for years, but then it stopped working and we had to adjust to where she now doesn’t bolus at all during exercise.

It’s just life: always changing. Keeping us humble. :slightly_smiling_face:

I too am NOT a medical professional and agree with everything everyone has mentioned. I’ll just share my experiences around highs. We got to a point where my son was hitting 200 with every meal. What helped us tremendously is pre-bolusing or injecting insulin before a meal and waiting for it to start or just about start working. For us this is about 30 minutes, but you would have to take baby steps before making such a big leap. If your endo said wait 10-15 minutes and you are waiting the full 15 try 20 then maybe 25, etc. If you take too big of a jump, you’ll be treating a low.

If you’re eating too early after injection, BG will rise before insulin is battling it so you’ll get that high spike. Later, when the food stops working, your insulin is still pulling you down, causing that low after lunch.

It’s all about timing and trying to get the action profiles of your food and insulin to match up. The thing that makes things difficult is that the wait all depends on what types of food you are eating. If a lot of fast acting stuff, you’ll wait longer then you would if you were eating a high fat/protein meal. This too, is all trial and error.

If you have a continuous glucose monitor (we use Dexcom), its a good tool for letting you know when the insulin starts working. We use the 3 hour graph and when the dots on the right of the graph start to dip, its time to start eating.

Again this has helped us tremendously with spikes, but its a little scary and I don’t think I would have done anything like it without a CGM.

Also, as all others have said, consult your endo before trying something like this.

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Keep a food diary with pre- and post-meal blood sugars and dosages. Go over it with your diabetes educator and/or doc so that you can estimate the right amount of insulin for carbs.

Call your Endocrinologist and have them play with her numbers. It sounds like she may still be in the “honeymoon phase” so that it is tougher too. You never know when her body is going to create insulin, so it’s tougher. You might try a pump and with the Dexcom G6 it should stop insulin delivery when she starts to drop and deliver insulin when she is high, then the G6 will alert you via your phone so it will wake you up if you are sleeping. Also with the pump there is no Lantus, you Bolus all day. T1D is so tough/tricky because you can do the same thing every day and get a different outcome every time. Good luck!!! But start with your Endo. I have always been able to just call and give them the numbers and they will make adjustments. Sometimes the smallest adjustment can have a huge impact.

I also suspect that the reason she gets different results when on virtual learning than when she went to school for the day is that she has less activity now. That would make the effect of exercise look more than it used to.