advice for morning bg. Lantus/novalog insulin sensitive

[Judy&Alli]

Hi everyone, I'm having trouble with Alli's morning bg. Alli is very insulin sensitive and we can't seem to strike a balnace. She has been waking up for the last two weeks in the 200-250 range. I hesitated changing the dosage because then we have hypo's. Last night I changed her lantus dose from 9 1/2 to 10 units. This morning she woke up at 66 ugh!!! Nothing else changed she had the same bedtime snack a normal bedtime # of 160. She should have been fine. This disease makes me crazy!!!!!! Anyone out there have any good ideas that could help?? All the rest of her bg during the day has been within target. Which that in itself is a miracle. Any ideas or advice is as always appreciated! Also she takes Lantus at 8:00pm if that helps.
Thanks,
Judy

[redmcgee]

Did she do any extra physical activity during the day. I found out that even an extra physical activity during the day can pull low's at night.
But on the other hand I am having the same problem was at 7.5 went up to 8 and the she started waking up in 50's so had to drop back down and she is not getting any extra physical activity right now with this weather. I talked on another thread about splitting up her lantus 1/2 at night and 1/2 in morning.

[GaPeach]

If other daytime #'s are good, it seems that the Lantus is probably right or close to right. Extra activity could have made her drop.

My suggestion is to either split the Lantus dose to avoid a high peak during the night or switch to morning dosing.

We dose in the morning. That results in lower ratios for Novalog Breakfast-1:30 and Lunch-1:45, then Supper -1:60 because Lantus is about to give out. It is rare for her to have a major drop at night as long as she is at 110 @ bedtime (160 with a day of extra activity). Most mornings, she wakes around 100.

[taximom]

Hi everyone, I'm having trouble with Alli's morning bg. Alli is very insulin sensitive and we can't seem to strike a balnace. She has been waking up for the last two weeks in the 200-250 range.


Do you check her in the middle of the night? like 2:00AM? If so, what is that number like? What has been she having for a bedtime snack? What is her bedtime snack i:c ratio?

[Judy&Alli]

No we don't check her at night. Her bedtime snack is always milk, which always seems to hold her through the night. She doesn't have novalog for her bedtime snack. The only time she gets a shot at night is for the lantus. I hope that helps.
Thanks,
Judy

[Ali]

Sometimes it is easier to adjust the snack (without any increase in insulin). You could up her snack a bit with more protein and carb. Cheese, or more milk etc. Good luck. Ali

[taximom]

For us: No insulin + milk = BG spike:eek: We always have to cover a snack with insulin, especially milk. You might want to try something with more protein. We like to give nuts at bedtime...low carbs, but high protein.

That may not be true for everyone, but that's what happens to my DS.

You might want to try some BG testing in the middle of the night (I'm not saying every night). But just to see what's happening. My DS is always higher at 2:00AM than when he wakes up. So if your DD is high in the morning (200's), I would wonder what she was in the middle of the night. Or on those days when she is waking up low, was she even lower during the night:eek:? especially since you are giving the Lantus at night. There may be a slight peak to it at around 6 hrs (YDMV, of course). Just a suggestion, to get a better picture of what's going on.

[Heather(CA)]

Hi everyone, I'm having trouble with Alli's morning bg. Alli is very insulin sensitive and we can't seem to strike a balnace. She has been waking up for the last two weeks in the 200-250 range. I hesitated changing the dosage because then we have hypo's. Last night I changed her lantus dose from 9 1/2 to 10 units. This morning she woke up at 66 ugh!!! Nothing else changed she had the same bedtime snack a normal bedtime # of 160. She should have been fine. This disease makes me crazy!!!!!! Anyone out there have any good ideas that could help?? All the rest of her bg during the day has been within target. Which that in itself is a miracle. Any ideas or advice is as always appreciated! Also she takes Lantus at 8:00pm if that helps.
Thanks,
Judy


I'm going to throw something out there...

