These graphs look familiar to me. The hard part is getting ahead of the meal, but not so much as to go low before. I like to use the “car going over the hill” analogy. Give a small amount of extended bolus about an 0.5-1 hr ahead of the meal (get your car rolling), give a prebolus 15min before the meal (giving some gas to get over the hill), and extend the rest of the bolus (lay off the gas and put in cruise control).
Looks like each spike is prefaced with a pretty steep drop. If you give an extended bolus ahead of time, it may lead to a lighter drop beforehand. As always, everyone is different and this strategy may or may not work.
Trying to predict what your child eats is hard. Trying to predict how active your child will be is hard. Basically, even the best strategy won’t work 100% of the time. You will have an especially hard time because it takes such a small amount of insulin to make drastic differences–which means a small miscalculation turns into a big mess.
I’m now intrigued. Do I request this from Lilly? Do I need a prescription?
I’ve asked my endo about diluting, and he replied to me to not go there. Quantitatively speaking, it would make more sense to dilute for more accurate measurements. Of course realizing that the insulin is now diluted.
Yes, Lilly will send it for free. You just call them and tell them you need to dilute your Humalog. They may ask you for some information, but nothing too bad.
You do NOT need a prescription, but Lilly won’t send it directly to you. They will either send it to your doctor or your pharmacy. If your doctor is not on-board, you can just have them send it to your pharmacy and you pick it up from them. I guess they do that for liability purposes, or whatever. I do not know why, it’s a little odd.
Why is your Endo not on-board with you for this? What is your TDD? Diluting makes so much more sense. You get the same granularity that you can have with a pump.
Sometimes Endos…I dunno. If someone wants to take a fraction of a unit, why not let them?
I can send you some vials. I have a bunch of them.
I wonder if this varies state-by-state? When we ran out of Diluent we called the company and and the pharmacy and they said they couldn’t give it to us because it was not a prescription item. In the end we had to go to our doctor’s office because they were the only ones who could get it. Maybe we just got people on the phone who were not knowledgeable? Regardless it was a huge hassle.
no it has some preservatives and stabilizers too. I mean, it’s possible saline mixed right at the time would be fine, but I wouldn’t personally experiment with that to get better accuracy. You’re trading one source of variability for another, and in my experience, the diluent made the onset of action for the Humalog more unpredictable.
The diluent is PH balanced to match the insulin and mix completely. It is designed for a homogeneous mix. I imagine saline would do the same thing, but not be as stable.
I think using saline in a small batch that don’t have to live long is relatively safe. But if you want it to be stable and last longer, using their diluent is the way to go.
I guess I could get some random saline, mix it in a bottle, let it sit out a month, and try it. I’m game for something like that.
Did you call Lilly Pharmaceuticals? That’s who I called. I got it for nothing but asking, but just had to get it sent to my local pharmacy, that was the only restriction.
My TDD is usually 12 split 50/50 between basal and bolus. I would prefer to have the diluent so that the measurement is easier when using the syringe. If I want to correct with 0.5 unit or less, it’s not easy. My BG is generally pretty good about 80% of the time. It’s when I engage in social eating that’s a little more challenging.
I may inquire at my pharmacy- I use Novolog presently. Therefore the Lilly Humalog diluent may not work.
NOVOLOG may be diluted with Insulin Diluting Medium for NOVOLOG for
subcutaneous injection. Diluting one part NOVOLOG to nine parts diluent will yield a
concentration one-tenth that of NOVOLOG (equivalent to U-10). Diluting one part
NOVOLOG to one part diluent will yield a concentration one-half that of NOVOLOG
(equivalent to U-50).
I’m currently having this issue with breakfast. We are currently at a 1:7 carb ratio in the morning! We were at 1:10 for a while, then 1:8, and recently 1:7, and yet I’m still watching his blood sugars climb to about 220 after breakfast (2 kashi protein waffles, scrambled eggs, milk, for a total of 38 carbs). We have better morning numbers with breakfasts that have sugar subs in them (low carb cereal, muffins with sugar subs, etc), managing to stay under 160ish. My concern is how much lower do we go for breakfast??!! Although I don’t routinely check, he does seem to have ketones in the morning. The hightest was 1.7 on a blood meter and when I called about it the nurse said not to worry as they are just starvation ketones. Sure enough, they come right back down after he eats and remains that way for the rest of the day. I’ve checked randomly on a few days and I will see ketones, though not always that high, and they always come right back down and stay that way (so I’ve quit checking again). Anyway, I’m guessing this is contributing to the insulin resistance in the morning? The rest of the day he is around 1:10-1:12, which is still fairly agressive, but that seems normal for kids??
For a high-protein, low-carb meal, dosing for the carbs alone won’t be enough. That’s not an insulin:carb ratio issue, it’s the fact that dosing for carbs alone presumes that the carbs in the meal will be the major source of glucose after eating, so we can ignore the protein. To dose for a low-carb meal, consider the fact that about half the grams of protein will be digested into glucose over a period of several hours. Either that, or just overbolus before the meal and make ongoing adjustments over the next few hours.
Our body determines how much insulin we need. The notion of “normal insulin:carb ratio for kids” is somewhat dubious. Given a good basal, the right insulin:carb ratio is one that generally brings the BG below 140 a couple hours after eating, provided it doesn’t cause a hypo a couple hours after that. In that latter case, either try a smaller dose of insulin pre-bolused earlier, or just add a small snack a couple hours after eating to head off the future low.
I think his basals are fairly good in the morning hours. Although we haven’t fasted (finding that much difficult) taking advantage of a slower weekend morning indicates we’re set pretty good.
Huh. Great idea. I think this was mentioned in the thread, to “rev up” his system. Problem I have with prebolusing the full amount is it drops him like a rock pretty quickly (and I can never quite predict his pace in eating). I think trying to get a unit or two on board as a prebolus then giving the rest at the onset of eating is worth a try. He is on control iq, which will huff and puff and decrease/suspend as he starts to drop, but perhaps the smaller amount won’t hit as hard.
I make pancakes once a week and would love to take that spike!
Trial and error is the easiest way, although the article that CatLady posted is helpful to understand what is happening. The tools you have available are pre-bolusing, over-bolusing, and using an extended bolus. I’ll bet you nail the proper combination in no time.
I get this too, when pre-bolusing for higher carb meal. I use an extended pre-bolus for 30-60 minutes that counters some of the basal decrease/suspend. I wish I could tell the pump “more carbs coming soon, don’t suspend”. Of course can turn off CIQ, but need to remember to turn back on.
