Sunday, December 28, 2008

Insulin Question?

So...this is what happens when you get insulin before a meal...then your child decides she's not as hungry as she thought she was! Kacey tested for lunch.... 257....but she'd just come in from riding her bike. So we tallied up the carbs she was gonna eat and gave her a correction. She sat down to eat and then decided she didn't want her mashed potatoes... ummmmm can you say... UH-OH! Thats about 2 units of insulin and we can't take it back! So I figured I'd just wait and see what happened.....WELL......

Two and a half hours later.... she comes to me and says "I think I need to test!" YIKES! I always know that it's bad when she asks to test because she's feeling that low come on. She tested.... 53! Yowsaaaaa! We were at Frankie's grandmas house and we had her diabetes pack but she turned her nose up at glucose tabs. Hmmmm.... gatorade? NO! juice? NO! Kacey you HAVE to drink juice or eat the glucose tabs. The last time she was low and we did the glucose tabs she went from a 60 to a 495 and it made her sick. last time it was 4 tabs... lets try 2 and see what happens? I managed to get her to eat 2 of them and the result.....
A perfect number! She immediately started to feel more perky and smile. So thats good :) and we managed to bring her up without making her high again!

The reason for this post....
I've always had issues with giving her the insulin before her meal. I know the doc told us that we have to give it before the meal and I did raise the question...What if she doesn't eat what we bolus for? and the response was... give her juice to make up for the difference. But what scares me if there may not always be juice at our fingertips...and we end up having to treat with the glucose tabs. Is there a way to avoid this all together? Does the insulin HAVE to be given before the meal or can we do it as soon as shes done? I'm guessing to gain better control it has to be given before so it keeps the blood sugars from rising so fast but it's times like this when she doesn't eat everything we bolused for that I wonder if we should have waited?
Any suggestions or advice?


Cara said...

It's not such a big deal to wait. But, I always carry juice boxes with me in my purse. It's not a bad idea. You can get the kid ones that are right at 15 or 16 grams of carbs (instead of the normal 25) and then you don't have to worry about overtreating. Mine have big bird on them! :)

Jill said...

I do have the juice boxes that are 15g (the Elmo ones...LOL) but we had one leak in the last diabetes bag she had. I guess I could put one in a ziploc baggie so if it leaks it wont spill out! I was just trying to figure out how I could get around those lows when she doesnt eat all her food and we gave her the insulin already. Talk about frustrating! Usually shes a good eater and will eat everything she boluses for but its freak times like this when she says "I'm full" and I'm stuck cuz I can't take back the insulin I gave her! I shouldn't complain though cuz it was the potatoes she pushed away! LOL!

Scott K. Johnson said...

Hi Jill,

Nicely done with that end result!

For me, this topic is an endless debate about the relatively slow speed of (even the fast acting) insulins, calling for dosing before eating, versus the risk of a bad low blood sugar.

I think that most parents weigh the risks and decide that because they can't ensure their kid will eat what they've served, they dose after their kid has eaten what they want. In the end, I think that is probably the safest.

But you also have to consider that any food we eat will always hit the blood sugar before any insulin given (at the same time). Which means her blood sugar may spike up a bit before the insulin catches up and has time to "do its thing".

There is no right answer here, only what works best for her. Keep in mind too that I am not a parent of a child with diabetes. But I have thought about how the heck I would dose one of my kiddos (6 & 9) beforehand and have decided that it would be pretty near impossible.

Jill said...

Thanks Scott!

Like I said, it doesn't happen often and usually she shoves away something low carb and it doesnt really matter because it's such a low carb or little bit of food and it doesnt make a difference in her sugar....but when its something like mashed potatoes and she got 2-3 units for it...thats makes a HUGE difference! When she was first diagnosed we dosed her after she ate but it was because I was still not comfortable doing the dose before and reacting fast to a low. For about 3 months, we've dosed after a meal and this is the first time she's gone really low because of it. The last time was when she had that 60 and we did the 4 glucose tabs and she shot to a 495. I think thats why she didnt want the glucose tabs this time because when she hit that 495 she got sick at her stomach. I knew it was temporary and it wasn't something I could give her more insulin to bring her down because we'd be back in the same viscious the one you talked about... go low, treat or eat, go high, correct, go low again...over and over! Since I knew 4 tabs shot her so high last time... we did 2 and it put her at that perfect blood sugar and she didn't feel sick. We were told for sugar under 70 we do 15 carbs in 15 min and then test again. Those glucose tabs are 4 carbs a piece but they seem to really reak havoc on her and her body reacts badly to them. Taking only 2 of them was only 8 carbs but it didnt send her soaring. I almost feel like Im playing a chess game...figuring out which move to make so she doesnt go too high or too low....figuring how out her body is going to react to certain foods...and then making the adjustments!

