We know this one well 
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It already feels sometimes like a game of chicken. Where is the line between holding your nerve and respecting the disease? This morning I bolused Juno 2 units as he was already 120 and the breakfast was not carb rich. 45 minutes later heās edging 200 and Iām wondering if just the timing was off, or whether in the morning ā or even just this morning ā heās less insulin sensitive. I make a 1 unit correction. Over the next hour and a half, he drops 120 mg/dl. At 84 and -10 mg/dl Iām wondering how far this can go. Should we do anything? We ride it out and now heās 88 +6 mg/dl. Five minutes later, 91 +3 mg/dl. So a great number.
What do we learn? 1) Timing is key. Weāre still feeling our way. 2) Every hour weāre learning. Weāre just at the beginning.
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Took me a ridiculously long time to learn that. I think itās evidence youāre paying close attention. Itās an important part of managing the disease. Things can change often, but if you are looking, youāll collect tools for dealing with whatever you see. Canāt do that if youāre not paying close attention. I think you all are doing an amazing job, and youāre picking it up quickly. It is just the beginning. Which means pacing yourself is also a good idea. 
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Hi Iām totally late to this discussion, but there were a few things I wanted to say
- Based on your graph above and how much you seem to be open to learning (and learning fast!), I think youāre doing fantastic for such a recent diagnosis!
- Regarding the discussion above for lows overnight, when I was diagnosed (16 years ago) my parents were told that icing was a good low treat for night time (not sure if this still holds true - just wanted to throw another idea out there). (Also not sure if icing is easily found in Egypt, but again I just wanted to offer another option.) Iāve personally only used icing a handful of times over the 16 years, but I believe you can put it on the inside Junoās lip and it still helps treat a low (someone please correct me if Iām wrong!)
- Regarding the discussion on pumps above: pumping would definitely help with being able to give smaller boluses - huge benefit. However, I believe that being on MDI for the beginning of diagnosis is essential to learning how the disease works and also how to handle it if the pump ever breaks. Also - I can attest to using tubed pumps as a child, and I felt like the tubing with the pump never held me back from being like the rest of kids and enjoying my childhood
Itās all totally personal, but I can see why the omnipod is the most appealing of pumps even if itās not available yet
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It is as good an option as any other sugar source that can be ingested when very low. I think that many people think that sugar can be absorbed by the gums, so smearing sugar (icing) on the gums will result in some absorption. I remember reading a study on here that showed this was untrue, that the gum absorption pathway was limited. With that said, if you put icing in most peopleās mouths some will find its way down the gullet, and will raise blood sugar. We honestly have never had a low where my son couldnāt swallow, so we havenāt had to test.
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@Nickyghaleb @LarissaW Thank you both for your kindness. I really appreciate it.
I recall the statistic on how many on average donāt survive DKA, and I know weāre lucky, and need to continue to earn our luck. Courage and caution, and as you infer, Nicky, endurance.
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Your son picked his parents wisely it would seem @ianrobertdouglas
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What of sublingual (under the tongue)? Was that shown to be any better?
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Funny, I was just reading about that the other day. Apparently no, itās no better.
https://costr.ilcor.org/document/methods-of-glucose-administration-in-first-aid-for-hypoglycemia
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Thank you @Beacher for posting the article.
Under Treatment Recommendations it mentions that oral is the favored for
individuals with suspected hypoglycemia who are conscious and able to swallow .
The process then becomes a tiered response:
We suggest against buccal glucose administration compared with oral glucose administration
and goes on to say,
If oral glucose (e.g. tablet) is not immediately available, we suggest a combined oral + buccal glucose (e.g. glucose gel) administration,
followed by,
We suggest the use of sublingual glucose administration for suspected hypoglycaemia for children who may be uncooperative with the oral (swallowed) glucose administration
Edited to add:
All but oral administration is said to have a
weak recommendation, very low certainty of evidence
Oral has a very low certainty of evidence, but has
strong recommendation
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So are some adults. Iām glad Juno has you guys on board to help out. 
While Iām the partner of an adult with T1D, whoās now using a pump, I can say for the first ten years after diagnosis pumps were out because of tubes for EH. He didnāt want tubes. And honestly neither did I. So the OmniPod has been a really good compromise between no tubes and having a pump and regular jumping and playing and living without thinking about the pump, even though EH is sometimes bummed to have something stuck to him all the time. (Clearly some of us are worse at leaving childhood behind than others. 
