67 and 545!

I saw both of those numbers today - yes, I did.

We have many days where we rarely see over 200 - except at breakfast(which I'll discuss in a minute), so to see 67 and 545 in the same day was quite a feat.

Now that Emma has finally kicked her bug, she has a couple of trends that I want to address. The first was the SPIKE that she has after breakfast - she can easily hit 350 to 400 at the 2-hour or even the 3-hour mark after breakfast (she has a 5 hour IOB). So, I wanted to try what so many on the Children With Diabetes board suggest - pre-bolusing. I had discussed it with the CDE and a couple of different approaches. Today, I wanted to just be simple. Estimate her carbs and then dose her when she sits down to eat (instead of after). That will give the insulin a 20 minute head start.

So, we do that and her 2-hour reading was 250 - not bad. But, then I realized that might not be good at all. A quick IM to Mike confirmed that she had NO protein at breakfast. Without protein, she SPIKES really high and then PLUMMETS to a low because the insulin can't catch the food. I don't know WHY Mike thought we could leave out the protein, but oh well. So, today wasn't a good test of the pre-bolus. That's where the 67 came from - at lunch.

So, I gave her some juice and then her lunch, did a slight negative correction and she went down for her nap. I set her a temporary basal rate of +20% when she goes down for a nap because she always goes HIGH. Well, definitely she did that today. She woke up at 545! Turns out we were at the full 3-day mark for her site - and her sites don't last 3 days. So, I did a quick site change (if I don't have to reload the cartridge or prime new tubing, I can do it very quickly) and gave her a correction to handle the 545.

But, the 2nd trend I wanted to treat today was perpetual lows right before dinner. Its usually between 4:30pm and 6pm that she drops - just about every day - whether she has a nap or not. Mainly because that is our running around time and she is often running down the sidewalk at Tae Kwon Do, or on the soccer field. So, I decreased her basal rate at 4pm (my first change in basal on my own without asking the CDE). But, I couldn't test it because of the 545 at 4pm that had to be treated.

So, two changes tried and none able to test the result. We'll try again tomorrow.