Talked with Carly's Endo..new instructions again

[carlysmom]

For those of you who have been helping me. I sent in the numbers for Carly since the last changes, about 8 days worth. The endo doc himself actually called me back (a first other than emergency). They are upping her Lantus to 11 units at bedtime, and changing all her carb ratios again. She will be at a ratio of 1-15 for breakfast, 1-20 for lunch and 1-10 for dinner. I am a bit scared of this new Lantus dosage, but the first night she was still high all night.
Last night she was 96 after dinner, I knew that was coming she forgot to finish her milk, actually thought she would have been low. I gave her a small glass of milk when we realized (2 hrs later) because I wanted her up a bit more before bed, she also got her Lantus shot at this time. I gave her snack about 30 minutes later and she went to bed. I checked her at 11:30 hoping to sneak into bed a few minutes earlier than 12 and she was at 128. I really felt that this number was too low to go overnight with, but struggled with having to wake her up and feed her, since I knew she had a good snack ( waffle with peanut butter and milk) and this number didn't make sense to me. Finger was clean and test was done right. I decided to wait and test again at midnight, and yes I paced for 30 minutes straight. At midnight she tested at 225. At her 3am check she was at 203 and woke up at 156. Best numbers in a long time. I guess I was right to wait, but it was scary. What do you think happened to cause the numbers we saw?
Also is it true that it can take a few days for you to really see how the new Lantus dose will affect her all the way? I know we do 12am and 3am checks for three nights after a dose change, I'm assuming that is why.

[Schpoodle's Dad]

For those of you who have been helping me. I sent in the numbers for Carly since the last changes, about 8 days worth. The endo doc himself actually called me back (a first other than emergency). They are upping her Lantus to 11 units at bedtime, and changing all her carb ratios again. She will be at a ratio of 1-15 for breakfast, 1-20 for lunch and 1-10 for dinner. I am a bit scared of this new Lantus dosage, but the first night she was still high all night.
Last night she was 96 after dinner, I knew that was coming she forgot to finish her milk, actually thought she would have been low. I gave her a small glass of milk when we realized (2 hrs later) because I wanted her up a bit more before bed, she also got her Lantus shot at this time. I gave her snack about 30 minutes later and she went to bed. I checked her at 11:30 hoping to sneak into bed a few minutes earlier than 12 and she was at 128. I really felt that this number was too low to go overnight with, but struggled with having to wake her up and feed her, since I knew she had a good snack ( waffle with peanut butter and milk) and this number didn't make sense to me. Finger was clean and test was done right. I decided to wait and test again at midnight, and yes I paced for 30 minutes straight. At midnight she tested at 225. At her 3am check she was at 203 and woke up at 156. Best numbers in a long time. I guess I was right to wait, but it was scary. What do you think happened to cause the numbers we saw?
Also is it true that it can take a few days for you to really see how the new Lantus dose will affect her all the way? I know we do 12am and 3am checks for three nights after a dose change, I'm assuming that is why.

Carly - just a guess because I am estimating on some of the times, but my interpretation is that your Lantus may be too high.
Here's how I came up with that :
9 pm (?) - Lantus and milk
9:30 pm (?) - snack
11:30 pm - 128
12:00 am - 225
3:00 am - 203
7:00 am (?) - 156

If this is correct, at midnight she was likely still coming up from the snack. After her peak at about midnight, she started to come down and came down 70 points by morning. This is a lot more than what we like to see with our DD (30-40 pts)

You can be comfortable that the effects you are seeing are from the Lantus because the last Humalog was at dinner (correct?)

Also, don't expect the BG readings to be constant overnight even when you have your doses correct. We see BG rise slightly between midnight and 3-5am and then fall until 6-7am and then rise again until we get our DD up at 8am. We don't pay too much attention to the readings in the night except in the case of lows. We use the 11pm and 8am readings to calibrate our Lantus and expect those two readings to be within 30 points. Also, we do not change our Lantus dose unless we see the same trend for 3 days (except in the case of illness or significant lows).

In your case here, I used the midnight reading instead of the 11:30 reading because I guessed that she was still coming up from the snack.

Your other ratios are similar to what we see, except our breakfst ratio is lower than the other two. YDMV.

[Hollyb]

I think the snack probably kicked in later than you expected because waffles and peanut butter are both fairly high fat so that slows down the release of carbs. Which can be a good thing at night, because many kids tend to dip down at around 2. But it does make it hard to interpret that bedtime number -- we have said before that it would be nice if a pump could calculate "food on board" as well as "insulin on board."