FUDiabetes

Help with some erratic blood sugars

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!

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A few notes from what we’ve learned over the years with Liam.

  1. Any exercise causes a nose-dive in Liam so anytime he is running around, we put some carbs (fast) in his system before he starts doing it (that’s not always possible since he’s a kid and just runs/plays whenever he wants too, with his brothers, but as soon as I realize it, I ask him to get some carbs in his system.)

  2. Trust the science. If I know how much insulin Liam has on board that is all the info I need to make my decision about how many fast carbs I need to put into his system to cause the curve to shift and head up again. For instance, in our case, if he has .5 units onboard and is double down at 120, I would give liam 3 sugar pills and ask him to not run around until his sugars come back up. We stopped using juice because it’s really unpredictable in the measurements…you never really know how many carbs he’s getting. So we shifted to glucose tabs, or skittles, because we can quantify how much he’s actually getting. Once he has the carbs on board, we trust the science and wait it out. If he dips low, it’s very fast and comes back up again. If we stack carbs, he’s going to go high again and we’re going to run into the fun roller-coaster. So, we give just the number of carbs that we know the science should get him turned around and then we wait. Now, if he dips low and is there for 10 or 15 min, then we check sugars and if needed, give another couple sugar pills. But the key, we’ve found, is to treat early and then trust the science. When he’s double down, though and anything under 150, we make him sit until the sugars have turned around.

  3. Stacking anything, carbs or insulin can be a recipe for disaster. Sometimes it’s necessary, but we try to avoid doing this at any cost because that’s what causes roller-coasters and we want to avoid those as much as possible.

  4. After a heavy excersise/horse playing, IF his BGs are heading down, we give a fast carb to stop the fall and we ALSO give a slower carb. The reason for the slower carb is to help regulate the body after he’s exercised and his body is recovering. The fast carbs are to stop the fast fall. Usually only 2 or 3 glucose tabs + something slower but not super slow carb.

  5. We ALL (caregivers of T1Ds and adult T1Ds themselves) have difficult periods where things occur and are just inexplicable. Don’t let these things make you lose confidence…you’re rocking it. Just try to study every facet of what you are doing and determine if it makes sense to be doing things that way, or if you should try to tweak this or that. Tweak one variable at a time so that you know what makes a difference and what doesn’t.

You’re doing great and I would just breath, look at the data and try to determine what changes you should incorporate. The first thing that really helped us personally was to discontinue juice boxes (unless it’s a lunch drink and he gets the full bolus for it) as a correction method. If he’ll do skittles/glucose tabs or something else like that, that would enable you to do PRECISE carb counting in your corrections. For little guys like ours, it doesn’t take much (carb or insulin) to cause wild shifts in BGs.

You’re doing great! Keep up the good work! Breath, refocus and try to determine what the root cause may be… Study the data, analyze your methods, ask questions as you are doing and continue learning and growing! This is a marathon for us parents - not a sprint!

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Thanks so much for such quick feedback!

If I know how much insulin Liam has on board that is all the info I need to make my decision about how many fast carbs I need to put into his system to cause the curve to shift and head up again.

Yes, I do try to do that, in prior to this past week I was getting fairly decent at it. The night that he just had that sustained low really confused me because I knew he had little to no IOB, yet he was hardly staying up. So in that case I just didn’t know at all how much he’d need.

Last night when I saw the double arrows down I intervened right away, and thought I got it good with a landing at 70 then up to the 90s. But then he just help dropping. Obviously the half juice I gave then was probably enough, but with the blaring 55 on both Dex and the finger stick, I just panicked. Clearly that whole second juic wasn’t completely necessary.

We stopped using juice because it’s really unpredictable in the measurements…you never really know how many carbs he’s getting. So we shifted to glucose tabs, or skittles, because we can quantify how much he’s actually getting.

Yes, that is my complaint about juice. I do like it for the double arrow down situations because I know if he’s, say, 120 with double down, he can pound the whole juice w/o risking a rebound high (and he needs those carbs in that situation) He does not like glucose tabs (even though I have a TON everywhere). He says they hurt his teeth. I use skittles as well, especially for those nudges up because, as you said, I can’t quantify exactly what he is getting. I don’t like them for rapidly changing situations, though, because I find juice is faster (or at least seems to be, and he’s not trying to savor the juice like he does the skittles). Plus, at night, when he’s sleeping and I have to wake him up, getting him to chew anything is difficult. Skittles are a much better day time treat for us.

