Prior to Diabetes camp we had three weeks with almost perfect control (for us), since camp and baseball have ended we have been having a difficult time getting control back. It is almost as if, that crazy week of camp has somehow snakebit my son. His exercise level has dropped a bit, but he is still running a couple of miles most days, and weightlifting every other day.
This is what happened this morning, and I am wondering if you guys who have lived with diabetes for a lot longer have some insight. Sure, we can probably attribute some of this to dawn phenomena, and he should have added more insulin before eating after the pre-bolus didn’t result in a drop, but for 30g of carbs (Tamale) to shoot him to 350 seems a bit crazy.
At first glance I would say that the decrease of basal from earlier bit you later on. For us, a change in basal has long lasting effects–so if we decrease basal at night or early morning to prevent a low, then we know the breakfast spike is going to be extra nasty.
I agree with @Bradford’s comment. Your basal dose now is your insulin playing out 3-4 hours from now, so sometimes the basal adjustments for a low play out over a length of time.
Also, sometimes these things have nothing to do with food. Stress, hormones, infusion sites, all of those can factor in.
@Chris, I did not reply earlier because I thought people with more experience would have a better understanding. Here are some thoughts:
the spike occurs exactly with the eating of breakfast, so it would be very coincidental if it was not directly linked to breakfast. I am mentioning this because, 20 minutes earlier or later, I would have said it would be a puberty peak.
It is possible, as @Bradford mentioned, that the nastiness of the spike was worsened by the basal adjustment, even likely – but you only took out 20% basal, so it can’t have been all caused by it.
we have noticed a similar phenomenon ourselves, for carb corrections when low. Most of the time, our carb corrections follow the regular BG/carb ratio, which is, at this time, about 4.5x for us: 1 carb will bring BG up by 4-5 mg/dl. But, once every 10 corrections or so, my son will spike like crazy on one of these corrections, where the ratio will be 1:12 or 1:15. This peak had an apparent BG/carb factor of 7x, although it is really worse because you pre-bolused about 40 minutes early: you did everything right for this breakfast.
So, it is possible that there is such as thing as high carb sensitivity that crops up occasionally in everyone? The only other explanation for these kinds of peaks that we periodically see would be that a puberty peak would be exactly coincidental with carb ingestion (for us at correction time when he is close to low, or low) – but we see that often enough that such repeated coincidences are not believable to me.
Michel, I think you are probably right. But it is frustrating when it happens. We know my son is more carb sensitive than the average. Cody’s diabetes friends can’t believe how few carbs it takes to send Cody to the moon, i.e. the 15g corrections actually work for them, where for us, we never correct a low with more than 6g, and sometimes that is too much as well.
It is going to be an interesting month, since my son is starting to run with the cross country team and we will need to up his carb intake to match the activity. Not looking forward to it.
Thanks for your thoughts Bradford and Eric. I just wish the inputs matched the outputs more often the last few weeks. It is particularly frustrating because he was so dialed in for a bit.
Once you get it figured out, this will be a great thing. If he is churning out enough miles, he will be able to eat whatever he wants. His body will just laugh at 6g of carbs.
Just an off the wall idea - could your current fast acting insulin pen or vial have gone bad? Because that’s exactly what you’d see. It would work but you’d need a whole lot more insulin for the same coverage.
Yeah, it is a shocker, about a week ago we had our first low that took 30g of carbs to correct. It was hard to wait it out. But fortunately, those are not the rule or he would be packing on the pounds.
Not a bad thought. If he hadn’t flat lined all night and this morning I would have thought this could be part of it. It helps that we live in the pacific northwest, so we are hardly ever exposed to the temperature variations that the rest of you live with. Yes, I inferred it, we are temperature weenies.
Is he using two kinds of insulin? A flat overnight means your basal insulin is dialed in just right. Inadequate coverage for food would fall to short acting insulin. That’s the one I’m suggesting might have lost potency. Insulin is a living protein and can go bad when subjected to extreme heat, cold, contaminants or age. Sometime there is a telltale cloudiness or precipitate but not always. Anyhow, I’d try a new vial/syringe and see how it goes.
Sorry, for not being more clear in my answer above. Yes, my son is on a pump and is now actually only on one insulin. We had been using Lantus for 50% of his basal during baseball season, but that ended.
Good discussion, thank you! I thought I was the only one with weirdly changing carb sensitivity…for several days I’ll be pretty flat with regular I:C ratios. Then BLAMO, I’ll need 3 to 4 x the amount of insulin.
These fluctuations happen fairly frequently (I can pretty much rule out hormonal reasons for the swings ). The good news is that I’ve seen the peaks and valleys mellowing since starting “the Pump”.
Just something to keep an eye on - pod day 1, versus day 2, versus day 3. Sometimes, putting insulin into the same spot for several days affects absorption. This isn’t a pod issue, it can affect any type of pump.
Not sure if that is what you are seeing, but just something to think about and see if your needs change somewhat based on the pod day.
Please let me know! I am curious if others see this. I don’t see it much, but on occasion.
So the changes I was referring to were primarily what was happening with MDI. @Michel - for me the variability wasn’t just a point in time, it would last for several days at times. Sleep patterns and stress are usually the 2 big culprits for me.
). The good news is that I’ve seen the peaks and valleys mellowing since starting “the Pump”.