As I predicted in “Diabetes is MINE” post, the time has come when Mr T wants to be more in control of his diabetes, when HE wants to do it by himself, especially when away from us. With that, came a time of making mistakes and that is fin. We all learn best through our own mistakes. Of course we are there to catch him when he falls and to help him understand and learn from them.
The two “HI” readings, identical on the surface, had two completely different background stories. Two different causes required two totally different approaches to correcting them. This is what happened:
CASE OF HI 1 Talking through the earlier events we figured Mr. T had counted the carbs incorrectly: He counted significantly MORE carbs than there were. Therefore giving MUCH MORE insulin than needed. (nearly 3 times more) Result : BG dropped too low and then rebounded. Liver dumped Glucagen sending BG sky high - HI We corrected by doubling the normal correction. We increased the temp basal by 100% for 2 hours. Liver still keeps dumping Glucagon, BG still 25 mmol/h although 2 hours had passed We kept correcting and correcting. A total of 8 units of insulin were given for the correction (1/4 of the daily dose) in addition to raised basal over 5 hours. BG finally back in range after 6 hours. | CASE OF HI 2 Talking through the earlier events we figured Mr. T had counted the carbs incorrectly: He counted significantly LESS carbs than there were. Therefore giving MUCH LESS insulin then needed. (possibly half the needed amount) Result : BG kept rising to HI. No liver response here, just HI level of glucose in the blood for the unbolused carbs. We corrected with the normal correction + 50%, having guessed how many carbs had been missed. We increased the temporary basal by 100% for 1 hour to help out a bit. Only one correction was needed, total of 2.5 units of insulin were given for the correction in addition to the 1 hour of raised temporary basal. BG back in range after 2.5 hours. |