The reason for the slower carb is to help regulate the body after he’s exercised and his body is recovering. The fast carbs are to stop the fast fall.

That was my thought with the PB cracker after the juice last night once he seemed steady in the 90s. And even just 1 PB cracker can really boost him. But then he fell again- that’s what caught me so off guard and I just didn’t expect it (again, I realize it was likely stacking that night, and I really should have known better). I obviously over treated the second drop, but it was just such a hard thing when I thought I had gotten it settled but you’ve got Dex blaring at you and you verify the numbers with a finger stick. I know I need to trust it more, and I’m better able to do that 1.) in the day time when he’s not sleeping and I’m not so tired and 2.) when the blood sugars are acting more predictable (even if they are falling or rising). Seeing a second drop, or a sustained low, are things I wasn’t anticipating and admitedly I do not do well in those situations.

You’re doing great! Keep up the good work!

Thank you. My husband says I have to quit beating myself up. But it isn’t so much that as I just want my son to be safe and healthy, so when things are wildly swinging or really unpredictable, it more out of just sheer worry than anything else. I’ve been reading through so many threads on this site that have been helpful and interesting. But I find sometimes i just get overwhelmed as it seem so unbelivable to this all is just so complex.

I wish I was independently wealthy and I’d hire a nurse to come and make these decisions so I could sit back and just enjoy my family again instead being so frazzled all the time!. I guess I just get burned out making all the decisions every day, and then especially when those don’t seem to be working out. When there are so many variables at play, it feels impossible to isolate what is a root cause to a problem (all you know that!). Both my husband and I are math/engineers by training, so all these changing variables does.not.compute.

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So, a few things. I am not an expert and we still have these crappy days. For instance, our son spent almost all of the day yesterday above 140, and a lot of the night at 300, only to touch down to a low of 55.(so take my advice with a grain of salt)

But, reading your description, it sounds like the primary problem is the lows, and that any highs are happening as a result of underbolusing or overtreating lows. So, what could cause repeat lows?

My first question would be if he is in honeymoon. If he is, then it’s possible he transiently had a period of greater insulin production, meaning he needed less insulin. Numbers can be really erratic in honeymoon, but they are usually not a great representation of how stable things will be afterwards.

The other possibility is that a slight tummy disruption could be making him digest less of his food or experience delayed digestion, leading to more lows, overtreatment and occasionally eventual highs. We see this with our son sometimes; it is usually after he is getting over something, but sometimes he never has the vomiting or other really obvious signs – the only sign is the blood sugar. And then usually after that resolves he has a period of high blood sugar before settling down.
If this is what’s going on, then usually our son will need about the same amount of basal, but less for bolus. To give you a sense of how much variation there can be, four days ago my son used 8 units of insulin, and then two days ago he used 22. That’s not uncommon for us, with about the same number of carbs.

All that to say, this does happen with diabetes. Sometimes you can get ahead of it but sometimes the best you can do is hold on for dear life and just make it through the ride. And then later on, you can troubleshoot or gain insight into what patterns might be causing it, and try to get ahead of them a bit more.

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I don’t know that a nurse would/could do any better than a loving parent. No one cares about our kids more than us. I would prefer my treatment for Liam over any nurse any day because I actually have a vested interest in his health. I know nurses/doctors are “do no harm”, but they aren’t always as interested in outcomes (shortterm/longterm) for each patient as they see so many of them.

I got frustrated and irritated often…for the first year or two into Liam’s diagnosis. I really made it rough on my wife because I’m a perfectionist and hate when things don’t go according to “my plan”…but my plan isn’t perfect and I finally realized that my wife and I are doing the best we can, we both love our son and I finally realized that being who I was, wasn’t helping Liam or our family. So, I really analyzed myself and made some core changes to relax more, breath and really let things roll off of me.

