hi everyone,
my daughter has started to run high at night. I increased her basal from 0.3 to 0.4 and have give increase at dinner. she is still running high in mid to upper 200s. she will start going up at 7pm and continue all night. Her ratio for dinner is already 1 unit per 10 carbs. Does it sound like we need more basal insulin? this has gone on for few days now.
Not sure what time she eats dinner. If she eats around 5, then going up at 7 would likely be from dinner. But otherwise you might want to raise the basal starting around 4 or 5PM. Most of us find we need different basal rates at different times of days. If she is having highs in a consistent time period not related to meal spikes, then you will want to try increasing basal a bit at a time until you get good results.
I agree with Zoe. Assuming that she is not sick I would very slowly increase the basal. You didn't mention if she was on a pump or her age. That kind of info is missing on your post. It would be invasive to ask you age, weight, height, type 1 or 2. All I have to work with is her carb ratio. Would also like to know what her carb intake is at dinner on average.
Need a bunch of data to help you.
Still a little unclear.
I assume the 200 at 7:00 is postmeal.
I assume that it levels off at 200, but doesn't keep increasing from ther.
I assume that when she wakes up in the morning, she is still high, in the 200s.
If this is the situation, I'd say increase the pre-meal bolus first to correct the postmeal high before you start adjusting the basal. Seems to me that if your postmeal BG isn't responding to the bolus, then adjusting the basal isn't really doing anything to correct a possible issue with either your carb ratio or carb counting.
Different basal at different times of day is not unusual. After raising the basal very little every 3 days, you also repeat the same supper to ensure the carbs from that are controlled and BG is not varying due to an inaccurate i:c ratio. I would want to know at what time this running high stops so that basal is reset back to covering the next part of the day accurately.
Have you tried basal testing? You know, the terrible torture we endure where we don't eat and watch to make sure our basal rates are working properly? That would tell you for sure if it's the I:C ratio or the basal rate (or, even worse, a combination of both!) Hope it gets worked out quickly!
Thanks for all the replies! Yes she is on a pump.
Here is what has happened the last 2 nights.
6:00 pm - bolus for dinner. I increased her I:C from 1:10 to 1:8
6:00 pm - eat dinner
8:00 pm - check BG (2 hours) - She has been running about 220 at this time the last 2 days.
8:00 pm - give correction bolus : .75 units for every 50
10:00 pm - check BG (2 hours) - She is 200!!
10:00 pm - give correction bolus again.
12:00 pm - repeat the above...she was still 200.
I did increase her basal rate from 0.3 to 0.4 and finally to 0.5.
My daughter is 8 years old on a pump and is very average weight and height. I was thinking maybe the honeymoon phase is finally over? Is a basal rate of 0.5 average for a 8 year old?
I think that you should dose to the meter and not worry about "average for an 8 year old" as everybody is a little bit different. These are still tiny increments (I bolus .3U to take a shower in the AM!) but a little bit can go a long way. I would see how .5U works and the 1:8 carb/ insulin ratio works for a couple of days. I fiddle with my rates/ ratios all the time and am always like "damn, it didn't work" on the first day but then it mysteriously works great the next day?
I forget what kind of pump is your daughter on? I too think dose to the meter not what is "average" for an 8 year old. Everyone is different. But go slowly and give it a couple of days to work. Also as you say her "honeymoon" phase maybe running out now, or any number of things. Just make small changes, I think sometimes change one variable at a time, you start changing to many at once then it is hard to know which one really worked. If she's not already she may need different carb ratios for different times of day, and she may need more different basal rates throughout the day as well. Currently I run three different rates, but I to tweak mine as needed, sometimes adding in a 4th rate.
How everyone is different, lol I did that when I first got my pump thinking crap I've been disconnected for about 30-45 min, maybe I should bolus a tiny bit...thinking .3 units is NOT much. LOL dropped me like crazy, now I dont even bother for bolusing when in the shower, not unless Im really going to be disconnected for a while, like the other day I was disconnected more like an hour, plus kinda a carby breakfast too, wasn't super high but def probably could have used a little bolus that day.
Also what is her BG running before meals, and how high in carbs is her meals. That can make a big difference. I tend to get a little higher during hormone changes, right before ovulation and right before I start, those few days I try to watch the carbs a little more closely.
But if she is say premeal...130 and eats like 50 grams of carbs, she is already a bit high starting off. Also maybe she needs to bolus and wait 10-15 min before eating, or maybe her insulin isn't working as good as it did to meet her needs. Im thinking about asking to switch to Apidra, I tend to eat within minutes of bolusing, and if Im not already low to begin with it can cause a bit of a spike, also I am very insulin sensitive and having insulin still on board 4 hours later and working tends to make me run on the lower end, like 60's easily. Apidra from what I hear starts working faster, and is absorbed quicker. Currently I use Humalog. Might be worth discussing with your doctor. Insulin is something you may have to try different ones. I got great results with Lantus when doing MDI, but horrid with Levemir, ALL over the place on that. But several others say the opposite, they don't do as well on Lantus but much better on Levemir.
Yeah, I was just curious if we are on a really tiny basal rate.
Is it normal to run into these periods your entire life? Its only been 1 year and 7 months and I drive myself crazy trying to keep her down into range all the time. So when she is out of range for 2 weeks it really stresses me out. Our endo tells us this is normal and stop worrying over everything.
Yes unfortunately its normal. There are so many things that can effect our BG, and truthfully all we can do is the best we can do, there are going to be days we do everything perfect and its just NOT going to work. That's the nature of this beast, the key though is to minimize those days, keep them on the LOW end. Unfortunately as your daughter grows, hits puberty, hormone changes, weather changes (some people tend to get more insulin resistent in colder weather and more insulin sensitive in warmer weather)..D is just affected by so many things, and I think right now, especially as your daughter maybe coming off a honeymoon phase, she's at an age where Im sure she is growing rapidly and will soon be at an age where all the lovely hormones start coming into play. You just do the best you can, make changes where needs to be and just realize tomorrow you might have to change again, either by cutting back, or increasing. You are doing a great job, and Im sure as a parent it is even harder with a child with D as we want to do everything we can to protect them and keep them well, you are doing a great job and just know its nothing that you are doing wrong, its just the nature of this disease, you are doing exactly what you need to be doing, keeping on top of her numbers and making little corrections when needed,
nice job, christy...good, solid advice with a bit of praise and empathy built in...nice! :)
I agree with Christy's reply but would add that I think that it seems very reasonable to run into changes. After *years* of pretty much blazing away with the same amount of insulin, I cut back, saw some A1C issues (long story...) but when I got the pump, I noticed that changes would just happen, sometimes seasonal. For a while, I thought maybe it was that I'd continued losing weight or exercising differently (more?) but I think that it just changes sometimes. Which is another reason it's important to keep an eye on things, which it seems like you are doing? Hopefully you can get the habit instilled in your daughter so she can pick up the torch when she's old enough!