Today at 8am while Layan was still sleeping I tested and she was 63, it was weird because she slept at 300 and was at 3:00am 204, so I couldn’t understand how she dropped this much at night. Anyway I did not wake her up and 10 minutes later she was 74, then she woke up and tested after another 20 minutes and she was 114. It happens many times with her in the morning that her BG increases without taking any food, any ideas??
if you search our "Forum" for "dawn phenomenon" you will find many many discussions on this. here's one
Hi Nisreen. As I recall, Dr. Richard Bernstein writes that he automatically takes one unit of insulin when he gets up in the morning. I use something like 24 units daily, and do the same amount as he on average when I get up. Of course I check my meter first; if I'm low, I forget it; if I'm high, I add a bit of correction as well.
I've had to start taking some insulin upon waking to avert my DP as well. But I am more concerned about Layan going to sleep at 300 and dropping to 63 by 8am. I know that kids are much more prone to large overnight swings and can be prone to sudden drops from post exercise hypos. But most guidance suggests that you should target your overnight basal to average a reasonable drop (I try to being with 20 mg/dl).
That's not unusual at all. About the only solutions I can think of are to bolus and wait to eat or have a basal "bump" with a pump maybe 10-20% more (it seems to change occasionally like everything else...), which has worked decently for me. Maybe exercising can help too but I dunno how realistic that is for kids?
Perhaps a third idea, which I don't have very precise info on, might be to split Lantus/ Levemir shots? While they are supposed to be 1) flat and 2) last 24 hours, some people have noticed that the basal insulin sort of "runs out of gas" towards the end of the 24 hour period? I never took Lantus or Levemir as I went straight from NPH to a pump (long story...) but splitting shots seems to help "cover" this for some people taking that particular type of insulin?
Layan was diagnosed since 12 months but until now I am still unable to understand her pattern and how she reacts to food and to insulin, she is still on the high edge and not yet close to our targets. I never let her go to sleep with BG less than 200, sometimes her BG at 3am goes extremely high although it would be 7 or 8 hours after her dinner, in other nights her BG starts dropping with no rise and it drops overnight more than 150, for that even if she sleeps at 200 I would still be cautious and test 2 times overnight, I would even feel more safe if she sleeps with even higher BG although I know that this is not the right thing to do. Her dose is 8u at night of Lantus, and she takes for her meals between 10-15 units of Apidra. Today after she woke up at 114, she had her breakfast of 40 carbs, she took 4 units of Apidra which should cover around 60 carbs , yet her BG was 2 hours afterwards 330!!She stayed high all day regardless of the corrections and now she is off to sleep with BG 230.lets sees what the night would bring.
The moral to the story is the only thing consistent about diabetes is its inconsistency. Just be thankful she doesn't feel like a trainwreck at those levels or you'd first have your hands full.
Infact even her reactions to highs and lows is not consistent, like sometimes she is nervous and feeling sleepy and lazy if she is high but in other cases she can be in the 400range but with no sign whatsoever ( other than the reading in the meter) and she would be actively running, playing and in an excellent mood, so the number comes as a complete shock to me.
Maybe talk to your doctor about switching to giving the lantus in the morning. I had similar issues when i used lantus with dropping low overnight. I switched to the morning and that helped that issue, but then had more issues with DP.
DPis Baloney- Is no Phenom.. It's Just a Fancy Wording for what your body does Naturally
-Liver Releases Sugar to Provide the Energy to Get up and going in the AM..
-I need 3 units in the AM , Plus 1 Unit for every Cup of Coffee
and not knowing what the age is of your Daughter, but I would want to find out why she is fluxuating so much and In Such a Wide range.. 2-300's are just too High..
Is she on a Pump? Takinng a Bedtime Basal?
She is on MDI, she takes bedtime basel of 8units. As for the liver release of sugar, I remember asking her endo at the beginning of Layan's diagnosis but I am not sure about the answer but I remember it was something like if there is a trace of Insulin in the body the liver would not release sugar??Maybe I need to search this because it might explain the mysterious highs that Layan frequently has in the morning.
but if I would consider this ,how can I count her insulin in the morning. Usually, at school days I would be very cautious with the Insulin dose because I don’t trust the school catching a low, so this is the reason why Layan is still on the high edge and not even close to target for her age
When I'm high, I have brain fog and can't think. I do believe your little girls would do better in school with lower blood sugars, even at night since it takes a while to begin to feel normal again after a high. Perhaps you can talk to/educate her teacher, principal, nurse; maybe arrange to have her blood sugar monitored at lunch and/or break time.
Ah, the inconsistency of diabetes!! You and Layan are not alone. We all experience this.
My first reaction is that you have to try and get her BGs down. I understand where you're coming from by letting her "run high;" heck, I've done the same thing myself more times than I can count! But it's not healthy. Being that high doesn't feel good (it makes you feel sluggish, tired, unable to concentrate, THIRSTY, etc. Kind of like you're in a fog). While children can tolerate highs better than adults, complications are still an issue. What was her most recent A1c?
I don't know what the schools are like there in Jordan, but is it possible for you to educate her teachers about what to do in the event that she has a low? Keep in mind that most lows are NOT very serious; she may be able to treat most herself. Is she able to test regularly at school? Is there a nurse around who can assist? What is her level of awareness regarding her diabetes? The more she can learn to do, the better. I don't know how old she is, but even very young children can quickly learn some basic self-management.