The most important thing I would tell anyone is NEVER make changes based off of one-offs. There are too many variables going on in the body (especially in young ones), so making changes based off of 1 or 2 days isn’t recommended. The only time I make changes is when I observe patterns over 7 days or more. All the other bad days I now just let roll off of me and think to myself “tomorrow will be a better day.”

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Also, the sheer worry about their health; the data shows very little improvement in outcomes below about an A1C of 7, and that’s based on data from the early 90s when blood sugar control was much worse – many more lows and highs that were missed. No one has even been able to tie standard deviation on Dexcom to outcomes as yet.

So remember that any given high or low, or even weeks of highs or lows, are not going to make a difference in terms of his long-term health outcome. It’s the long game that’s important, and the transient lows and highs need to be treated to remove the emergent element, but once he’s in a safe zone, he’s good.

I wish I was independently wealthy and I’d hire a nurse to come and make these decisions so I could sit back and just enjoy my family again instead being so frazzled all the time!. I guess I just get burned out making all the decisions every day, and then especially when those don’t seem to be working out. When there are so many variables at play, it feels impossible to isolate what is a root cause to a problem (all you know that!).

I know the feeling. I won’t say it never happens ,but it becomes way less exhausting to manage the numbers as you gain confidence and you realize every single blood sugar is just that – one period in time. I do get burn out and when I do, it is helpful to let the other parent take ownership for a while and just turn off the alarms, if possible. I’m also an engineer by training, married to a mathematician/computer programmer. So, I get it. We see the numbers, and we feel like they should be interpretable and tractable. There should be some rhyme or reason and it’s incredibly frustrating when there’s not an obvious one. I guess I comfort myself that there is a root cause but that it’s maybe not relevant to solving a particular high; coming up with a reasonable explanation and pattern recognition is usually enough. For instance, the description I gave where I assume tummy troubles explain these weird lows – it’s just a guess! I have no idea. It could be wrong, but I find it to be helpful and over time this pattern has become familiar enough that I know how to exit this crazytown cycle a little quicker and don’t get as flustered.

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This is a huge consideration for you to keep in mind. Liam was in honeymoon for nearly 2.5 YEARS!!! He’s now no longer producing insulin so our settings are as they should be for a non-insulin producing body, but when he was still producing insulin, our requirements had to be set to less to avoid the very frequent lows.

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The other possibility is that a slight tummy disruption could be making him digest less of his food or experience delayed digestion, leading to more lows, overtreatment and occasionally eventual highs.

So this is something I have been pondering. Interestingly, beforre diabetes, he used to complain of “my belly hurts” or “im getting full” all the time, pretty much always at a meal time. Never between. And If he said “im getting full” I’d let him be done and he’d bolt away as if no tummy troubles existed. I always thought it was him just trying to get out of a meal he didn’t like, or really just not being that hungry.

After diabetes, we went several months with zero complaint of tummy troubles (or at least very very few by comparison). After a while I thought, hmm, maybe it was the diabetes and high blood sugars causing the stomach complaints.

Fastward to the past week weeks and I’ve been getting that complaint more frequently, same as before- always during a meal and rarely sustained (only once was he still complaing for a long while after dinner, but it eventually subsided). Sometimes I think it’s because he just eats too fast (he always has yogurt at lunch and he inhales that thing). Sometimes I think he just has to poop, and sometimes he does and feels better. Sometimes I wonder if he’s just slower to digest sometimes, (like that day I waited an hour to bolus), for what reason I don’t know. BUT, his complaints of “I have a belly ache” while eating has increased this past week. But it never progresses to anything. more than a complaint and then he’s out the door play afterwards.

To give you a sense of how much variation there can be, four days ago my son used 8 units of insulin, and then two days ago he used 22. That’s not uncommon for us, with about the same number of carbs.

So how do you keep up with this? One of my concerns is that I made some tweeks to his ratios the past few days, giving him less insulin to similar meals. It seemed necessary for a few days, but like I said this morning he sat well over 200 all morning, which is very unusual. So how do you know when it’s time to change? My concern is making changes in such short amount of time is I loose sight of what his needs really are, and then we are just up and down for a while. I generally donn’t like making changes over one bad lunch or dinner bolus, and chalk it up to a mistake. But I get this knee jerk reaction to such lows at night.

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My first question would be if he is in honeymoon.

