When do you know the dose is correct?

My son was diagnosed in May, so his doses are changing a lot. He was running high (200-300’s base line, at nighttime etc) so we slowly increased his long term insulin from 5, to 6 to 7 with the doctor’s advice. At 7 he was in a good range at night, 130-140 ish all night. But, he was having these fairly rapid falls about 2 -3 hrs after eating - like 10 per 5 minutes, and needing to snack to stabilize. And at dinner time he was falling both before and after dinner to 70, 65 sometimes and we would intervene with snacks and stabilize him. This dose seems and feels really risky like we’re always on the edge of a low and having to watch closely. Is this however “normal” rather than being in the low to mid- 200’s most of the time with more gradual and safer lows ?

@bonetje this is a complex question

warning: long answer

basal (long acting) insulin is supposed to keep your blood sugar fairly flat throughout the day. that means if you are not eating, and your blood sugar is 200, then in 4 hours it should still be 200. getting basal insulin right can take moths if not a year. In the case of a growing child, it can take form now until he reaches his late teens.

at meal time, he either needs or will eventually need a mealtime (fast acting) insulin. this insulin starts to work in 15 -30 minutes and continues to work for 4 hours. this kind of insulin is taken relative to his pre-meal blood sugar and to how many carbs he eats. for example, 1 unit of fast drops my blood sugar 30 mg/dl in 4 hours - and I take 1 unit for each 16 grams of carbohydrates so if my pre-meal is 130 (my target is 100) and I am going to eat 16 grams of carbs at that meal… I take 2 units of insulin. 1 unit for correction, 1 unit for the carbs. Do not use my numbers. seriously - everyone is different.

dropping between meals can be from too much basal or too much mealtime (bolus) insulin. the way you tell is by skipping meals, because meal time insulin overlaps lunch and dinner.

in my opinion, you have to fix basal first then you can fix bolus. Basal insulin doesn’t always absorb over 24 hours… sometimes people have better results splitting the basal over 2 shots.about 12 hours apart. others (I’m in this group) never get basal right and that’s why I switched to an insulin pump.

fixing bolus is a matter of eating a given amount of carbs, taking insulin, and checking every hour for 4 hours, then adjust and repeat till the results are repeatable.

this may be a lot to take in. A CDE would be of great help and support, but if you like to read I always recommend “Think Like a Pancreas”. there are practical and fairly easy ways to test basal and bolus until they are the best they can be.

diabetes is a bit of a science experiment. good luck to you.

Thanks so much! I am glad to know I am not crazy, and none of this feels right yet. He is either too high consistently, or crashing every four hours. I think the timing of his long term is off, since he is consistently high after breakfast and low after dinner - but they haven’t made any suggestion to change that yet. It can be frustrating waiting to hear what changes to make when school is impacted so much by these ups and downs. I appreciate your response!

So its good to hear - if I hear it right- that there shouldn’t be an inevitable crashing every few hours as a diabetic person. that felt just so frightening to me. I know exercise and things can effect that but it was truly like clock work every 2-3 hrs with the higher dose of long acting.

@bonetje if his basal and bolus are correct, his blood sugar will only rise in the 2 hours after a meal. Please allow me to offer contrast… what I just said has a “mad sized if” I’ve been doing this for 39 years and I get highs and lows, occasionally, mostly due to differences in activity and stress levels.

Of course it is not for everyone, but all of what you just said will be magically treated with an insulin pump. I switched to an insulin pump 2 years ago and it has changed my life.

We have a pump on order for him and should receive it soon. I would love to know how these things will specifically be helped by the pump. I would love to hear your experiences with it.