First of all, sorry for my English, I’m Spanish and I can understand much better than explain, “typical Spanish”!. My daughter is only 2 y/o, she was diagnosed diabetes when she was 18 months and she wears an insulin pump and a Dexcom G4 since June 2014. During the day her BG levels are more or less controlled but the nights are still a nightmare… hypos and hypers one or the other depending on the night, and often both together in the same night (one after the other)… Our endo says than this is normal because her age, but I don’t know what to think because here in Madrid there are not many cases of diabetes in children so young and maybe the endos don’t have too much experience with babies… Is there anyone in the same situation as me?
That sounds horrible. I don’t the types or how much insulin you are using so it is difficult to guess what is going on. All I csn say is that I would rather have my child running slightly high at night to avoid the lows. Not for a long period of time but maybe until you get things figured out. I have reduced my 3 year old sons dose of the 24 hour insulin a few times to get it right. On days he has had a lot of physical activity before bed I may even skip it. But hd never bounces from high to low as you explained. Sounds confusing. There is a specislist here in the US that does Skype appointments. He has written books about diabetes and has had it himself since he was a teen. If you are interested I will get the info for you. He is a real expert so he may be able to help… Good luck, hang in there!
Sarah, thank you very much.
My daughter hasn´t basal insulin from 00:00 to 05:00. She has dinner at 20:00 with a dual bolus before dinner. At 22:00 if it´s necessary because she is high (>200), we put a very little correction bolus of 0,025 what is the minimum possible dose with our pump. The problem is that at 3:00 aprox., and without basal insulin in this period, her glucose is low (80 -85 with a tendency to fall, we know it because the Dexcom) and we have to give her some yogurt (we give her only half portion, 3 teaspoons), and after that at 06:00 aprox. it occurs the opposite effect, the glucose is going up (probably yogurt takes effect later) and we have to correct it again with a bolus (although of 5:00 to 9:00, she has basal insulin).
It is still very complicated to control her levels at night, endos have change a lot of times the insulin doses (both basal and bolus), and there is no way to stabilize her. They say she has an extreme insulin hypersensitivity (even tiny doses) and the same with the hydrates (we only give her two or three teaspoons of yogurt). Every 15 days they review the values and change the pattern of insulin, but nothing changes.
Could you send me the contact details of the specialist please? My email is email@example.com.
I wish my Spanish were better so I could tell you in your own language! But your endo is right. This IS typical for her age, and my son's endo told me that very thing as well. My son was the same age at diagnosis, and when he was on a CGM, we used the CGM data to tell us when he was going high, and it was always at night. I could almost set a clock by it, and what it told me was that his need for insulin rose in a very specific time frame. It would start at around 8 PM, then get higher and higher until midnight, and then boom, his insulin needs came back down. I ended up setting his pump's basal rate to increase a little at a time, perhaps 0.25 units every hour to two hours, from about 6 PM to 10:30 PM, then from 10:30 I decreased it about 0.5 units every hour until it was back down to the level it normally is in the morning.
The reason for it is that growth hormone release in small children occurs mostly while they are sleeping. Growth hormone makes the child insulin resistant. So at the time of the day when they have the most growth hormone, is also the time of the day they need more insulin. Does that make sense?
It is complicated, from what you said in your answer to Sarah, by the fact that she probably is in what is called the "honeymoon" where she still makes a little of her own insulin. If that weren't the case, she would need basal insulin in the night. I would suggest that maybe instead of dual-bolusing her dinner with half going immediately and half slowly, you might wish to try giving her more of the dinner bolus in the first part of the dual bolus — so, for instance, if she needs 2 units, give her 1.5 in the regular bolus and 0.5 in the square part of the dual-wave bolus. I think that the correction bolus reflects that she is having dinner during the time she probably also is somewhat insulin resistant, but the second wave of the bolus hits when she is much less insulin resistant so it tends to drive her low. It is often a matter of trial and error, figuring out how to bolus dinner time!
I also do not think there is anything wrong with skipping that tiny correction so that she stays in range. When Eric was that age, his endo said that maintaining a stable supply of glucose was more important at this stage than worrying about the long-term complications associated with high blood sugar. He was of the opinion that it was okay to tolerate some overnight highs if the daytime blood sugar level was in range, because the risk of harm to brain function related to lows was greater than the risk of harm to organs related to short-term highs. His advice to me was, "Worry about the lows, and once you have him to a place where he's not having many lows, THEN you can worry about the highs."
Gary Scheiner is his name, if this is the guy Sarah meant.
he is awesome, he has done loads of interviews here, make sure to check them out:
just a few examples, there are way more here:
please note also that there is a spanish version of this site: estudiabetes.org
if you feel comfortable here, you are welcome to stay, just in case you feel like talking to people speaking your own tongue.