So, yes, I have definitely considered that. At his last endo appointment in April, the CDE said he was definitely still honeymooning (she seemed to base it on a ratio of his long acting insulin to weight), but she did not explain why (though I asked). How do you know if they are still honeymooning? And how do you know when it stops?

That was my first thought that night he just seemed to stay low for several hours, I just wondered if his own beta cells were kicking in at the time. Obviously there’s no way I can predict if/when that will happen. Does it just sputter here and there?

It was at least the explanation that made the most sense to me in that night as he had no IOB on board by 9:30, and his lantus from the evening was likely not doing much by then.

Can increased exercise/play/ cause someone honeymooning to kickstart more of their own insulin production?

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So how do you keep up with this? One of my concerns is that I made some tweeks to his ratios the past few days, giving him less insulin to similar meals. It seemed necessary for a few days, but like I said this morning he sat well over 200 all morning, which is very unusual. So how do you know when it’s time to change? My concern is making changes in such short amount of time is I loose sight of what his needs really are, and then we are just up and down for a while. I generally donn’t like making changes over one bad lunch or dinner bolus, and chalk it up to a mistake. But I get this knee jerk reaction to such lows at night.

So, we use Loop, which is automating insulin delivery based on predictions of where his blood sugar will be. It is, however, based on fixed numbers like ISF, basal rate and carb ratio. I too don’t like to fiddle with settings more than necessary, so what I typically do is use a “temp override” of, say 120% or 80%, which just increases all the settings by a certain percent. However, I also use a spreadsheet that keeps track of my ISF basal and carb ratios at every time of the day. I have bolded in the first column what I think are the default settings. That way, I never fear if I need to get back to that time period or start from scratch.

If you’re on injections, it gets a little trickier, but I’d wait for two or three days of sustained highs or lows before making changes… a little less time for lows and a little higher for highs. I’d look at TDD for the few days prior and see if it aligns with what his “normal” is, figure out if that’s *with or without a bunch of carbs as corrections, andmaybe tweak settings based on how much it is elevated/reduced.

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So, you can see honeymoon either by the amount of insulin he uses per weight (Know someone who is 90 lbs and uses the same amount of insulin per day as ours, at 45 lbs. He’s definitely honeymooning.)

But the gold standard is the c-peptide test. Most doctors wont’ run it because it doesn’t change treatment at all. But it will tell you how much endogenous insulin production there is.

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This article, from WebMD explains it nicely. Honeymoon phase will inevitibly cause inexplicable rises and falls (falls by result of the extra insulin being produced by the pancreas and highs because of your corrections to those falls). The lows that you describe could definitely be explaned through honeymooning…inexplicable lows/prolonged lows, even after corrections…because his body is producing insulin (perhaps a lot) and is pushing those BGs down.

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You recognized that his BG was falling all by itself for no good reason, so you lowered the basal. That’s sound reasoning and response, because the basal requirements can change, especially with varying levels of activity and with childhood growth.

You saw that he was ending up too high after eating. When I see that in myself it means I needed more meal bolus. If I see it a few times in a row, I change the insulin:carb ratio to give larger meal boluses.

But it was reasonable for you to take strong measures to prevent a severe low. I’ll take intentional overdoses of carb when faced with a plummeting low, and intentional overdoses of insulin when I see a rocketing high. Over time I got better calibrated, but I make sure the error is in the safe direction, and I think that’s the right thing to do.

My CDE taught me early on “If your BG is too high, you need more insulin.” It’s really that basic fact that enables me to cut through all my confusion. I like to model and predict accurately, but that’s not required to get a good result. Add insulin or carb to push the BG in a good direction. Watch what happens and do it again. I don’t worry because I know that I can handle any excursion by taking glucose or insulin. And with CGM alerts it’s a matter of knowing who’s in charge. (It’s not the Dex.) So for me the alert is just a tap on the shoulder that I may wish to look at the graph and see whether I want to do anything. No obligation, no criticism, just a nudge for attention.

ClaudnDaye finds that it works to “trust the science” and that it’s important to avoid stacking of insulin or carbs. Predict, calculate, and let the result unfold. That’s the way that works for Liam.

