# 1 week since diagnosis - BG still high



## JessD (Dec 11, 2020)

We’re still coming to terms with my son’s diagnosis. He’s 14. We haven’t been able to get his blood sugars in the normal range and we’ve been out of hospital a week now. He was 22.5 two hours after his supper this evening. They just don’t seem to be prescribing enough insulin. I’m so worried that his levels have been so high for so long. Is this normal for a newly diagnosed person?


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## Drummer (Dec 11, 2020)

As it is late ish, although I am not using insulin I read a lot of the posts, and I think it is usual for levels to be brought down slowly to reduce the shock of large alterations. 
Have you been given any sort of information about counting the carbs in a meal, or what sort of numbers of carbs the insulin is expected to deal with?


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## JessD (Dec 11, 2020)

@Drummer We did our carb counting training today and they programmed his smart meter to calculate his doses. We started from lunchtime but his levels are as bad as/worse than when we were doing fixed doses. I thought more tailored doses should improve things.


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## Inka (Dec 11, 2020)

HI @JessD Are you able to test for ketones?
While it’s true levels will be brought down slowly, 22.5 is too high really. What ratios has he been put on for his meals?


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## Lucyr (Dec 11, 2020)

It’s normal for the ratios to be very cautious at first and to then need increasing over time, as reducing blood sugars very quickly can cause additional problems. Do you have more appointments set up to review the doses?


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## Inka (Dec 11, 2020)

And what was his blood sugar _before_ his evening meal?


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## Drummer (Dec 11, 2020)

Perhaps it is a matter of fine tuning for foods - I know that if I eat peas or beans I react as though  had eaten twice as much.
You are not alone in finding it difficult to sort out doses, particularly in the early days. Were you told about correction doses, that is another thing I have read, to correct any misalignment of food and dosage once it is detected.


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## JessD (Dec 11, 2020)

Inka said:


> HI @JessD Are you able to test for ketones?
> While it’s true levels will be brought down slowly, 22.5 is too high really. What ratios has he been put on for his meals?


His ketones are good. Consistently very low. They only programmed his smart meter today. I think his insulin to carb ratio is 1:15/1:14 depending on the time of day.


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## JessD (Dec 11, 2020)

Drummer said:


> Perhaps it is a matter of fine tuning for foods - I know that if I eat peas or beans I react as though  had eaten twice as much.
> You are not alone in finding it difficult to sort out doses, particularly in the early days. Were you told about correction doses, that is another thing I have read, to correct any misalignment of food and dosage once it is detected.


As we’ve only just started carb counting, they’ve told us not to count veg for now (except for starchy veg like potatoes). He’s not a great veg eater though at the best of times! We have been told to test 2 hours after meals and give a correction dose as indicated by the smart meter.


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## JessD (Dec 11, 2020)

Inka said:


> And what was his blood sugar _before_ his evening meal?


13.3


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## JessD (Dec 11, 2020)

Lucyr said:


> It’s normal for the ratios to be very cautious at first and to then need increasing over time, as reducing blood sugars very quickly can cause additional problems. Do you have more appointments set up to review the doses?


Due back at the clinic next Friday. The nurse is going to ring us before that though so she might suggest we change his insulin to carb ratio before Friday I guess.


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## Lucyr (Dec 11, 2020)

The ratios are set by starting with a cautious guess then adjusting by trial and error. It’s totally normal to not have them quite right yet and I’d expect they will increase doses at the next appointment. Keep an eye on the ketones and hopefully things will start improving.


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## JessD (Dec 11, 2020)

Thank you. That is reassuring. Everything feels so out of control but it’s early days.


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## Inka (Dec 12, 2020)

JessD said:


> 13.3



That will be part of the problem then. Eating on a high blood sugar tends to push you higher than the same meal on a normal blood sugar.

Even so, I’d think his ratio needs looking at (presuming you counted the carbs right) and perhaps his basal dose too. That’s all quite normal. 

Personally I’d be phoning the nurse rather than waiting for them to phone next week. I’d also ask about the blood sugar range they were aiming for your son to be in, just so you know.


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## trophywench (Dec 12, 2020)

Contrarywise somewhat - I think it sounds like his basal insulin dose(s) need tweaking too cos until you get the basal as right as it can be right now (which is always temporary anyway cos things need tweaking quite a lot as time goes on) you can't crack the bolus doses.

Patience!!  This is a marathon - not a sprint!


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## pm133 (Dec 12, 2020)

JessD said:


> His ketones are good. Consistently very low. They only programmed his smart meter today. I think his insulin to carb ratio is 1:15/1:14 depending on the time of day.


Hi Jess, just to add that those ratios are very small amounts of insulin so there's plenty of scope to increase gradually. To give you an idea, I ended up at 1:7 bolus and 22 units of basal.
Because of the high post meal reading and the high pre meal reading, I would also press for a more rapid increase in bolus and basal.

Try not to worry too much.

Good luck.


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## trophywench (Dec 12, 2020)

Of course it is wisest to reduce high BG slowly since doing it mega quickly can certainly cause damage eg retinopathy - so let's not risk going there!!


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## Thebearcametoo (Dec 15, 2020)

Frustratingly you’re still at the data gathering phase. With a new diagnosis it will take a while for them to get an idea of if his body is still producing insulin or not, how sensitive he is to the insulin, and other factors. How was he 4 hours after his insulin? Whilst novorapid works hardest 1-2 hours after injecting it does keep working for 4-5 hours after and sometimes we can see with the CGM that my daughter only gets back into target 4 hours after injecting but if we up the ratios she will be hypo 4 hours after injecting. What you may have is that the ratios need a little tweak but it may also be that actually it’s about the timing of the dose. Keeping a record of what he eats (the foods, the carbs, and roughly how fatty it is) may help you work out when to give the injection. Sometimes 20 minutes before a meal is needed. Sometimes splitting the dose so some goes in later is needed. But right now you’re still data gathering so don’t worry about making too many changes just yet. Him going up to 20+ isn’t ideal but is very different to him staying at 20+ for long periods so don’t panic. Keep in touch with your team. Keep data gathering. Have patience.


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