My Grandson

My grandson is 10 yr. old he was diagnosed as type1 insulin dependent, brittle diabetic  13 months ago. He has highs of 400-575 in the evenings he takes humalog with 1 unit per 10 carbs,also 17 units of lantus around 9pm. He is often high around that time also. So his father (my son ) gives him the lantus as 1 injection and follows it with the -150 and divide that by 40 equation for his humalog. So if he is 500 then he gets 9 units of humalog after the lantus. Then by 2-3A.M. he has dropped below 60 or sometimes as low as 25. Does this sound normal as to how he is giving his 9pm injections? I think it is incorrect, but he says the endochronoligst at Morgantown is the dr. that told him to do it that way. Any advice-opinion would be helpful.

If something isnt working it should be adjusted.  If he is 500, I would not give the 9 units of humalog all at once, since he is dropping so low.  Maybe split it in half waiting an hour in between.  And test every hour until its normal to make sure it coming down at a nice pace.  But its hard to give advice without all the information.  He shouldnt go to bed that high without testing every hour.

I don't know if it works the same way with children as with adults, but I have found that 1 unit of insulin will lower my blood sugar 15 points. That is called my insulin sensitivity level. If I was 200 and wanted to be 100 then I would need to lower my blood sugar 100 points. I divide 100 by 15 and get approximately 7, so I inject 7 units. Your grandson would have a very different insulin sensitivity level. One unit might lower his blood sugar as much as 50 points. His correct insulin sensitivity could be found by experimenting and changing by small amounts until the appropriate level is found.

I have been type 1 for 65 years and am very healthy. I hope your grandson will have better control soon.

Richard

It is similar for children, and I think it's incredibly important to know a child's insulin sensitivity level. In the beginning you're often given a scale of how many units of insulin to give for a range of blood sugars - and this is a great place to begin - but as soon as you're comfortable with managing on your own, you need to know how each unit of insulin affects his blood sugar.

Here's how we do this. On occasion, my daughter is high in the evenings. Assuming it's been a few hours since dinner, it's a great time to test insulin sensitivity. For example, if she's 250, I might give her one unit of insulin. I'll test her an hour, two hours, and three hours later (I know that in Sarah, insulin lasts about 3.5 hours). So at one hour she might be 190, at two hours 150, and at three hours 125. Her insulin sensitivity level is 125, because that's how much one unit brought her down. Unfortunately, it can be slightly different at different times of the day, but it's a place to start. As Richard pointed out, each person has varying needs. I know some kids who are smaller than my daughter who need three or four times as much insulin as she takes in a 24 hour period. So really, it's about learning, paying close attention to how foods and insulin affect blood sugar, and then learning to act on those facts. I feel like I've turned into a diabetes analyst, or detective, in the last year, but by being very proactive I've kept my daughter's blood sugars in a pretty good range (most of the time).

And I should point out that in the beginning you should check with your grandson's endocrynologist before making any major changes. I still do this sometimes. I will call and provide a log of her blood sugar, food, activity for a 2-3 day period and explain what I think is going on and what I want to do about it. Usually they agree with me, but sometimes they have a different take and I usually try their suggestion first if it makes sense. The thing about diabetes, especially in kids, is that it changes frequently. I probably change my daughter's ratios at least 2-3 times a month, sometimes increasing and sometimes decreasing.

Michelle

Adjusting insulin means trying to get the timing and dose accurate for the individual's needs.  It can be a challenge with shots because they require both short (Humalog) and long acting (Lantus) insulin.  And because each day is different in food eaten, activity level, stress level, etc. the amount of insulin needed can vary.

The information your son has about insulin dosing is basically correct, but probably needs to be fine tuned.  Your grandson's doctor can help him do this.  To help you understand better, look at chapter 8 of this book published by the Barbara Davis Center for Childhood Diabetes.  It gives a good overview of the insulin types and how they work.  http://www.ucdenver.edu/academics/colleges/medicalschool/centers/BarbaraDavis/OnlineBooks/books/Pages/UnderstandingDiabetes.aspx

2 other great books that you may be able to find at the library:  "Using Insulin"  by John Walsh and "Think Like a Pancreas" by Gary Scheiner.  Both books have charts of average insulin sensivity factors based on a diabetic's age and weight. 

P.S. The term brittle diabetic isn't well defined and is often used as a derogatory term.  It doesn't describe your grandson.  He's just a diabetic whose insulin dose needs to be adjusted. 

 

Thank you for all the info. I found it very useful,in fact I am going to ebay and see if I can get the books you recomended  as soon as I leave this for you! Chapter 8 was very informative. I would have never thought that a warm bath or shower could cause insulin to be absorbed faster.Thank you again. I need all the info. I can get!

Wow, Everyone has been so helpful ! I would like to thank everyone that gave me the above info. I still have a lot more to learn,so if anyone has any more info. or comments,please leave them for me. Some of you have been dealing with this horrid disease for years,and you may think that a little comment or advice is not important, but please leave me any and all info that you think might help.I am greatful to have found this wonderful site! If anyone has any info. on meetings and/or classes in a 30 mile radius of Morgantown.WV  or how I might get info. for this area It would be greatly appreciated.