I’m returning to this wonderful community for some more help. (one of these days I hope to pay it back, but it seems like I’ll never get there!)
I’d been having a pretty great streak with Ethan for several weeks- no huge wild swings, nice steady overnights, predictable responses to meals, etc. Sure, a few spikes or lows thrown in for good measure, but nothing that we couldn’t seem to reasonably handle. We weren’t even seeing that night time climb I had posted about before for the most part. I felt relaxed and gained a bit of confidence.
But the past week has been horrible, especially post dinner and nights. So in part I was hoping to gain some insight into what the issue may be. I realize everyone is different, but even just a “yup, diabetes will do these things” may help reassure me. I’m going to try to give a complete picture, so bear with me.
It started last Friday. Everything was great through the morning, He had a typical lunch, but I took off 1/2 unit because we were headed to a playground right afterwards. At one point he started dropping more than usual about 1.5 hours post bolus (83 quarter arrow down). I decide on 1/2 juice box. About 15 min later he’s 63 (verified by finger stick). I tell him to finish the rest of the juice box. He responded to that and about an hour later I end up giving 1/2 unit correction with BS 149 quarter arrow up. Turned out to be a good choice because he was 155 at the start of dinner about 3 hours later.
Ate dinner, but 1 hour later he was falling fast. He did go outisde to play after dinner and was jumping on a trampoline. took almost 2 juice boxes to keep him up. I chalked it up to playing and jumping with BOB from dinner, right when its hitting its peak.
He has his typical no carb bedtime snack (some cheese mostly) and all seemed well. But then at 9:30 he started dropping. My notes are fuzzy but between 9:30-12:20 we went through almost 2 more juic boxes to keep him up. He never dropped dangerously low, into the 60s at the worst, but just never stayed up. Had a few PB crackers in there as well. Finally around 12:30 he got up to maybe 120s, but he drifted back down by 3:30 (80). I gave him 3 oz milk. That kept him good until 4:45, at which he drifted again (80) and this time I did 3 oz milk with a PB cracker. Then he was fine through the next morning.
The sustained low that evening really concerned me. His last bolus was at dinner at 6:15 pm. Certainly by 9:30 that was mostly gone. Was it his activity that kept him low? Didn’t really seem right to me because, yes, he was out playing, but nothing overly rigorous. Could he still be honeymooning and his beta cells kicked in? Are random sustained lows something some kind of diabetic voodoo that we just won’t know the why? Regardless, it really rattled me.
The next morning a very unusual breakfast. Gave him something he’s had lots of times, but has a tendency to keep him higher. Well, about an hour after eating we loose dex arrows so I finger text and sure enough he’s dropping. I decide on a full juice box(!!!) which again turned out to be the right choice becuase he was 130s by lunch. NEVER has that happened with breakfast!
At lunch that same day, he was drifting low as he ate lunch (not that unusual. I sometimes wait to bolus until after he finishes eating). But I eeded to wayt a full HOUR after eating before giving the bolus for lunch!! He just drifted lower and didn’t start to come up until then. Again, it worked ok . . . he was a bit high through the afternoon (170s), but I was grateful I didn’t bolus at the time he ate (FYI, lunch was a carb control wrap that is 18 carbs, but 15 g fiber. He has them ALL The time. with peanut butter, and banana, a Two Good yogurt. Lots of fiber and protein. He has this lunch all the time, and I will typically wait to bolus, but maybe like 15 min after he’s done eating)
Thankfully the rest of the day settled.
That night I decide to reduce his basal to 7.5 U (had been on 8 U the past 3 weeks which was working really really well, but I thought maybe with weather getting nice and more play outside, it might be needed to take that back again a bit).
The next day I also adjust his carb ratios just a bit (I know I know. I probably shouldn’t, but I just got so rattled). All in all things work ok this day.
The next two days were ok, working well with my ratio changes. But then we had a repeat trampoline experience after dinner. This time the 2 juice boxes seemed too much as he went high afterwards. I’m wondering if the spike afterwards was a combo of 1. too much treat for a low and 2. delayed digestion from dinner since all his energy went to jumping and not digesting. Gave him a correction and was able to get him settled into the 140s over night.
Then yesterday with dinner I decided to take about 1/2 unit off dinner bolus (similar carb count as the other days) bc the plan was to go jumping afterwards. Well, of course that didn’t happen but he did stay outside to play. He was steady in the 200s, but I thought “At least he’s playing, that should help out”. Well, he just kept rising. I got inpatient and gave him a 1 unit correction 1.5 hours after his meal bolus with a rising blood sugar of 220. Then an hour after that he was 279 and rising, so again I got inpatient and gave him another unit (verified by finger stick he was 299). Well, that all was an epic failure. He began falling off the cliff. Gave him a whole juicbox about 45 min after that bolus. At one point I was patting myself on the back because he came in for a nice landing at 70 and rose gradually to the 90s. I thought “Phew!” Decided to give him a cracker to keep him up after all that. About 20 min later, he started falling again! Down to 74, then 63. Give him 1/2 juice. Was steady in the 60s for about 10 min then the CRITICAL LOW alarm goes off, and Dex has him at 50. I’m like WHAT!! Impossible. I finger stick and he’s 55! I give him a WHOLE juice box. Probably about 3-4 min after that I decide to finger test (I get nervous and inpatent) and he was already 75! I don’t know if he had some delay in processing the earlier juic or what.
I realize some insuline stacking was likely an issue with this night. My take away is I really need to be patient and wait 2.5-3 hours before deciding on another correction, even if he is high and rising.
He of course spennt the whole night around 200, but I decide not to do anything about it becuase I was just exhausted. He did drop down to about 160s for a few hours, which is where he was early this morning. He of course rose up to 190s by his breakfast. I gave a good 30 min prebolus, gave his usual breakfast that gives us good glysemic control. He got down into the 150s while earing, but then that’s it! Now he’s back to sitting in the 230s. Prior to this week his ratios were about 1:15 for most meals. I increased that to 1:20, but now I’m wondering of that is a big mistake.
I’m ready to pull my hair out. I’m exhausted, lost any confidence I had, and just don’t know how to get back on some kind of reasonable track. I realize I probably jumped the gun on adjusting some of his rations, but for at least a few days those adjustments seem to be working. He is struggling with allergies, but he was before all this started as well.
So how do you do this? How do you let your kid run out and play and know how many carbs he might need to sustain that? How am I supposed to know if he needs extra carbs at bed because the warm weather and play catches up with him at night? Or maybe it has nothing to do with that? Do you nomally need to decrease insulin needs in the summer?
I had more questions, I know, but I’m just one frazzled mom now. I haven’t called our endo bc that doesn’t usually get me anywhere. I would just get some random CDE that would just want his number and tell me to adjust his carb ratios. They never spend any time. Which is why I 'm turning to you fine folks!
Thanks, if for nothing else, reading!