I am a father of a type 1 5 year old girl who is 8 months into diagnosis. I am having extreme troubles figuring out night time, and hoping the experts here can help me figure out what I'm doing wrong. I'm Canadian, so my daughters range should be between 6-12. So, last night at dinner, her pre meal blood sugar was 7.8, yeah, we bolused, ate dinner, then 2 hours later her bs was 9.1, again, yeah. But here is the problem. We give her snack based on her level before bedtime (the 9.1) so I gave her 6 carbs in whole wheat crackers, two slices of cheese and some water. She went to bed at 8. We checked at 9:30, she was 11.4, we checked again at 10:30 (so see her trend) and she was 12.1. I'm happy, I go to bed. We wake up at 6:30 and she is 18. WTF. What am I missing? This has happened a few times now. Please help.
A couple things could be the issue-- one, she isn't getting enough insulin at night to cover her basal needs. Two, it could be the dawn phenomenon, where BG rises in the morning (I doubt it's the main problem here, but who knows). Three, it could be inadequate bolus for bedtime snack. Protein/fat does tend to raise BG levels but many hours after they are eaten. So eating cheese before bed could be raising her level later at night (that happens to me, I have this same problem). I'd guess it is a combination of inadequate basal at night and inadequate bolus for bedtime snack. Sounds like she is on a pump, in which case you could try increasing each of these (bolus at bed and basal at night) slightly. Or first try a night without a any bedtime snack and see what happens to her BG then, to rule out a problem with the basal. good luck!
Thanks for the response, no she is not on the pump. We don't bolus for night time snack and we give her her basal in the morning (lantus). She only bolus's with meals, not morning, afternoon or night snack. So, with that, you think maybe loose the cheese? I"ve also heard of people splitting up the basal, as it tends to wear off. What we are doing has worked in the past, but doesn't seem to be working anymore. I know this is one of many changes to my little girl.
Having just moved my daughter from injections to a pump there is maybe not a lot you can do for small variations in the blood due to the body requiring different basal rates throughout the day. The problem with lantus is that it gives a constant (ish) level of insulin all day where the body does not work that way. On moving to a pump, we have learned that my daughter needs high basal in the morning which decreases through to very little in the afternoon to evening but around 10pm I am needing to double it due to a sudden rise which is not food related. The only thing that you could consider, if you are sure it is a regular pattern would be a small bolus with her supper to cover the rise. Od course once you have sorted it, it will all change!
Also I believe that Latus does not have a full 24 hours life so could it be wearing off by the morning. We always did Lantus before bed but due to food and bolus would have always disguised any rise with correction.
It does sound like her basal is wearing off. My son's basal which he took at bedtime used to run out in the late afternoon. We always thought it was the snacks and dinners that were a little more high fat and had adjusted his boluses accordingly.
But, when he went on the pump and had steady basal in the afternoon, suddenly he was always low and we had to adjust the boluses back down. It became evident that the basal really did not last a full 24 hours for him. Since this is only happening a few times, the burnoff rate for the basal may be tied to her activity levels that day or other factors.
We are in Niagara Falls, Ontario. Thanks again for all your help. Think I'll try adjusting snack a bit first, then see about splitting up the lantus if the snack doesn't work. We had to switch the lantus to morning, as she was going low in the middle of the night all the time.
Hi Chris, my daughter will be 5 yrs old in September. We are 1.5yr into her dx and 1yr with the pump. I agree that it is not the snack it is the basal wearing off. I would suggest trying a no carb snack and testing her BG to make sure. We do "no carb tests" quite frequently to make sure her rates are still working. The other issue is simply her age. As we have learned after some frustrating nights/days, what works one day doesn't always work the next day with these little ones!! We are in Victoria, BC. Good luck to you!
The other thing no one has mentioned is that she may be going low in the night and the 18 at breakfast is a rebound high. My daughter is 4, dx 8 months ago also. We live in southern Alberta. On the days she is more active she tends to bottom out about 2-3am. Its amazing how much she can drop in a matter of a couple hours. She usually gets 13g for a bedtime snack (yogurt) and some cheese. I can often check her at 1130 and she will be 15, but when I check her at 3 am she is somewhere in the 4-5 range and I have to wake her to feed her yogurt to prevent a low. Maybe try checking sometime in the middle of the night on those active days and see what the trend is. She may not be continually climbing thru the night like it seems, she may actually be going low. Because this is not happening every night, it may not be the basal. We have learned that on days we go swimming, we have to give an extra snack regardless of bedtime BS as those nights she will drop quicker. (and ya, sometimes it ends up being too much and she runs high all night or wakes up on the high side, but rather that than too many lows.)
maybe she is coming out of her honeymoon period?? i know with my son he could go without insulin for snacks for a while but then needed small amounts of rapid acting for snacks even at bedtime if his bs was high even 1/2 to 1 unit helped keep him steady at bedtime with a 20 ish carb snack. the other thought is, if her supper is very high in fat or protein it will kick in during the night another time she might need a little quick acting with her bedtime snack, just some thoughts there are soooo many variables, if the trend continues i would touch base with her endo team. best of luck amy
Before we went on the pump we changed to Levimere as the Basil insulin -it is healthier and unfortunately takes 2 shots a day usually to maintain a constant basil. If she is coming off the honeymoon as one person mentioned you may want to use the Jr. pen to administer 1/2 unit as the above person has mentioned. It is a nerve racking balancing act - but it does get better. If there is anyway to geta CGM (continuous glucose monitor) that will solve the mystery as to what is actually happening. Just use it for a week and check her every night and times when she is having wild swings. Most kids don't like the extra poke.
Good luck -
Sorry I haven't updated, but have been busy trying to get it all under control. We have been in touch with our clinic to decide which steps to take. We changed the Lantus, hoping either we had a bad batch, or somehow forgot to change it after a month. That didn't work. We tried minimal or no snack. That didn't work. We did normal dinner, and covered it off, and even though her bedtime levels were good, she kept rising through the night. We have been up every 2 hours over the weekend to see what is going on. Last night, her blood sugar was 12 before bed, gave her 0 carbs, but cheese and water. Before we went to bed, she was 17. Gave her .5 NR, 2 hours later she was 11, but 4 hours later had to give her another .5 units as she was 16. I hope the clinic has an answer/suggestion for us today. I'm guessing either the Lantus is wearing off, or the honeymoon period is officially over and we need to re-asses everything.
Hi Chris, sorry things are not better, i know how frustrating this can all be. My thoughts are that she is not getting enough basal and she needs more at night, i would suggest switching her lantus back to night time and increasing the dose. what might also help is correcting with her rapid acting conservatively is she is high at bed time and maybe giving her a bigger carb snack with coverage and correction at bed time, as long as you include some protein and or fat like you have been doing she will not likely drop. i would check in with her endo but i bet this will help. best wishes hope your little one is still smiling and helping to keep you sane with her good attitude and bright spirit! best wishes. amy
My 6 yr old daughter needs 3x basal at night as during the day. It is from growth hormones since she is growing like a weed. Even with that, if she is a bit on the low side of her range and we give a small snack at bed time to bring her up a bit, she'll go way high. She just needs the extra insulin at night and comes up after she falls asleep even without having a snack. We just watch her Dex (CGM) and have her basal adjusted for nighttime.