So, Liam is sick…he’s been sick for a week now. The only symptom he really has is loose stools. We know he’s sick because his TDD has gone up to 10 - 12u/day from 5-6. @ErinElizabeth and I have discussed the possibility that perhaps he’s also going through a growth spurt that is accounting for some of the increased insulin. He is congested during the night so I know there’s something going on relating to his overall health.
What’s strange is that, for the past week, even though we have had to increase his TDD by 1/2, we are getting BETTER control than when he’s healthy!
His previous week(s), for the past few months, have trended between 135 - 140. Has anyone else experienced BETTER control and numbers WHILE SICK? I find this strange, but it’s what we are seeing this week.
We never do We are always adjusting basal to try and map to his sick needs, and we are always a bit behind – lots of highs or lots of lows.
I wonder if your increased comfort has to do with the fact that Liam’s higher needs make it slightly easier to meter the very small doses you normally deal with?
I have, but I just attributed it to it still being early in my diagnosis - I was running lower (using same amount of insulin, though) the few days I was sick with a cold. That was a few months ago (or maybe more than a few - I’ve lost all concept of time), and already things have changed, and I now run high when sick.
Our “sick” profile effectively doubles all his basal requirements EXCEPT nighttime…we found that double from .10 to .20u/hr was bringing him low so we backed off of his nighttime basal to half that, .15 which is giving us a flat-line most of the night. Besides this, we’re (OK…I’m) just bolusing the crap out of him after he eats. Even with multiple micro-boluses (.30 bumps twice or even 3 times), he goes nearly to 300, but turns around quickly, comes back down and, after a small 5 carb snack (sometimes two of these are needed), he levels off nicely between 70 - 100.
I refuse to let him go high and stay high…and I know the threats of stacking, but for me, it’s easier to fix a low than it is to bring down a high after it’s gotten there and decided it’s not going anywhere. I prefer fast spikes that get up and come back down quickly. This mornings breakfast he went from 90 up to 290 and back down to 78 in 2.5 hours…which seems like a lot, but it only stayed at 290 for one tick, then it headed down quickly.
Since Liam has now been over 1.5 years diagnosed I’ve already learned “how far” I can push his insulin so that I don’t cause a severe spike, high or low…and I go to the very edge to avoid prolonged highs…even if that means stacking. I’m really not afraid anymore of piling on the insulin and I think that has been our issue in the past. Being too timid and watching highs just sit there festering.
It’s a great feeling to have these numbers, but I’m just stunned at them because I would think his “healthy” numbers would be so much better…AND THEY USUALLY ARE when he’s sick…just this time they’re better. But I’ve been a lot more bullish in my treatments this past week than I have been before. Maybe this has a lot to do with it.
If his digestion is disrupted, then he’s likely to be absorbing all of his carbs more slowly and incompletely. We do find better control while sick with tummy stuff.
Maybe the more aggressive treatment lately has decreased his insulin resistance overall (or rather, increased his insulin sensitivity), allowing for easier control even while sick (I have NO idea if I’m making that up)?
I also agree with @Michel that once you get to higher dosages, it becomes easier to titrate more precisely. I think when you’re at the 5 or 6 units a day range, for instance, there are some times when it is literally impossible for the basal rate to be right and times when you’re clearly rounding off the meal boluses by a substantial amount.
I suspect it’s the tummy stuff though. That’s what we’ve seen. A few days of highs sometimes, but usually his BG is better if his digestion is disrupted, even if he’s overall taking in more insulin.
well I think the issue is that with this kind of mild disturbance it does get easier to bolus – but when they’re really puking, or even if they have more comprehensive digestive issues, they go low and can’t be brought up. We had that a few times early on, when Samson was coming home with more tummy bugs, and it was scary.
Yeah, I don’t want that kind of tummy bug…no vomiting or anything like that. If that occurs, you run into issues with dehydration and other things piled on. Just what he has this week. I’m joking, of course…I don’t want my son sick ever with anything. But it has been an interesting week!
We are always adjusting basal to try and map to his sick needs, and we are always a bit behind – lots of highs or lots of lows.
