hi, my son is using NPH, a insulin peaks in 6-8 hours. I was told to check him only before meals. However, there are a lot of moms told me they checked their kids every 2 hrs. I know only checking before meals doesn't give the whole picture of how his sugar would like during the day. I am wonder how other moms are doing? I just think it is very hard to manage high before meals with NPH.
Our son is on Humalog/Lantus, so it's a different program. But when he was first diagnosed the hospital had him on NPH. If I remember correctly, I was instructed to give him a sliding scale correction for highs before meals. Is this what you are doing? Are you able to give him corrections at other times of the day?
When our current endo switched William to Humalog/Lantus, he told is there will be more testing, more shots, and more work, but that, for kids especially, you can achieve better BG control with this program. We generally test about every 2.5 to 3 hours during the day, followed by a meal/snack and/or correction. I usually have a pretty clear picture, from day to day, of what his BG does at different times of the day, and he is able to eat just about whatever he wants to at meal/snack times because his dose is based on the carbs he will be eating, as well as his current BG.
I *personally* feel that Humalog/Lantus (or another rapid/long acting combo) is a better option for kids who do MDI. It's more flexible, and allows you to respond to events that affect BG, like exercise, unexpected snacks/delayed meals, illness, growth spurts, etc. There are sooooo many factors that affect BG, especially with kids, I know it would be far more difficult for me to manage William's BG if he were on NPH. You may want to consider asking your endo if you can switch programs, or find an endo who would support a switch. JMHO.
our son is on the pump and we typically test him every 2-3 hours. More frequently at night when we are trying to get his #s under control before bedtime. He started out on NPH and it was very difficult to deal with since the timing of the afternoon peak was so variable.
Is your son using a short acting insulin (Humalog, Novolog, or Regular) in addition to the NPH? If not you might talk to your doctor about it. The short acting starts working quickly and is out of the system in a couple hours. They're ideal for treating pre-meal highs or correcting a high blood sugar.
People who use pumps or Lantus use short acting insulin and test every couple hours because the effects of the short acting can be seen by then and if blood sugar is still high, a correction can be given.
Test whenever it makes sense. It's can be different every day. Before meals is good. I'd probably add a test first thing in the morning and also before going to bed. Your son should also test before and after extended exercise and anytime he feels off.
Don't judge yourself against how others test, find what works for your son. Testing isn't useful unless you're using the results to make adjustments or catch a low.
There are great books that can help you, including this link for the Barbara Davis Center Pink Panther Diabetes book.
Others that you may be able to find at your library and for sure at Amazon are:
Think Like a Pancreas by Gary Scheiner
Using Insulin by John Walsh
T1 since 1977 Minimed pump since 2002
My son is on Humalog/Lantus as well. We usually check before breakfast, at recess at school, before lunch, after school, before dinner, after dinner and at bedtime. We check any other time he does not feel well or when we are trying to bring his sugars up or down we will check more often
Technically, the more you check the better you will get a picture of your son's blood sugar. That being said, you need to find what works for you and your son. If he is well controlled then he could probably test a bit less but the minimum recommend amount is at least 4x per day before meals and bedtime. However, most parents I speak to test on average of 6-10 times per day.
I agree with Monique (I think we talked about this once) that a quick acting insulin for meals is great although my son takes Humalog/Humulin N at breakfast, Humalog at lunch and dinner and Lantus at bedtime.
I am looking into the pump for him and I just started the pump myself a week ago today and LOVE IT. The only issue is getting use to carrying the pump on you at all times. I don't even mind the tubing but it is attached to the pump which stays on you 24/7 so not sure my son will like having the pump on him at all times.
Is you son taking NPH twice a day and that is it? I really don't think this is the best protocol given all the other available insulins out there :-(
My daughter is on Humulin N at breakfast and Humalog at breakfast and supper. We check 4x a day and more if we are trying to make adjustments to get numbers under control. I agree that you test with what works for you and your son. If things are working well, his A1C is acceptable, then checking when you are should be fine.
Jodi, I find it interesting that your sone takes humalog at lunch even when he takes N at breakfast.... shouldn't that dose control his lunch carbs? Just wondering why the extra dose there? We don't do that (but currently my daughter had been quite high at supper so wondering if I should ask about a dose of Humalog at lunch to help?) I don't care for Humulin N either, b/c of its lack of predicatability regarding peak times but if we can get it to work, then when my daughter is school aged we avoid insulin at lunch at school when she won't be old enough to give it herself (and the schools won't, of course.)
thank you for all these great conversations, my son is taking Humalog and Humulin N (NPH) before breakfast and supper. The reason why I asked because occationally i checked him more often and found his sugar is outside the range between meals. although his AIC is good but the peaks worries me, so I am thinking I need to work out something works better. We are also thinking a pump for him too.
my son is too young to use Lantus as this is only approved to use for kids over 6. So to get better control and flexibility. pump is the better choice.
