What are your middle of the night "low" action numbers and morning routines

So I'm wondering if at 2AMish you check your childs bg what level has you headed to get juice or something?

What level is your childs bg upon waking in the morning and how long do you wait to feed them breakfast?

Naomi's pulled 80's/90's a few times at 2AM so I've treated them with a box of OJ. Is that what the rest of you would do?

We currently have about 30-40 minutes after Naomi wakes up before she eats breakfast and has her AM insulin. We used to have her eat right after waking up but her NPH was peaking 30 mins prior to lunch at school so I was ending up with lows requiring treatment within an hour of her classes scheduled lunch.

Any suggestions? Does this sound like we're headed on the right path?

Thanks everyone for your continued support. I so appreciate it!

~Alissa

Just out of curiosity, why is she on NPH? Is she not allowed to have a shot at school? I think that has a lot to do with the answers to these questions, so I’m not sure my answers would really help but . . .

Personally, we don’t treat a low at night unless it’s under 80 - but that’s also because we are pumping- and we usually adjust the basal if he’s between 80 and 110. Over that I just hope for the best. We also wait about 15 minutes after his bolus in the morning for him to eat, but that’s with Humalog so there is no later peak or anything. And it doesn’t have anything to do with when he wakes up for us - just how long between the bolus and the food.

Naomi doesn’t get a shot at school. I’m pretty sure the only reason is to avoid one more injection. I check her bg when I’m at the school picking up Naomi’s little brother at 11:30 but she doesn’t eat until 12pm.

I don’t totally understand how the pumps work. Sorry - I’m still new to so much of this. Naomi gets Humalog and NPH in the AM right before breakfast and then gets Humalog and Levemir right before dinner.

If my son is below 100at night, I give him glucose tabs. He can reliably chew them without really waking up.

Until a couple of years ago, we were on exactly the same routine as your daughter except my son was on Lantus instead of Levemir. NPH makes it a lot easier from a school perspective, but harder on the schedule.

Our doctor has my 7 year old staying between 100 and 200, so I would give her a 7 to 15 carbs at 2 am if she was 100. When she was first diagnosed back in May of this year we would give her 7 carbs even if it was 115. Not anymore. I dont usally check her often now. She is staying really steady thru the night. What do you give for a bed time snack

Usually I give my daughter one Nutragrain crunch bar (15carbs) and a slice of cheese before bed but last night I gave her a slice of whole wheat bread with peanut butter on it. It’s now 5:23am and when I checked her at 4:45am she was at 97, so I checked again at 5:00am to make sure she isn’t dropping and she was at 99. Naomi doesn’t normally wake up until 7am and doesn’t eat breakfast until 7:40am. I don’t know if I should have given her something back at 4:45am to keep her up until breakfast or not. The buzzer just went off so I’m going to go check her again.

My daughter (10) is only allowed a bedtime snack if she’s under 130. She’s on Novolog/Lantus. Last night she was 113 (8:30), had a snack and just 30 min. later felt low. She was 54. She had 4 sugar tabs and it brought her up to 162. I decided to check her at around 10:30 just to see if she had gone up anymore, she was back down to 60. I decided to wait 30 min. to see if she would come back up (it has happened and I didn’t want to over treat) so when I did she had dropped to 45. I gave her a juice box, re-checked and she dropped to 34! I then gave her 1/2 cup of regular root beer. She finally came up to 107 at which time I gave her a snack. By this point it was midnight and we had to get some sleep. I set my alarm to check her at 1:30 and of course she was 336! What could I do? It’s scary when they just keep dropping.

