My 5 year-old dd is on honeymoon as per the docs. She has been off basal since almost 3+ weeks now, which she had been taking at night-time soon after diagnosis. She goes to bed with good number (between 90-130) and wakes up with good fasting numbers (between 75-110). The problem is she spikes at around 12-2 AM (between 140-200). Why would this be happening? What can I do to prevent it? I can’t give her basal because I know even 1 unit will crash her at around 4-5AM.
i started experiencing that too when i started pens. what i have started doing is i don’t really eat carbs anymore for dinner. because when i don’t have carbs for dinner, i don’t spike. not sure though that is the right approach for a 5 year old. how high does she spike? what you can try is give her short acting before bed, maybe that helps a bit.
Hey! So, she spikes anywhere between 140-200. And, we give her short acting insulin post dinner; 2 hours post dinner she has very good numbers (90-130), so, I feel giving another dose of short acting may be a little risky. Thoughts?
What you are likely experiencing is a spike caused by the release of somatotropin (growth hormone). The easiest way to deal with this is by setting a temporary increased basal rate on an insulin pump. Without pumping, the only thing I can think of would be to anticipate this spike and give an appropriate dose of rapid-acting insulin. But I am not offering medical advice; you definitely need to speak with your daughter’s physician!
I guess you don’t have any possibility for a pump? as @rgcainmd suggested, that would be the easiest.
have you actually tried to raise the basal? i was also hesitant at first, but found out it worked quite well. maybe only 0.5 units? as well as the bolus before bed, as long as you check her bg every hour (for the first try only of course).
Sorry, other than that i am out of ideas…
I know that you would like to have your daughters blood sugar totally controlled around the clock, but that ideal is just not achievable. Your daughter is having a honeymoon and there are going to be really variable times. Having a blood sugar between 140-200 mg/dl for two hours during the night is not ideal but it really is not that bad. I know it is hard, but you will have to at some point accept that when you do everything possible you still won’t get perfect results. I would urge you accept that there really isn’t anything in your control to do and that your daughter is actually “ok.”
THANK YOU @Brian_BSC!!
I was actually wanting to write that but was fearing too much hate from some people here who feel that every minute spent above 140 will be paid for later in life (which i feel is totally untrue, still i was not brave enough to stand up and speak for myself, which is in retrospect somewhat sad, but i am glad you said it )
I feel it is very important that we let kids be kids and that they can spend some time in the higher range and still be totally fine. The stress of being an adult comes early enough…
I want to emphasize what @Brian_BSC said. Figuring out the appropriate level of concern/anxiety is a part of the trick with this disease, and it sounds like you’ve got a bit of a puzzle, but what you don’t have is a crisis. The problem is that all the rules and calculations around carbs, carb ratios, basals and whatnot can put you in the mindset that there is a Correct Answer for everything and if only you were a Good Diabetic (or Parent) you would be Getting it Right. In reality the expectation is NOT that if you were really conscientious your kid’s BG would be a perfect flatline; the expectation is that there just are going to be excursions and you want to keep them as moderate and transient as possible. I would say that you’re pretty much at the limit of what you can do with MDI for this kind of thing. A pump and CGM would give you more options, as others have pointed out, so that’s something to think about in the longer term, but it decidedly does not mean you’re doing a bad or inadequate job with what you have. Actually, looking at those morning fasting numbers it sounds like you’re doing fine. What you definitely don’t want to do is get in a crisis mode or worry that you’re not doing it right or not doing enough–that way lies burn-out, which is not helpful to you or your kid.
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