# Is it the injection or the food?

How to begin… we recently (yesterday) had an appointment with my child’s endo. She has shown some new signs that I do not understand, im not sure if this will make sense… so I will explain as best as I can. Maybe some can shed some light, or have experienced this yourself. She does not insulin if its over 3units. So lets she gets her plate her food and I measure it out (including her BG correction) and I say ok…this is 5 units. She will then say “im not that hungry” and then take some porptioned of food off her plate and until basically we are down to about 3 units or so. Does this make sense? So basically, all of her insulin measurements are under 3- 3.5 units. I know she is getting healthy food. But then when we weighed her she isnt gaining any wieght either. Perhaps this is her way of feeling like she is in control, which I do understand. Not having control of your must be a horrible feeling. I asked her does more insulin hurt? She said no, I dont really understand. Her endo did speak with her in trying to make her open-up but, and we had a long conversation. Her doc and i feel as rigjt now possibly time can resolve this. However, if this do not change another plan of action will need to be taken.

Hi S,

I think I understand what you are asking, and I can relate to your concerns because I’ve been through similar situations. I’ll assume that your daughter is a growing girl and that she, you and her doctors agree that additional weight is desirable.

Put on her plate what is healthy food [plus an occasional “extravagant”] in the quantities she will eat and what you think is sufficient. Count the carbs and divide that by the rate for that time of day and take that amount of insulin. Carb/insulin ratios DO vary for most people over the period of a day. For example my standard breakfast is 51 gm of Carb and my carb/insulin need is 11 so [ 51 / 11 = 4.63 ] I take 4.6 units of insulin; if my BG is above 130 mg/dl I will add to the 4.6 a correction amount of insulin at a ratio of 1:60. I hope this isn’t too confusing. Fifty to sixty years ago, before MDI and BG testing, I would one 18 unit shot of NPH every morning and made my meal plan for the entire day fit that - UGGgggg!

I don’t think that more insulin would hurt her as long as the food she needs and eats needs the additional insulin - yes, watch out for hypos if she takes more insulin. Some people do blame their additional weight on “… well my endo put the wrong ratios in my pump”. Just be reasonable, be your own best doctor and know how and when to make adjustments.

You are learning and there is much coming to you now that will be difficult to understand - you are doing the right thing and asking questions. For your daughter insulin is a tool, a very valuable tool; the body needs insulin to use food, fuel our muscles, allow us to function and to think. Your daughter’s body because of an autoimmune “malfunction” no longer produces [sufficient] insulin to help her utilize the food she eats so she must take those injections. Her sensitivity to insulin [how much a unit of insulin will lower BG] will change and fluctuate over time and the sensitivities vary from person to person - and a higher or lower insulin sensitivity doesn’t make one person a better “good” than the other.

Keep up your great work, she and you will do well. Stay in touch,

Dennis

Dear Shariza, Every diabetic does not equal same experiences. I hope others can comment on this as well with their own stories. I will tell you my thoughts based on my experiences with this same thing.
So, lets say my blood sugar reading is 200. I would normally correct this with only 3 units of fast acting insulin and wait. The wait to bring it down takes my body about 40 minutes or so (remember everyone is different and others may take shorter or longer depending on many factors). Anywho, during that time, I refuse to eat. The reason being is very similar to what your child may be experiencing. Think about it this way: If I was going to eat, I would take those 3 extra units on top of carb counting to what I am going to eat, lets say 30grams of carbs is 3 units. Now we are up to 6 units. So if I was going to eat, I would take 6 units of insulin, eat, feel wuzzy, tired, sort-of-high, non-productive… What your child may be trying to tell you is that -do not do corrections with high carb food, try correcting first, wait 1-2 hours then check blood sugar, then eat.- If hungry, I would eat meatballs (meat=no carb) or sugar free jello or water, lots of water. I would wait to eat until the sugar is out of the system and the blood sugar stabilized so I may take another shot.
This would guarantee I do not feel wuzzy, dizzy, tired, lazy, or anything of the likes.
I hope this makes sense, and I hope this helps understand what may be going on. Let me know if you have any more questions.

Sorry, I forgot to add… The main reason may be too much overload of insulin and/or carb which equals out to the weird wuzzy, kind-of-drunk-or-high-like feeling… when I do that, I most definitely feel my heart beating too hard, I need to lay down. SO it is a very rare occurrence that I do both food and correction at the same time.

hmmm, about how old of a child are we talking about? some young children go through about a year of less physical development ad more brain development and during that time they may not be “big eaters”. what does the pediatrician say about nutrition/appetite this year?

higher blood sugar can trigger an “im full” feeling and low blood sugar can trigger a “I’m starving” feeling. do you think she eats lighter when she’s a little high?

it can be okay to bolus after a meal, for very young children it’s not that big of a deal to just to the math and then a final shot based on the meal. check with the endo.

it’s possible she’s connecting the shot to the plate - and thinking diabetes is “less” when she’s eating less… no matter what your child is saying she likely hates the shots and will go far to avoid one, make one less, etc. just a guess.

if her numbers are good I’d say you are going to be okay. hope you are both getting the support you need. take care, and please let us know what happened.