I think your problem is the snack, this is why..
There isn't supposed to be a bedtime snack needed with Lantus to keep them level. So what I think is happening is that she's good, you give her a snack, that makes her go up and stay there until morning...If it's keeping her level, it's right. When you raised it, it was too much so it brought her back down (It's not supposed to do that if it's right...)

What do you think? Is that poss? YDMV:cwds:

Seth only gets a snack at bedtime when he's had a LOT of exercise that day.

I just read your other responses, I only give Seth milk if he's not low, but not high enough for bed, like say he's 76, I will give him 4oz. If she's not low, I still think the snack is your problem, I would put the Lantus to 9 units, give it in the bootie and eliminate the snack. Test in the middle of the night for that night to see how it's doing.

BTW, we have always adjusted Lantus 1 unit at a time, did your Endo tell you different? A 1/2 a unit would not drop her from the 200's to the 60's. It's so spread out that 1/2 a unit wont make a big enough differance unless their really small. Seth was dx'd at 7 and we've never done 1/2's for the Lantus. (That's why I said to go down to 9, since with the 10 she was in the 60's)

[twodoor2]

No we don't check her at night. Her bedtime snack is always milk, which always seems to hold her through the night. She doesn't have novalog for her bedtime snack. The only time she gets a shot at night is for the lantus. I hope that helps.
Thanks,
Judy

Give her the Lantus in the morning, prior to breakfast. Otherwise, she will be more prone to suffer lows at night. Just note that if you do that, her carb ratios, in particular the afternoon ones, might need to be adjusted to accomodate the slight peak that Lantus has (they might go up). At least you will be giving her food to accomodate any potential lows from the peak.

I think you should start there first because it can be dangerous giving Lantus at night for some children.

[Heather(CA)]

Give her the Lantus in the morning, prior to breakfast. Otherwise, she will be more prone to suffer lows at night. Just note that if you do that, her carb ratios, in particular the afternoon ones, might need to be adjusted to accomodate the slight peak that Lantus has (they might go up). At least you will be giving her food to accomodate any potential lows from the peak.

I think you should start there first because it can be dangerous giving Lantus at night for some children.

You could be right, but I think if the problem was dropping during the night, she would be waking up in the 300's from rebounds...:confused:

[wilf]

I'd also start with trying to reduce or eliminate the carbs in the bedtime snack, and seeing what that does..

[Momof4gr8kids]

Given the amount of lantus you are giving, half a unit is only about a 5% change. Unless your DD has an ISF above 400 I don't think a half unit change in lantus would make a 200 pt drop.

I really think you should go back to 9.5u and get rid of the snack, and then do some overnight testing. Without those over night numbers you are not going to figure it out.

[mph]

JMO, but I'd start with some night time readings to assess what's really going on. Then maybe experiment with no snack or a different protein snack or whatever. Overnight with no readings leaves a big fuzzy picture of what may or may not be happening with her bg. Especially if there are lows........:(

Best wishes!!!!!:)

[Judy&Alli]

I'm going to throw something out there...

I think your problem is the snack, this is why..
There isn't supposed to be a bedtime snack needed with Lantus to keep them level. So what I think is happening is that she's good, you give her a snack, that makes her go up and stay there until morning...If it's keeping her level, it's right. When you raised it, it was too much so it brought her back down (It's not supposed to do that if it's right...)

What do you think? Is that poss? YDMV:cwds:

Seth only gets a snack at bedtime when he's had a LOT of exercise that day.

I just read your other responses, I only give Seth milk if he's not low, but not high enough for bed, like say he's 76, I will give him 4oz. If she's not low, I still think the snack is your problem, I would put the Lantus to 9 units, give it in the bootie and eliminate the snack. Test in the middle of the night for that night to see how it's doing.