For myself, I’m a big fan of stacking both insulin and carbs, with frequent small corrections when I’m trying to keep ahead of a BG excursion. I use an eager approach because I want to blunt the spikes and drops soon rather than ignoring or chasing a large excursion when my predictions turn out to be wrong. I agree that multiple large corrections can lead to “the rollercoaster,” but with experience I’ve learned to push the BG in a good direction without forcing wild oscillations.

In any case, treating the BG remains a dynamic effort, especially during honeymoon and childhood. With time I learned to just treat what I see without getting an emotional reaction. Like managing the gas pedal to keep the car at the right speed, it’s frequent attention but minimal effort. Others prefer the rocket launch approach, where everything is measured and calculated, then it’s just supposed to turn out as predicted.

You’ll find an approach that’s comfortable for you. You are learning an advanced skill, and that comes with some frustration and disappointment while moving through the novice stage. I can see that you’re thinking about it in a way that will lead you to elite-level control once you’ve gained enough experience, and in the meantime you have all you need to keep Ethan safe.

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I will say; however, that during Honeymoon phase in Liam, all bets were off…I stacked everything all the time because that was the only way to combat honeymoon. Without stacking, it’s impossible (I found) to keep BGs even slightly manageable.

Once honeymoon is over you’ll find his management to be MUCH easier…there will still be growth hormone related highs and lows, but honeymoon, for us, was a time we struggled a lot.

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Yes it does. Honeymoon joy.

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I sure hope so . . .

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I was in your shoes and had very high stress levels over the fluctuating BGs. If I could have done things differently, I wouldn’t have stressed as much (which Liam saw and frustrated my wife) and thought “long term”…maraton. Days are going to be bad…there is no way to get around that no matter what superhero’s we are in management. Letting things roll off of me sooner is something I wish I’d done much earlier on. I have many gray hairs because of the endless beating up of myself that I did early on.

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That’s my approach as well. I’ll wait out highs post meals for several days, though, figuring there always may be some other factor contributing to a high other than a need for sarb ratio adjustment. I think he’s running higher now because in my knee jerk response to the lows we’ve been getting in the last several days, I’ve adjusted those ratios. I think I’m going to sit with the ratios I have now at least for a few days and see how it goes. If he’s staying high, I’ll start to bring them back down. He was about 180s all afternoon today, and of course we had a hectic than usual schedule and traffic jams and all sorts of things. So I was kind of relieved he stayed there as I wasn’t rescuing lows either. Not great, but not horrible. the past few days may have just been a hiccup, maybe a trend, who knows. I guess that’s whats stressful about making adjustments and when.

My CDE taught me early on “If your BG is too high, you need more insulin.”

I’ve seen you post this before, and sage advice. I find it so asynchronous that the mechanism behind diabetes (body quits making insulin!) and the treatment (so give insulin!) is so very simple, yet the decisions that go into day to day mangement, and the variablity between people, is so very complicated. But I do try to apply that idea- if he’s high for many days after lunch, say, well, time to give more insulin.

With time I learned to just treat what I see without getting an emotional reaction.

I need to do this. I really need to be able to do this. Fear creeps in with lows (especially those rapidly approaching ones or ones that don’t seem to abate), and frustration and confusion, even anger to some degree, with the highs. I want to get to a point where it’s not all consuming, where I can look at the numbers, come up with what to do, do it, and move on.

I can see that you’re thinking about it in a way that will lead you to elite-level control once you’ve gained enough experience, and in the meantime you have all you need to keep Ethan safe.

Thank you for that. We’re only 8 months into this. Its sobering because I think on the one hand “experience is the best teacher. the more we see, the more I’ll feel comfortable dealing with it”. On the other hand I’m like “OMG, we are ONLY 8 months into this. How in the world is this sustainable??!!”

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Yeah, my husband is much better at rolling with the punches than I am, and I have a very hard time with that. I let the events of the previous day or night or even hours completely impact moving forward. And I’ve never dealth with unpredictability well at all! I’ve said so many times I am totally the wrong person to have a T1D child.

Your husband is like my wife. She tells me that I do enough worrying and stressing for the both of us! lol…and it’s a true statement. But you may be like me and just learn “with time and experience.” Nothing anyone could have told me would have made me worry or stress any less until I just “got there” by myself.

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