My niece was on NPH at dx and endo in town keeps them on NPH until he allows them to go on a pump (six month to one year wait). We switched endos and she was immediately put on Lantus and Novolog. NPH, her numbers were high all the time on it. I have heard there can be lows also on NPH so, yes, I would give her the full juice if BS was 80 overnight because I don’t think NPH is a very predictable insulin. Using pump therapy, if I see a BS of 80, it’s the middle of the night and I am going to bed, I will give half a juice or 7 grams or, better yet, a half cup of milk. If there is only two or three hours until the time we wake up, I may or may not give her anything. Depends how she has been trending over the past day or so. She does not have to eat when she wakes up, though on school days she does. But on the pump it is different. P.S. Ask the endo about the timing of lunch. It has to be exact, i.e., you have to time the mixture of NPH and Humalog given at breakfast to peak at lunch. They can time it for you. They did this for us at dx but I forgot the exact time period. No matter, as I said, she never got out of the 200s on NPH. It was a very rough month.

Yikes! Sorry for the rough time you had last night. I was scared just reading your post - that must have been hard. I hope your daughters able to have a more stable day today. I’m thankful so far Naomi hasn’t had a big drop down below 60’s yet. I’m afraid of it really. Was your daughter able to wake up okay for you to give her the juice and rootbeer while you were battling those lows or was she able to be awake and alert? Naomi feels low when she’s in the low 90’s and acts like a slug in the low 80’s…which is why I’m so afraid of the lower numbers. Naomi’s remained in the 90’s until 7:15am when I checked her (she wanted to go play in the little snow we got last night) and she had gone up to 127. Is that odd to go up like that after a nights rest but prior to eating?

It sounds like some day the pump will be a great thing. I am finding that our change from Lantus to Levemir seems to be a good one, more stable overall. I’m still not sure what I think of NPH. Maybe it would be better just to give an extra poke at lunch with more Humalog but then I’d have to hang around her school for 45 minutes until lunch time after I pick up little brother. Maybe it would be worth it though. Hummmnnn…

I’m also wondering if the pump is something we should switch to. She doesn’t want to try it till she starts jr. high, which is next year, but I’m thinking after everything I hear that it really makes a difference. To answer your question, my daughter, Emelie was very coherent during the whole ordeal. I’ve only seen her loose all the color in her face once when she was in the 40’s. But, otherwise she’s really good at knowing when she’s low and most of the time treats it herself. She woke up at 180 today, so we’ll see how she does later. I have noticed that after a day of exercise she will be consistently low the following 24-48 hours. This might have caused all of her low’s last night. But, it doesn’t allow for my much sleep on this mommy’s end! :wink:

My only advice is to make sure the pump and its timing is your child’s choice as well, not just yours. I have learned a lot from other parents and have been reminded before that our children have a lifetime to deal with T1D (or until there is a cure) and they need to feel as if they are making some of the decisions. If your child thinks Jr. High is the right time, then consider taking that in to account. Control will be much easier if they are bought in to the choices too.

My doctor tells us if we are having lows in night then our insulin dosage is incorrect. You should not be having them. and we have been told that usually you will see your lowest point between 2 and 3 am. After that time the body is usually getting ready to wake up and have what they call the dawn phenomenon.

Our son just got on the pump in March. He’s 6. Before that we were doing NPH and Humalog. Does she take a snack in the am at school? Will alway ate approx 15 gm around 930. He doesn’t have that now since we are on the pump. As far as nighttime lows I always treat if he was 90 or less. Usually we did Gogurts. It was easy for him to eat and not have to really be awake. He is usually rather uncooperative in the middle of the night. Now with the pump I’ll just usually just adjust his basal rate for a little while and then recheck . Will always had a bedtime snack around 30 gms. He took his night NPh with dinner. Most nights we do 1/2 cup of icecream for a snack. It’s got enough fat and protein to chew on for a while at night. Will feels his low more around 80-90 than he does when he’s really low. His only cue is that he’s hungry. Since on the pump we aren’t having the lows like we were on shots. I understand about being at the school everyday. I’m there everyday to make sure Will eats. I bolus him and then just hang out so I know he eats. He gets too distracted and after finding his entire sandwich from that day when repacking his lunch, I can’t trust him. So it’s just what we do.

Our change from lantus to levemir was a much better fir too.

My daughter is 5. She’s been T1 for 3 years now and she’s been on Humalog and Lantus the whole time.