BTW, we have always adjusted Lantus 1 unit at a time, did your Endo tell you different? A 1/2 a unit would not drop her from the 200's to the 60's. It's so spread out that 1/2 a unit wont make a big enough differance unless their really small. Seth was dx'd at 7 and we've never done 1/2's for the Lantus. (That's why I said to go down to 9, since with the 10 she was in the 60's)



Hi everyone I am cofused. I've read this a few times to try and understand. So here goes. Our endo has discussed bedtime snacks at almost every visit. Before I had the power to change dosages I would skip bedtime snacks so as to not raise bg. When I mentioned this to the endo I got a very kind butt chewing. They told me to never skip bedtime snack no matter what the bg#is. Has anyone else heard of this before?
As far as the Lantus with the half unit this is a new practice for us. About a month ago they changed Alli's dosages very aggressively. Very bad mistake!!!! We had so many very severe hypo's. It was MLK and I didn't even try the endo and just changed her back almost to where she was before the aggresive dosage change. Little by little I have tweaked things on my own to get Alli's numbers in target. I'm not sure if they would agree about the half unit thing but they do know and did not tell me to change to a whole unit. So since the severe hypo's I don't run to the phone for every dosage change. I think I can do better on my own. Oh my gosh I hope I don't upset anyone by not doing it by the book..... I just feel like I know my daughter better than they do. Feel free to yell I can take it LOL!!!! So your suggestion is no bedtime snack and go down to 9 units of Lantus? Won't that mess with her other beautiful numbers for the rest of the day??? Could it just be a fluke? Should I wait a day and see how tomorow is?
Thanks,
Judy:)

[saxmaniac]

The first thing that popped into my mind was precisely that... the snack can be covering up an incorrectly tuned basal. I'd drop the snack and do some basal tests to see what's happening overnight. The only time I give a nighttime snack is to get him up to 120. Sometimes that's only 4g of carbs if he's close.

If it messes with numbers during the day, so be it. Then adjust the I:Cs for daytime. I'd rather have a flat night and a bumpy day than the other way around.

I think you deserve an explanation why she needs a snack. If your endo will not explain to you why, or refuses to accommodate a desire or request you have, it might be time to go Endo Shopping.

[taximom]

They told me to never skip bedtime snack no matter what the bg#is. Has anyone else heard of this before?
Judy:)


They only told us this back when we were on NPH.

Now the endo says only give a bedtime snack if you cover it with insulin, or if they are on the low side (small snack like Saxmaniac does). Otherwise a snack is not necessary. I love the nights when my DS does not want anything for a bedtime snack :). It's always a much smoother night.

[twodoor2]

I guess my big issue is that if you give the Lantus at night, you may have a peak around 4 to 6 hours later that may interfere with the accuracy of your basal testing. That's why I mentioned to give the Lantus to the morning. What could be thought of as an incorrect dose with your basal testing, in particular if she starts dropping 4 to 6 hours later, might be due to a peak. However, the dose may still be correct.

The numbers tend to stay more level at night if you give the dose in the morning. Look at a Lantus curve and you will see that.

http://www.rajeun.net/images/Lantus.gif

The above is a graph of a curve of Lantus (in solid line). Ignore the dotted line, that's NPH. There's a slight peak there that can be more pronounced in some children.

In my humble opinion, I feel that accurate basal testing of Lantus cannot be done properly at nighttime if the dose is given at night.

You can still take away the snack and do the basal testing, but the peak might interfere with the accuracy of the test. That's all I'm saying.

