Johnny's target range is between 100-200, and I am learning more about the "whys" all the time. I thought the range was higher for him because the doctors were trying to avoid going too low (still partly true) but it is also because the hormones that allow for Johnny's body to grow will cause higher blood sugars and they are allowing for those hormones since he still has so much growing to do. Target is 100-200, but we don't fix a "low" unless it is below 80 and we do not correct a "high" unless it is above 250.
I have yet to see the "Honeymoon Phase" kick in. At least not that I can tell. We have not backed off the insulin yet, and I think that is typical when the Honeymoon Phase starts.
Children's Hospital in Dallas has been wonderful for both Johnny and myself. They have classes for parents/caretakers one of which I attended this last week. I learned a lot, nothing that was a completely new concept, but it did confirm some of my suspicions. For example I learned that when I anticipate Johnny is going to be engaging in higher activity above what is his normal (play date at the park, zoo trip, and so on) I can give him extra 15-carb snacks for every 45-60 minutes of activity. It makes sense, and I thought about this before but having it confirmed as okay helps put me at ease.
The class was from 9am -3pm and I couldn't bring Johnny. John has missed a lot of work these past few weeks and our business is a little short staffed as it is so he really shouldn't be staying home with Johnny (of course we will do what we need to do, but it wasn't our first choice). Lucky for us Johnny's Grandma is always so helpful and agreed to come to our house and stay with Johnny for the day. She had 2 crash courses in injections over these past 3 weeks, and 1 time I supervised while she administered the injections. I don't know how comfortable she really was staying home alone with him, but she didn't lead me to believe she wasn't. The morning of, I handled Johnny's breakfast and his first 2 injections. That left mid morning snack, then Lunch (BG check, carb counting, and insulin injection) and afternoon snack for Grandma to handle. I felt really good leaving him for the day.
I get a text from my husband at lunch time. "Mom just checked Johnny before lunch and he was 71. I told her to go ahead and feed him lunch and we will probably test again before snack. Let me know if she needs to do something different. She said he was a little cranky asking for you and after he got over that he seemed to be sulking." It was interesting that we just talked about this in class. If we hadn't I would have just agreed with Johns plan. However, class taught me to treat the low first. So what the plan should have been was to give Johnny 15-carbs (simple carbs to quickly raise blood sugar) wait 15 minutes and recheck. If he was still not above 80 then repeat. Once he is over 80 feed him lunch as usual and give him insulin for lunch carbs only, not the carbs used to treat the low. I called Grandma to tell her this new plan, but by the time she had called John and chatted, John text me, and I read it, she had already started serving lunch and Johnny was gobbling it up. So we adjusted. I just said to give him some juice with lunch and not count it in his insulin. You would think that is fine... and it was. But I learned at class why it isn't the BEST option, eating carbs along side of protein and fat will slow the rate of digestion of the carbs which slows down how quickly Johnny's blood sugar will rise. 71 isn't crazy low, but remember that we only get a snap shot of what his BG is doing, I don't know if 71 was stable or just a picture of a fast drop and he was going lower fast. So you want to get him the simple carbs right away, with out the protein and fats so that it does act quickly to correct him.
In the end, he was fine, Grandma did good, and we learned from it. Since then we have had just a few other low numbers, mostly in the 80's (technically not low enough to correct but it puts me on edge and I check frequently). This morning Johnny woke up at 7:30, and instead of his happy bubbly self was a little sad seeming (hey kinda like Grandma described as sulking) and said he was hungry. We checked right away and he was 78... not scary low but our 2nd lowest number ever. He had a very active day yesterday and while he was running good numbers all day I was taught in my class that delayed lows often follow lots of activity. So at bedtime when he was in the 80's I gave him 25 carbs not 15. John was out late and checked him just before 2am and he was 154 so I felt okay sleeping the rest of the night. And I still think it was okay that I did, but he fell 75 points in the following 6 hours of sleep... which isn't normal for him but I guess normal isn't a word that will always apply.
I studied applied math in college... I am very much into formulas. It is shocking to me that the "formulas" for managing diabetes are not set in stone. I think there are so many variables that either they can't create a true formula yet or they think that parents wont understand a complex formula with multiple variables to calculate. Just something to think about... well something I and many many other T1D parents think about.
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