So, I think Gavi is getting to the point where he will probably have to start Novolog. There have been about 2 or 3 occasions within the last 2 weeks where his endo was going to start him on Novolog, but his numbers would go down significantly on its own (i.e. one night before dinner his number was 309, 2 hours after dinner it dropped down to 111) and she decided to wait and see. Then his numbers seemed to be okay for a few days. But then they would start going up again. This happened about 2 or 3 times. They were fine until Thursday of last week but now they're way up again, and this morning his number was higher than usual. It is usually around 100, this morning it was 150. His daytime numbers have been in the mid 200's to mid 300's, I saw maybe 1 or 2 daytime numbers in the 100's, and it was closer to 200. He's been on a small does of Lantus since January, but his endo. doesn't want to increase his does unless his morning numbers are consistently around 150 or above. I am so nervous about starting him on Novolog. What if his numbers start stabilizing again and his blood sugar crashes because of the extra insulin? I think in a way it would've been easier if he would've started Novolog at the time of diagnosis so we would kind of know what to expect.
I am a young adult who was diagnose late in life but I know personally that by using the novolog carefully and monitoring the blood sugars you will ultimately be able to have better control over his daily numbers. that way when he gets to 300 you can bring him back down to where he should be and you won't have to deal with him being cranky from being high and not feeling good. ultimately most type 1's end up taking a short acting insulin. I have taken lantus and novolog for almost as long as I have been diagnosed. I was diagnosed in 2005 at age 20. I spent about 6 months on different insulins but ultimately the lantus/ novolog combo worked out best. Especially since the Novolog is a short acting insulin and only stays in the system for about 2 hours so it is great for treating a high that you can't get down. Stable numbers make for a happier person and also makes life easier.
I was diagnosed at 18 and was in the honeymooning phase so I started out on only Lantus. Well as time went on my numbers began to creep up. But since I hated shots I tried to remain on the once daily Lantus as long as possible. My fasting number was usually around mid 100's and during the day I would have 200's, sometimes 300's if I ate a high carb meal. Finally I thought to myself, What the heck am I doing? I can't keep going with my numbers this high. I hated the shots (I mean I have a HUGE fear) but once I started Humalog I felt so much better! I don't know why I didn't do it sooner! To avoid lows, they started me out on a very low ratio. I took 1 unit for every 40 carbs. After about 2 weeks I found this wasn't lowering me enough so I went to 1:15. That did the trick for a while but now that I am out of the honeymooning phase totally I am on a 1:10 ratio. The other good thing about starting meal time insulin is that he would now be able to use a pump (if that's something you're considering?) The pump actually gives you the choice to bolus or basal VERY small amounts that you couldn't even do with shots. I think you can use like .005 of a unit in a pump. Also, you can do temp basals if he gets too low. For example, I usually have my basal set for .5 unit once an hour. But during the evenings I something get low so I will do a temp basal -35%.
The nice thing about humalog is it is out of the system in about three hours. so you will only have to keep a very close eye for a few hours after giving the insulin initially.
Also, if your child requires VERY small doses...humalog can be diluted. They can add 50% saline and 50% humalog...or whatever other percentage your doctor would like. 1/2 units are really hard to measure, so this could be an option in the beginning. Good luck!
It will be OK. You and his endo will now have information on how his body responds to the Lantus and so you will know when he will normally drop just from that. As Meri said, the Novolog will only be in his system for 3 hours or so (but ask your endo or CDE about how to test this when you are first starting.) On the bright side, there will be more freedom in that he can eat what he wants as long as you give him the right amount of insulin for it. No more adjusting meals to limit the carbs.
Sounds like my honeymoon stage at first. I was all over the place on levemir and novolog. It took about a month to start to even out but I still have to adjust all the time in smaller amounts now since I am still honeymooning.