)
ETA: of course I replied for reading all of the rest of the responses, so I see that the OmniPod is not available for you presently. I will also add that itās possible to cover the entire thing with a big sticker and it holds on fairly tight. But a pump of any variety will give some flexibility with the micro dosing youāre interested in. And it sounds like many kids use tubed pumps with no problems. 
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Thank you @TravelingOn I much appreciate your kindness.
Okay, given that I opened the thread, perhaps I can widen it a little and sound out others for more general advice.
In the game of chicken, Iām starting to feel the nerves.
As I said above, we started out with a prescribed 7 units of Apridra per meal (7am, 3pm, 7pm), in addition to Junoās basal rate. In the last couple of weeks it became clear that we were feeding the insulin. Juno was not just restoring lost weight, but noticeably putting more on. I scaled back the doses and tried to calm his overeating. His sensitivity to insulin appeared to grow.
Now, literally one unit will take him down anywhere between 90 and 120 mg/dl. I aim that he sleeps somewhere around 150. He climbs at night, but falls in the early hours (around 4am). When he climbs, heās usually above 200 (210-230), and for several hours. At 4am, heās around 65. So if he goes to sleep too high, he will be much higher for hours in his sleep. But if he goes to bed too low, we risk a real low at 4am.
But above all, as I try to nudge him in the right direction towards bed time, Iām almost scared to bolus at all. Just imagining that if he eats when heās 130 and takes 1 unit it could otherwise lead to seizure if he didnāt eat is pretty incredible.
Today we bolused one unit and he had one Skittle as well to reduce the impact given that 1 unit is the smallest we can administer with the pen and I judged it too much at the time, though he needed something to avoid going high.
Obviously, Iām eager to get Juno on a pump, as I said. But in general, has anyone experienced this kind of insulin sensitivity, and if so, do you have any pointers on how to handle it?
In solidarity.
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Very nice summary, @Tapestry!
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Right after you are diagnosed, after the first few weeks you are sometimes very sensitive. At the time, our CF was in the 70-80s but it worsened quickly 
Parents of toddlers, of course, face the problem daily for a while.
However, one thing I suggest is to switch to a pen with 1/2 unit capability. I know several people here like to do fractionals by diluting or other methods. For us 1/2 worked fine, and it is a really easy switch that makes a world of difference.
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Thank you. I will go searching tomorrow in Cairo to see if I can find a NovoPen Echo. A pen that can administer 1/2 units would be a step in the right direction.
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This is really common, by the time your son ended up in DKA he was literally starving. My son when insulin was restored started feeling better and ate like a horse, when he gained enough weight we mentioned something about it, and he literally broke down. It was one of my sadder diabetes moments, when I realized I needed to intervene but really couldnāt shoulder more of the burden. Sad dayā¦
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This is also pretty common, you now realize how serious and how easy it is to overdose on insulin, and want to do it right every time, but donāt have enough experience. Relax, this will pass as everything becomes the new normal. You are doing great, and if you royally screw up you have the glucagon. Wait for the first time you mix up basal and bolus insulin. Your son will get to eat his way out of a real mess, hopefully there is something he likes around when this happens.
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Yes, that or consider using syringes with smaller amounts for the time being. It is possible to draw out of the end of a pen with the syringe.
Those micro doses for younger people (or the old guys sometimes too!) can be hard to do with the pen.
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Indeed. And this becomes very real when an overdose could be as low as 1 unit. This is what is unnerving right now. The wiggle room for screwing up feels quite narrow.
Still, weāre lucky. Weāre lucky to be this far. Weāre lucky to be here. Weāre lucky to have gotten the G6 in our hands. We keep going.
In my youth I used to jump out of planes. I was telling my son yesterday that riding these waves feels like landing a canopy. You need to judge the final turn well, else you hit the ground or land half a field from the target.
Thereās also an echo of the part of the skydive that precedes a safe canopy unfolding above your head.
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Be careful not to spook him too much though We try to give our son the feeling that this is just a fairly normal day-to-day thing that is part of the routine like brushing your teeth. We donāt want him to feel limited or afraid in any way, just careful, like he would need to if he used a power saw or an axe. In fact, this is exactly why FUD exists: for those who want to be #UNLIMITED.
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