There isn’t a specific number that prompts me to give her carbs in the middle of the night. Once I know her Humalog has run out (4 - 4.5 hrs) then I take two readings and hour or two apart to see how fast she’s falling. That tells me if she’ll need juice or not throughout the night or when/if I need to check her again. Some nights she gets a few juice boxes. But we go on long hikes together most days, and the exercise makes her nighttime numbers inconsistent from night to night.

She gets her Humalog at the same time she wakes up. She doesn’t even feel it when she’s asleep. Then I wake her up and feed her. She spends most of the morning grazing on her breakfast. Morning shots are in the thigh, they absorb more slowly than other sites so she can eat slowly without going low. If she wakes up high she gets the shot and then I delay breakfast and check her BG often. When she comes down I give her part of her breakfast and wait for her BG to come down again. If I do the normal routine on high BG mornings then she feels crummy the whole day.

This is my advice to you … If you’re going to vary her diet don’t do it at bedtime. If you vary it during the day and she goes high/low it’s easier to fix than it would be at night. Also exercise effects BG, A LOT. My daughter needs extra Lantus at night if she’s exercised a lot during the day. Also watch her closely after extreme/unusual days of exercise. On rare occasions it makes my daughter’s BG drop and drop and drop before it suddenly levels off. It has to do with the liver dumping sugar during the day and then absorbing it again.

And don’t feel you have to put her on the pump if her numbers are good. Pumping is not going to prevent nighttime lows, and will not keep you from having to get up and check her at night. Actually they say you have to check more often on the pump. Personally I don’t want my daughter connected to a machine 24/7. And since my daughter’s last A1C was 7.2, I don’t have to put her on the pump.

Hi, my daughter is 4 and has been on the pump for almost 3 years. Pumping is so much better in general in my opinon. She never had a real low overnight since starting on the pump (thank God!). If the child basals are set right you can go most of the night without checking her. You just have to check her 3 hours after her last meal and that’s it. My daughter’s A1C was 6.8 last month and I totally recomend the pump. My daughter is now much more stable and I just have to change her site every 3 days (and I use a numbing cream so she doesn’t feel anything). I don’t have to inject her anymore. I believe that if you are ready the pump it’s really worth trying…

My goal is to be above 110 at bedtime. She generally has pretty steady number through the night, once dinner insulin is used up, so at 2:00 am, I would treat at 80 but probably not treat at 90.

I question the wisdom of automatically using 15/15 rule (treat with 15 carbs, wait 15 minutes), which is what you’re probably doing with the juice box. For my daughter 4 carbs, which is one glucose tab, will raise her 40 points - well into a safety zone. Presumably 4 tabs, which is a “dose,” would raise her 240 points - way into the danger zone. So my only advice is to make sure that the amount of juice you’re giving is proportional to the amount you want her blood sugar raised.

It really will depend on what she trends at night, that will mean a week or 2 of intensive tracking at night. We know that one of our girls will drop about 40 points until 4 am, and then she will stay steady or slightly climb (as she grows and her basal increases sometimes she tends to drop, sometimes climb. they are both so little that we can never get a perfect stable, so we get as close as we can). so we try to put her to bed around 140 - 150, so that we have a slight buffer incase of an unexpected drop. Our other daughter is fairly stable at night, so we try to put her to bed around 120 - 130, again so that we have a buffer. Both girls are extremely active, so sometimes we get some unexpected big drops. At 2 am we don’t want either under 100. Since their am levemir runs out at 4 am, we know that whatever they are heading into that time will be what they stay at. as for what we treat with, i only do juice if we need a big raise, and then give protein. We know pretty well what each amount of carbs will generally do (for example, 5 carbs usually = 15 - 20 BG). if we only need a small raise i try to do something with fiber or protein in it as well. I have found if we do juice only, then it won’t last, and 2 hours later we are back in the same boat. i hope this helps. As i am sure has been said earlier, everyones diabetes varies, and you will learn what works for your child. Even with my girls who are similar weight ,age and body type, and participate in the same activities there are still differences in their diabetes management.