# Highs without food?



## Heidi (Apr 29, 2010)

Help please! 

Ross is into the 'honeymoon' period - over the last ten days or so his insulin requirements have dropped more and more - great! 

However, today after a couple of hypos during the day - mid-morning (we still haven't got breakfast/novorapid/going to school sorted) he's continued to rise. He ate hardly any lunch - he was high just before (12.8) and the school phoned me in a panic, he then had three or four mouthfuls of lunch but didn't fancy it - he'd had 4 units of novorapid so had to eat something. Later he was 7.7, then he had his second hypo - down to 3.1 which he treated with lucozade tablets and since then he's just continued to go up and up - he's just tested now and is 13.9 but he's eaten NOTHING since about 2.30pm! 

I'm not happy that he's gone that long but he's continued to feel unwell and be high ever since mid-afternoon.

I suspect his liver is dumping glucose as a result to a hypo we missed but I'm not sure what we ought to do now....do we go ahead and feed him (we have to somehow, even if he doesn't want to eat) or do we wait and see?

Any ideas?


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## bev (Apr 29, 2010)

Heidi said:


> Help please!
> 
> Ross is into the 'honeymoon' period - over the last ten days or so his insulin requirements have dropped more and more - great!
> 
> ...



Hi Heidi,

If he was high before lunch it could be because he is coming down with something. Any illness or infection will send levels high - unbelievably high. Alex has been on 230% more insulin when he has had a sniffle of a cold.

His basal could be out - and if he didnt eat much for breakfast he is lacking novorapid which would mask the fact that the basal is out normally.

Did he eat enough carbs for the 4 units at lunchtime? If not - this is why he was hypo (3.1). How much hypo treatment did he have - did he over treat? If not - and he didnt eat enough food - he is coming down with something - it can appear days before you know he is ill.

Have you checked for ketones? Are his sites lumpy - meaning absorption isnt as good as it should be? Is his insulin in date?

If he doesnt want to eat - give him something to drink. If he has ketones - cover with insulin for the drink and correct the high. If he doesnt have ketones - leave it for an hour or so - because if he has had a liver dump (doubtful) it is best to let the liver recover which takes 24 hours or so - so let him run a bit higher for 24 hours as he is at risk of another hypo if you give too much insulin. He can still eat something - but you need to give insulin for it - maybe a little bit less to be on the safe side.Bev


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## Heidi (Apr 29, 2010)

Thanks Bev,

He did eat - I 'suggested' it would be the best thing to do...He also had his normal novorapid - we're not yet adjusting for carbs. 
Since eating he's had a hypo - in fact we just tested and he's down to 4.1.

All over the flaming place! 

I suspect you're right about him coming down with something. We did check for ketones - fine. His insulin is all in date - he's changed over both pens since he's been diagnosed five or six weeks ago. I haven't yet checked sites for lumps - if he'll let me I'll have a look in a moment. 

I also have a sneaking suspicion that diabetes is intelligent and sneaky - it must have heard me saying only earlier today how much smoother things have been for the last week! Grrr!


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## bev (Apr 30, 2010)

Heidi said:


> Thanks Bev,
> 
> He did eat - I 'suggested' it would be the best thing to do...He also had his normal novorapid - we're not yet adjusting for carbs.
> Since eating he's had a hypo - in fact we just tested and he's down to 4.1.
> ...




I hadnt realised you werent carb counting yet. I would suggest that if your giving (for example) 4 units for a meal and your son doesnt want to eat much - then I would drop it to about 2 units, otherwise he will certainly be hypo within the hour. If he is high - then still do the correction dose - but never the full amount of insulin if he isnt eating properly.Bev


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## Patricia (Apr 30, 2010)

Hi Heidi

Sorry I missed this! And haven't yet responded to your email -- but looks like events have overtaken anyway, darn it!

Agree with Bev here. Unless you are carb counting, the units of novorapid given are more likely than not to be off in some way or another -- UNLESS R is a very, very routine eater. The patches of things being smoother are in a way the honeymoon making small adjustments FOR you... So the minute insulin adjustments sometimes don't seem as important -- until you get hit by this!

However, it's pretty much anyone's guess when the pancreas splutters around in honeymoon. Some people get it for months and months, some seem to go through it in a matter of weeks. We seemed to have a 'short one' -- about six months -- but even during that time, as you are finding, there were long stretches where we seemed to be all over the place.

You are also finding the other thing that is a bummer: hypos can of their very nature send things all over the shop. Carb counting will reduce the chances of hypos generally -- BUT once you correct a hypo, you will go up -- but usually OVER where you need to be. The body also seems to naturally compensate in some way, esp I think on MDI. The more hypos, the more swings. It's like trying to herd cats, and you don't know which end to grab first. Do you treat the highs as a pattern to grab and treat, or the lows? 

The unexplained high, as Bev says too, may well be a basal which is running out or not right for today. This may be usually 'masked' by a meal novorapid, so you only find out the basal problem when he's not eating...

And then of course there's the whole variable of maybe coming down with something! So all of this might be tosh. 

Sorry. Get carb counting as soon as you can, as I know you will. You will still have swings all over the place, but you have more tools at your disposal to deal with them when carb counting.

Sigh. Sorry Heidi! Feel free to ring...

xxoo


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## Heidi (Apr 30, 2010)

Thank you both!

Things just deteriorated from then on last night - Ross was up with the OH until about 1am - I was unceremoniously sent to bed where I'm afraid I simply passed out. He was checked again at 3am when he was within range. This morning he was utterly exhausted so no school. Fortunately today he's pretty much kept in range and all seems back to normal. 
So who knows what on earth was going on then? *sigh*

Add to all of this it's my dad's 70th birthday party tomorrow - everyone is going into meltdown over the preparations and Ross is worrying about what he can and can't eat. 

I'm seriously considering going out for the day with Ross and we'll leave them all to it!


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## Patricia (Apr 30, 2010)

Heidi, try to get a shed load of no carb stuff in for him: cold sausages, cheeses, cold meats, does he like any salad? Then you can give him an actual meal of sorts with everyone else, but if there's snacking, you may be able to hold him back. Other than that my advice is to under-estimate everything for the moment of course!

Are you doing correction doses yet? If so, you can pick up the pieces later, eg a couple of hours after the last time he eats in the evening you give him an injection with no food. Then I'm guessing you will want to get up in the night to 'check' the correction dose is okay, but it may feel better than leaving him high all night?

If you are not doing corrections, then it might be tricky? But at the same time, it *is* a party, and he needs to not feel left out more than he has to. 

Let me know if you are doing corrections. Hanas may be a help here.

xxoo


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