Looking for any advice on this one. About 10 days ago, ds started running very high bs in the middle of the nite . … It happens every nite now… We are now checking him like every 90 minutes - and bolusing him about every 2-3 hours . . . We can’t get his bs below 200 - even when were bolusing ! Trying to figure out if the inuslin sensitivity needs to be adjuted at night time, or if it is just puberty and needs more insulin at night time ? He is on a Dexcom and it rarely goes off because he is higher than the trigger for the alarm to go off (200) ! ! His current regime is 6u lantus at night, and apidra basal at night time is around .25 hourly . . Thanks in advnance.
David has been using a pump since age 14. Since age 15 he has always had a .05 increase in basal from 3 a.m. until 10 a.m. for a BG that always starts to rise after 3 in the morning. Check with your endo. If you can figure out where the increase is starting you should be able to correct it by increasing the apidra from .25 hourly to .30 hourly overnight, starting about an hour in advance of the time of night where he typically starts to go high. You need to check the hours before the increase carefully, to be certain that he is not going low and that the increase is not his livers response to a low by dumping glycogen into his system.
Cheryl
Thanks Cheryl ! He is on a dexcom so I have been recording his hourly numbers .
Not sure when DS was diagnosed, but his basal of .25 hourly in addition to 6units seems very low for a teen. Maybe he is coming out of his honeymoon, which can be a dangerous time. I would up the insulin enough to get him down 100 more points an hour (you mentioned he stays at 200 every hour through the night). I would start by adding up his correction boluses overnight and then adding them to the night time basals. Take the corrections over 6 hour period, divide by six and add that amount hourly to the .25 per hour basals. But that is still clearly not enough. If it were me, I would then add even more insulin to this new amount because even with the corrections his BS is staying at 200 and you are only treading water. Can’t Call up your endo and have him/her factor and suggest new insulin adjustments, as endo knows your son’s situation…
This doesn’t specifically answer your question except that, like everyone else, I think his numbers need to be raised, ASAP. You don’t want him running about 200 for hour after hour. I make adjustments to my almost 11 year old’s regime at least once a week. I’d like to just set the pump and have it stay right, but that is not the reality of a growing child. And, frankly, since you’re up all night anyway, there’s not much danger in you giving him a good bit more, as you’ll be monitoring closely. (Sometimes having a D child feel like having a newborn, doesn’t it?)
Hi there – typed a response a few days ago but my machine didn’t connect, so all lost!
We have a 14 year old who has times of high, insulin-resistant nights. Our consultant and excellent clinic are clear with us that this is the result of spurts of growth hormone and problematic to stay in control of for several reasons: it is only produced at night; it is produced erratically and not consistently night on night; it is produced in ‘pulses’, so at different times of night; and it is produced in relation to blood sugar levels.
We had several weeks of extraordinary highs at seemingly different times of night – and not being able to really get them down easily – before we really took action: we just couldn’t seem to grab the right time to change settings. And corrections didn’t have much of an effect, for the first time in ages. Eventually we took the step of changing the correction factor – both for the night and for the day – and this immediately made a staggering difference to control.
We did not immediately increase basals overnight, because things seemed better, and the highs were erratic. We have since adjusted them once or twice, but actually taken them up, then back down, then up again! This is in the nature of growth hormone.
It’s worth pointing out however that at some point we DID increase the overall total daily insulin via basals and ratios, eg we made a complete overhaul. And this was because our son had clearly grown (1 inch in two weeks!), and his needs were clearly increased. This overhaul was as a result of actual growth, not as a result of trying to battle the erratic growth hormone. We upped his levels overall by about 30%.
Finally (sorry for long response): one thing we do to see if we need to increase insulin is set all day, higher temp basals, so we run 110% or 120% for 12 hours, tracking numbers from that, to see if an overhaul needs to happen, or if not, where the doses need tweaking.This enables us always to go back to settings we know are generally working if we need to, and tweak more efficiently.
Good luck!
I agree with carb101 though: we are always vigilant, and change things quite frequently. With a child in a the main growth spurt especially, it’s a roller coaster!
i know everyone is different, but I also thought that was a low basal. my 6 year old has .5 units per hour from midnight til 10 am (.4 rest of the time).
Thanks everyone !!
This is wonderful advice. We have the same issues, but deal with it by huge increases in basal (temporary) and just stay up until her numbers come back down… lots of sleepless nights. However, although we adjust her correction factor as well during times of insulin resistance, we have not made aggressive changes to ISF. May try that next time we have an issue and see how it goes.
To check/adjust my 16 year old son’s basals overnight when we went on the Omnipod pump, we did fasting basal tests. I thought it was great information and was upset no one had suggested it earlier.
For the first test, we did a low fat meal before 5pm and bolus/corrected and then no food in the evening. We then tested at 10pm, midnight and 2 am. Ideally, the basal should stay within 10 points. We corrected and discontinued the test if under 70 or over 300.
You may be able to go ahead and do the second test which is to test at 3am, 5am and 7am, but my growing teenager could not go that long without food especially once he was awake for testing. So for the second test a low fat dinner and low fat snack before bed at 10pm, no food or bolus between 10pm (except a correction to start) and 7am. Test at 3am, 5am and 7am. This many readings makes for a really long night but it sounds like you are doing that anyway with the Dexcom alarming.
It is amazing how stable my son’s blood sugar was on the Omnipod pump without the impact of his high protein dinner which can cause a rise up to 8 hours later (even if it is not high fat pizza). We did have to increase his rate at 3am until morning and we could see that clearly by the test.
I hope you are able to figure it out.