Any reason why not use pump?
Weide- Biggest disadvantage for using a pump on small children is there are limited infusion site areas. I'm petite (5'2") and sometimes struggle to find skin that's not overused. However, a child's tissue probably recovers faster, so maybe it wouldn't be an issue. Overall I love the pump and think it would be especially good for kids because you can tailor base rates and easily take insulin to cover a meal or correct a high. I did shots for 25 years and I've pumped for almost 10. Would never go back. I have more flexiblibily, a much improved A1c, and rarely have lows!
Jen- How high is your daughter at supper? Test your daughter's blood sugar about 2 hours after she eats lunch and if it's high for 3 days in a row, then talk to your doctor about options. You can add a Humulin dose at bedtime, or test 30-60 minutes before dinner and if blood sugar is high then give Humalog early so it can start working on the high blood sugar before eating dinner. You could try a Humalog dose at lunch. Even if she didn't do it on school days she could do it on the weekend/holidays. Not sure how old your daughter is, but as long as someone checked my syringe to make sure I drew dose correctly I gave my own shots by age 5.
We added Humalog at lunch because even with 14 units of Humulin N at breakfast along with his sliding scale of Humalog 4/5/6/7/8 for his breakfast he was always high at lunch. Our goal is to get him off of the Humulin N and just be on Humalog for meals and Lantus at bedtime. However, of course when you make major adjustment then his sugars may go high and I don't like to do this during school time.
Right now this system is working but hope to get off the Humulin N at some point.
Since my son is very inactive (especially in winter), he is more the creative type, his sugars are not as good as in the summer.
Whatever works! Right Jodi! Jenna, my daughter is only 3. We were giving her Humulin at bedtime, but have cut this out as she consistantly bottoms out between 4-6am. I learned that if I checked her at 4am and she was not above 12, she would be below 4 by breakfast at 7. If she was below 12 at 4am I would recheck at 530am and if she was below 9, I would have to give her juice or choc milk just to get her thru til breakfast and aviod a low. Our diabetes team, suggested getting rid of it for the time being. (Even 1/2u of N was too much) She now runs a touch high earlier in the night- around 14 (12 is high end of norm for her) but it was decided that this was better for now than waking her and feeding her every night or ending up low (she never wakes up if she is low). Also, Jenna, the problem with giving humalog early is that at 3 I can't really predict what/how much she will eat. I usually give the insulin mid way thru the meal, unless she is very high, then I give it just before she eats. She is still in the honeymoon phase (barely, I am thinking) but that sometimes presents another challange as she will put out her own insulin and screw up all my figuring! :)
I actually give my son's shot after his meal if he is in the normal range as I am not always sure if he will eat the full meal. If he is in the higher range then I give the shot first.
At bedtime, I also know his patterns as far as if he is 10-12 at bed he will normally wake up in a good range. If he is higher than 14 he will probably wake up a bit higher.
Last night, I gave his Lantus shot and drew blood. His sugar dropped from 14.5 to 5.4 in 2 hours. I had to give him 15 carbs of fast acting. He went up to 8.9 and then when I checked him at 3:00am he was down to 7.1 so fearing that he may continue to drop I gave him 9 carbs (he uses swedish berries and each one is 3 carsb-very portable since he does not drink juice). He woke up with 9.0 so really I think parent knows best and after some time has past (at least with an older child) you begin to see patterns.
If my child was very young like your daugther Jen, I would hold off on giving the shot until after thet meal as well to make sure she eats unless she was too high to start with.
I swear it is like have an MD and a science degree all in one.
The fact that the parent has to manage and treat this disease I believe takes a toll on parents. All the responsibility falls on us. Nevermind for parents like myself who are also diabetic and have two people to look after.
Good luck to all :-)
Is anyone out there now, I feel like crying. my son's sugar is consistently in the range of 14 today,
Weide: I'm sorry. We've all been there. Sometimes when you do everything right,diabetes doesn't "listen." It's like trying to push a stubborn elephant. Be sure to cut yourself some slack. You can only do your best, and it's clear to me that you are an amazing, conscientious parent. That's the best thing your son could ever have; it's even better than perfect numbers. Hugs from NC.
Thanks, Red, just feeling like i am going to fail him. Keep worrying his life would be if he ever gets complication. It affects my daily like, i can't concentrate at work. i JUST want to stay home with him. scared and worry.
What goes up, must come down. I can guarantee his BGs won't stay in that range forever. It's when it stays consistently high over long periods of time (through neglect and/or poor treatment) that complications become a sure thing.