Regarding your post - it sounds to me like she's experiencing some dawn phenomenon. This is one of those things that a pump can help address. I know you posted about being approved for a pump, and I definitely think you should pursue that. If it doesn't work, you can always go back to MDI. Minimed makes a good pump; I am very happy with mine.
For now, you may want to try splitting her lantus (4u every 12 hours or so). Also, she may need a different I:C ratio in the morning versus the afternoon. It's pretty common to need MORE insulin first thing in the morning. Overnight, your body produces a lot of other hormones (especially children, because they are growing). Those hormones make you a little more insulin resistant first thing in the morning, which means you need MORE insulin. Again, a pump can help with this as well, as you can program it to automatically increase the amount of basal insulin she gets at a certain time.
I also had the problem of drops of 100-150 points overnight with Lantus so I understand that you feel like you need to let her go to bed high. I was doing the same thing because I was scared to go to sleep quite frankly. The problem is really that her basal needs are different during the day and night but you can't fix that when she's taking one Lantus dose. Once you take that one Lantus shot, you're stuck with it for about 24 hours.
My solution was to go on a pump. Now I can set different rates for different times of day and I haven't had the huge drops since I'm not on Lantus anymore.
The second best option would be to talk to her doctor about splitting her Lantus dose into 2 doses.
Good luck, nisreen, I know how frustrating this has been for me to try to get consistent levels when they change all the time. As a parent myself, I can empathize with how much you must worry. Stay strong and keep looking for solutions. It will get better.
Lantus can also have absorption problems. If you don't get the lantus properly injected into the bodyfat layer just beneath the skin it can act like a rapid insulin causing huge drops in blood sugar. With a child, they may not have much bodyfat and this can be a real issue.
If you switch her Lantus to the morning, this would eliminate this as a potential cause. If she then has sudden blood sugar swings during the day, then you at least know what is causing it.
Her A1C is quite high, it was 2 months ago 9.2 but the good thing is that it dropped from 9.6,I try to concentrate on the good part of this number that it actually decreased slightly and I hoping in her next visit she would have another decrease even if it was a slight one.
As for the school, that is another big issue that I will need a full blog dedicated to me to describe my daily agony with the School. Layan is only 5 years, she goes to a kindergarten in one the best private schools in Amman, (it is a different culture in Jordan and I can’t send my children to public schools), so from the educational point of view, this school is just excellent and if Layan did not have diabetes I would have nothing to complain about. But her diabetes has changed our priorities with regard to schools; I don’t care that she gets the best education, I focus mostly on her Safety.
Her teachers and current management NEVER had a diabetic child, so I did start from scratch with them, but still they don’t really get it, they needed clear instructions of what to do and when, they could not understand that with diabetes you need to be flexible and adjust and that no 2 days are similar.
so if her BG before snack time was 80 they would be ok even if she was not in the mood to eat her snack, because my instructions did not mention any problem for BG higher than 80 and you can imagine how this situation will end!!!
I am quite stressed out when sending her to school and everyday picking her up I thank God that she is ok, and frankly speaking she has missed many many days from school because I would feel more safe to keep her home.
Anyway next year she is going to another school, this time my choice was based on the schools previous experience with diabetic children, they had 3 over the past couple of years and the school management do understand the basics, so that was a good sign for me, but I have to start again with her teachers.
Layan is a very independent child she started testing herself only 3 months after diagnosis, she was less than 4.5years. But of course she does not understand the number and what it means.
As for the pump, definitely I have to make up my mind within the coming week or 2 but the actual switch has to be after this scholastic year ends which will be in June, for I can’t make the switch between the MDI and the pump now and start again with the teachers.
But I really appreciate everybody commenting here, I did not expect this kind of support that I am getting.
Thanks to you all.
A trace of insulin will prevent the liver to release glucose to help us fight a hypo. Since we always have a high level of background insulin this reaction is broken for most of us.
However the dawn phenomen is a different reaction. It is caused by hormones created in the kidneys in dependency of time and light conditions. Depending on the level of these hormones the liver will release glucose - in the presents of insulin maybe less then usually but still there will be a reaction. Most of us can clearly see this pattern of elevated blood glucose or less sensitivity to insulin in the morning.
I would really recommend to switch from Lantus to two shots of Levemir per day. Two shots of Levemir (every 12 hours) have the potential to combine its reaction to one very stable reaction curve. This will help to make the blood glucose much more reliable and reproducible. Some members have reported about the huge drops Lantus can cause for them. Some splitted the dosage of the Lantus to reduce the drop. But I got the impression that the switch to Levemir with two shots worked better for them.
I will discuss the option of switching to Levemir and splitting her dose into 2 with the endo in her next visit, but to tell you the truth I am not too enthusiastic about giving ANOTHER daily injection, she takes already 4 injections on a daily base and her Lantus is usually during her sleep. She knows that I do give her while she is asleep and she is happy about it, she even asked if she can make all her doses during her sleep!!!
So to give her another injection in the morning while she is awake would again break my heart. Anyway at the end you do what you have to do.