How has dex changed how you prevent aand treat overnight lows?

Diabetes Technology Glucose Monitoring
1

Hi All, kennedy had a long dance day yesterday, then insisted on going to gymnastics open gym for two more hours with friends, so 6 hours total.

we were prepared to add in some snacks and turn down her basal like usual, but due to an unfortunate late night junk food situation, ( my husband insisted on sonic) we did some guessing on carbs, I watched her for another two hours, and gave her a big apple with peanut butter and 20 carbs pineapple juice extra with no bolus.

overnight midnight, I got the alarm, less than 50, and we did another 20 carbs and turned down basal another 25%.

but then it didn't come up, and an hour later I got the low alarm again, this time turned off the basal for an hour and a half and another 15 carbs pineapple grape juice.

It floated up after this, finally.

How do you best utilize the hypo snooze alarm. Do you set it for every 15 minutes, or wait 30?

What other basal refinements for exercise is everyone doing? maybe we need a program for moderate exercise, and another for prolonged, say over 5 hours.

what are endurance athletes seeing with their dex that has helped them avoid night lows?

guess I need to go back and look at ex carbs again...

2

Natalie,

As you are quite aware, intense or extended exercise is always a challenge. The dex certainly has helped tremendously. My daughter is a tennis player and in tournaments, she only has 90 seconds to get to her bench, check her blood, consume carbs and be ready to play. She has had referees stand over her and yell at her while she was checking her blood because she was taking too much time. The new dex has enough range that she still gets readings while on the court which cuts some of the time needed down.

Here is her routine for tennis which is usually a 2+ hour event. Between 45 and 30 minutes before the event, she will reduce her basal by 50%. When she starts playing, she will turn off her basal if she is 150 or below and keeps it off for the rest of the exercise period. We were having problems finding foods with enough carbs that could be consumed quickly until her CDE recommended that we go to a running store and buy the same type of products that marathon runners use. We found a wide range of products and her go-to product are energy beans (look like jelly beans).

When the exercise period is over, she will keep her basal off until she reaches 100 and then will go to a 30% reduction until she is around 130. In addition, she will consume some complex carbs like peanut butter, before, during and after the match.

For any low, when she gets below 70, she will totally suspend her basal until she gets above 100.

It took a lot of trial and error to come to this pattern. There have been long matches where it just seemed impossible to get her above 70 regardless of the amount of carbs she consumed.

3

A few thoughts

  • Dex has changed the way I look at overnight lows. Before Dex, I was very fearful of them due to hypoglycemic unawareness. I wouldn't treat highs agressively before bed in fear of going too low. Now, with Dex, I no longer fear nighttime lows
  • My endo recommends suspending basal for 30 minutes or so while treating a low. I never thought of it, but I will be following that advice. The idea is to not add any more insulin to the body while trying to recover from hypoglycemia.
  • For dealing with junk food, try downloading nutrition information from the "restaurant's" website. For Sonic choose Our Food -> Nutrition Guide. Despite the fact that many of the products contain fast-acting carbs, the high fat content slows absorbtion. My nutritionist cringes at this, but I get a very predictable, reasonably stable reaction from Bid Macs! For items that aren't on the nutrition guide, I look for something similar. For example, if there is a burger that is not in the nutrition guide, I look for one that uses the same bun. I figure for burgers, most of the carbs are in the bread, although the carb count for BBQ sauce is rediculous.
  • If I weren't so sedentary, I would try Larry D's recommendations. They seem right on the money.
4

wow! great detail! I can imagine a tennis match is such an intense activity and for two straight hours!! Dance is somewhat variable... they have different classes, and some are a predictible routine, with stretching, learning a combor, then moving across the floor, their rehearsals can be anything from a gripe session where they get feedback from a judge and sit there, to all out runthroughs straight for hours... we have found that turning down 50% 30 minutes before will hold her right at 80 to 100, but we have been chasing with glucose tablets rather than just turning off the darn basal altogether, I think this might help, especially in that third hour of exercise.

Kennedy's trouble is that she doesn't want to wear the dex right on her, because she's afraid she'd break it, rolling on the floor, etc... so we've struggled to figure out how to get her to check it during exercise, she is just missing the alarms altogether ( music is blaring loudly all the time)

I thought she should just put it at the side of the room, click her spibelt onto the ballet bar on the side, then just eyeball it every 10 or 15 minutes, but for her rehearsals, she's afraid to even leave and go over to the side and look.

I have talked to her teacher about it once, i need to talk to her about it again, and just emphasize that's what she's doing.

we may try some of those tights that have that little zipper pocket on the butt ( for your cell phone) that might work...

I bet those long matches are similiar to a dance convention, where you are literally taking class from 8 am to 5 pm straight, with 15 minute breaks between classes.

We should definitely turn it off more, I think. It's just that I read and our endo told us that your real pancreas doesn't generally drop below 50 percent so that that is more physiologic, but I guess her body doesn't read textbooks!!

thanks for you input! How old is your daughter?

5

My daughter is 15. She was diagnosed a few days before her 12th birthday. Her first question to the endo was could she continue to play tennis. :)

She finds that suspending delivery makes a significant difference in handling her lows.

6

Definitely don't be afraid to suspend. I suspend in advance before every run or intense workout unless my bg is sky-high for some reason; couldn't stay above 80 otherwise, even with carbs.

7

+1 on the nutrition info.

One of the (only) advantages to eating at a chain restaurant like Sonic is that you can know exactly how many carbs are being consumed by looking it up.

Of course, exercise modifies how you respond to that information, but at least you have exact grams of carbs to work from.

8

I never suspend my pump, but do set a temporary basal of 0 often. The advantage of a temporary basal is that you don’t have to remember to re-start your basal.

9

In general, I agree that that's the best way to turn off basal. But in an open-ended physical exercise situation in which you can't predict quite when the activity will stop, the bigger danger is forgetting to turn the pump off again once the temporary basal times out. So unless you know for certain what time it ends, or you have something carefully timed in place as part of the workout, it's probably better to suspend manually.

10

Our child is on the Dex G4 too, but we struggle with overnight highs mostly. Lately he has been burning through 8u of insulin in the first 3 hours of sleep--which is up from his usual 4.5u. I love the dex because we can treat the highs more aggressively and not have to worry about missing a low. We still set a 3am alarm every night "just in case."