Shannon said...

Jill, My daughter ALWAYS has her insulin after she eats. We do a correction dose before if she is too high so her food doesn't make her higher after she starts eating. She has 20 minutes to eat what she can then we give the insulin for the carbs that she just ate. We haven't had a single problem with it this way, but then again she is 4 and she was just diagnosed a month ago. When I read that people give the insulin before the meal I just think that sounds strange for kids. I guess it depends on each child. I hope you can figure it out soon! :)

Amy said...

Ha! We have the Sesame Street variety juice boxes as well! They are perfect to throw in my purse or her bag for a quick pick me up! I always give Jada insulin after she eats- it just works so much better and our dr.'s gave the go ahead, especially since she is so young. Jada sometimes rebounds badly after a low, too, so I find myself giving her no more than 8 grams at a time to get her coming up.
You're doing a great job! I've come to understand that it's somewhat of a trial and error learning process. Hang in there!

Lynnea said...

I love all the answers...mainly because there isn't a right or wrong. Every child is different and every parent is different.

When we were on shots we dosed after J.J. ate. On the pump I will generally dose before he eats, unless he's borderline low. We've only had once or twice where he didn't finish his food.(..and didn't tell me!!) For him it was easy to offer a "treat"...most kids will say they are full but offer them a cookie and they'll eat it!!:-) So I always have something on hand or in the house that is considered a "treat" to him. Recently I bought fruit juice freezer 7g's it was perfect to bring him up, healthy, and he considers it a "treat".

Also I agree with finding the right carb count to bring her up if she is low. J.J. would go to the moon with the recommended 15 grams. So we opted for around 6-9 grams.

Also....Scott got us hooked on Smarties instead of glucose tabs. The tabs are so least for a small kid....but Smarties are essentially the same as glucose tabs, but smaller....and more fun. We got some that turn to bubble gum....others that are super duper sour. Makes it interesting. Plus one roll is just 6g...perfect for J.J.

Jill said...

Shannon~ If shes high are you doing 2 shots? One before eating and one after?

Amy~ I faxed her weekly blood sugars to her Endo today and I asked them to please call me so I could ask if we could just dose afterward for now? I asked before and they insisted on dosing before her meal so I'll raise my concerns again when they call.

Lynnea~ Thanks :) I never thought about some juice bars! Those would be great! I also agree with finding the right carbs to bring them up without making them high again. I think 15 carbs are too much and send her soaring because her insulin:carb ratio is 1:15 for breakfast and dinner and 1:10 for lunch... so that means anything over 10 carbs she should get that shot and since this happened at lunch if I had given her the 15 carbs she would have gone sailing back in the 300's! I think 6-8 grams is perfect to bring her back into the "normal" range if her blood sugar is between 50-70. Of course if it was lower then I'd probably do the 15 carbs.

Thanks everyone! I guess like you all said there isnt a right or wrong answer. I did dose her before breakfast this morning and I'm waiting for the doctors office to call so I can discuss this with them further. I'll keep you all posted! Thanks again :) You all are the best!

The Turner's said...

Jill, I always bolus HALF before she eats and HALF after she's done. I know they say this and that, but doing it this way works very well for us.

Penny said...

The first couple of years of D, I never ever bolused prior to a meal. Riley was 3 or 4 and who knew if he'd eat what I put in front of him or not.

Now, most of the time I'll bolus first if it's something I know he'll eat all of. But, other times I'll just wait to see what he eats and then bolus. (If he's high I still correct that first, but he has the pump so it's not an extra stick for him.) The first 5 months when he was on injections I'd wait until he was done and correct the high when I bolused for the carbs.