What’s next? give her a warm hug!

You are certainly trying and she is frightened; I know that I was frightened and I was older - yeah, on my 16th birthday. There are many things that she doesn’t yet understand that will come with time. I hope her Endo emphasized for her that more insulin doesn’t mean she is “bad” and that even if she never eats a thing she will still need insulin. As time goes on, her insulin needs will most likely change [does she take a background insulin such as Lantus?] such as different insulin to carb ratios for different periods of the day, and being a female I understand she will face BG fluctuations during menstruation.

Why she jumped to 500 from one cookie I don’t understand unless her body is very tiny. Was there some nice sugary stuff on her finger when she tested??? [My daughter when with EMS has had to treat people for severe hypoglycemia who took correction insulin after testing with unclean fingers.] Were you able to get her readings back down?

She takes Lantus at bedtime and Humalog throughout the day. But we only try to correct for breakfast, lunch, dinner. And then snacks. However even snacks she wants free- carbs. It took about 18 hours to get her BG under 200, including a 2 am insulin injection. We checked for ketones as well. And pushed fluids! She weighs 64 pounds and is 9 (soon will be 10). When i seen her number, I couldn’t believe it I had her wash her hands and tried the other hand, sure enough it was right. Maybe time will resolve this, I was thinking maybe bringing up the CGM to her again would help her understand that no matter what her BG fluctuates with or without food? The pump still has been a topic she will not tolerate… her Endo also said it may even help her get passed the 3 unit “phase” but not to push her. That is why we must be patient…

Shariza,

First off, I am sorry for her diagnosis. I was diagnosed a year ago on the 30th and lets just say it was a whirlwind, somehow I think I was blessed because I was diagnosed at 17 and I have an amazing endo. I understand wanting to be in control because lets face it, diabetes will always have some control, but the highs happen and so do the lows and its part of our life. Have you ever had her try talking to someone closer in age about diabetes? Even a teenager? When I meet other diabetics it makes me open up, because they’re the only ones who understand. The only other person I actually open up to completely about how I am feeling with my disease is my bestfriend, I have known her for 5 years and she was and is with me every step of the way, I mean shes even coming with me to my endo appointment because my family can’t. Sometimes talking to your parents about diabetes isn’t easy and you dont think they will ever understand what you’re going through. My eating habits change weekly, sometimes I am not hungry so I wont eat except once a day or so and other times its every meal on time. Sadly, shes fighting this disease and I’m not sure how long this phase will last. I think talking to another diabetic closer in age might help her open up.

I hope this helps.

Shariza,
To me it sounds like you are doing everything right and you took a safe, cautious route to bring her down, back where you want her to be. To me, and I am not a medical professional, it sounds as if something else besides the cookie may have come into play to cause the 500. A mild infection or touch of the flu?

Kassidy, @calibound97, has a very good idea about your daughter talking with someone her own age who has diabetes - it may help her get a better picture of where she is. My endo asks me to share my experience with other od her patients - and we learn together.

I think you’re on the right track with your daughter. Be patient, reinforce that more insulin or high blood sugars don’t mean she did something wrong or bad, encourage her to keep doing (or eating in this case) the things she loves. When you’re talking to her, also encourage a healthy body image. I would hope your daughter’s still too young to be thinking this way, but I’ve heard of diabetics refusing insulin because high blood sugars = weight loss. When I was in middle school I got upset with a PE teacher for bringing up the obesity/diabetes connection in class. He didn’t explain that there are 2 types and was making it seem to my classmates - who all knew I was diabetic - that I had done something to deserve the disease. Not that it would’ve been ok if I really did have type 2; he shouldn’t’ve been body-shaming his students. Anyway, it’s possible she’s seen tv commercials or heard something at school to make her think she’s done something wrong. From what you’ve said, this does sound more like she’s trying to control the disease, and hopefully with support she’ll learn that it’s ok to lose control once in a while.

I also think calibound97’s idea is a good one. I’d suggest either letting her post to this site with you - I’ve seen 10-year-olds post from their parents’ profiles before - or help her to send an e-mail to JDRF’s online diabetes support team (http://t1n-migration.10uplabs.com/resources/online-diabetes-support-team/ Maybe ask for advice specifically from a younger Cyber Volunteer or for help connecting with other kids her age).

I actually do the exact opposite of what your daughter does. I don’t like to correct for a high blood sugar if the correction’s less than 3 units. 1-3 units are not worth taking an extra injection for. So I’ll often eat when my blood sugar’s high, even if I’m not hungry, just to make it “worthwhile” to take the injection. I also don’t like taking injections larger than 14 units in my stomach. It weirds me out. The number’s totally arbitrary. I don’t know how I arrived at it; it just makes me feel better. Anything more than 14 units goes in my arm or my butt.

RE the weird 500… She got her lantus the night before, right? There’ve been times I forgot and wound up with high blood sugars that wouldn’t come down. It makes sense, though, that it took so long to bring it back down if she’s only letting you give her 3 units at a time. With my ratios and target I would need to take 11 units to bring down a blood sugar that high.