[Judy&Alli]

Thanks everyone for all your wisdom. I gave Alli the 10 units of lantus. I will skip her bedtime snack and do a 2:00am check. What kind of numbers am I looking for at 2:00 am? Sorry for the ignorance but we haven't done 2:00am checks since the first month of DX. Also today's numbers were completely whacked out. Along with the 66 at breakfast she went low at lunch 43. The lunch was later than her usual lunch because of no school and no 10:30 am snack that she usually has at school. We were out and about running around and couldn't keep the regular schedule. Then the dinner time comes and she is 370 ,What the heck:eek: The only thing I can think of is maybe she is coming down with something. Maybe your wisdom can figure this out for me too.:)
Thanks,
Judy:)

[twodoor2]

Thanks everyone for all your wisdom. I gave Alli the 10 units of lantus. I will skip her bedtime snack and do a 2:00am check. What kind of numbers am I looking for at 2:00 am? Sorry for the ignorance but we haven't done 2:00am checks since the first month of DX. Also today's numbers were completely whacked out. Along with the 66 at breakfast she went low at lunch 43. The lunch was later than her usual lunch because of no school and no 10:30 am snack that she usually has at school. We were out and about running around and couldn't keep the regular schedule. Then the dinner time comes and she is 370 ,What the heck:eek: The only thing I can think of is maybe she is coming down with something. Maybe your wisdom can figure this out for me too.:)
Thanks,
Judy:)


If the Lantus dose is correct, you should see no more than a 30 point increase or a 15 point drop from the bg level that remains after all the bolus from the last dose has left the body. This is according to John Walsh, author of "Using Insulin". I'm usually happy with a +/-20 point drop or rise either way.

So for example, if she goes to bed and her BG, after all the bolus insulin is gone from her body, is 215 (I'm using a high number because it doesn't matter if you're high or low, the purpose of the Lantus is to keep you level no matter what number you are), then she should not deviate more than 230 or go lower than 185.

The night time peak may however interfere with an accurate test because that's another variable you're adding to the mixture when testing the Lantus basal. This peak may drop her further than 30 points. However, if Lantus was given during the morning, you might see a more level value at night. The peak may corrupt the test and cause you to think you're giving an inaccurate dose.

I apologize I keep harping on that, but even Ragnar Hanas (famous Scandinavian endo and author) indicates that studies have shown that giving Lantus in the morning helps to have better A1C's and less hypoglycemia at night.

[Judy&Alli]

Marsha,
How do I switch her to a morning dose of Lantus?
Judy

[twodoor2]

Marsha,
How do I switch her to a morning dose of Lantus?
Judy

That's a good question since I've never ever considered giving Elizabeth Lantus at night, just during the day. I would suggest you talk to your endo about the safest way to switch from night to day.

It may be more cumbersome to do this, and take a while to make the switch (maybe by giving two doses by splitting it in half for a day), but I think it's worth it.

You can still try your fasting basal test if you want tonight, it won't hurt anything, and if her numbers are level, than the peak may not be as pronounced on your child, so that would be good news for you there. However, if she's dropping 3 to 6 hours after the Lantus, then it could be caused by the peak, or it could be caused by too much Lantus, but you will never know for sure.

[saxmaniac]

I agree w/Marsha, definitely call the endo.

However, when I did this, I split the dose temporarily and changed the proportion every day, until eventually it was all in the morning. Our CDE liked my approach and gave the go ahead.

[Heather(CA)]

Thanks everyone for all your wisdom. I gave Alli the 10 units of lantus. I will skip her bedtime snack and do a 2:00am check. What kind of numbers am I looking for at 2:00 am? Sorry for the ignorance but we haven't done 2:00am checks since the first month of DX. Also today's numbers were completely whacked out. Along with the 66 at breakfast she went low at lunch 43. The lunch was later than her usual lunch because of no school and no 10:30 am snack that she usually has at school. We were out and about running around and couldn't keep the regular schedule. Then the dinner time comes and she is 370 ,What the heck:eek: The only thing I can think of is maybe she is coming down with something. Maybe your wisdom can figure this out for me too.:)
Thanks,
Judy:)

I'm curious why you went with the higher dose, when you weren't giveing her a snack???

Your looking for the bgs to stay within 40 points of the three hour after dinner number...

Only about 20% of kids have a peak on Lantus. Seth gets it at dinner in the bootie, he has gone to bed annd woken up within 5 to 10 points A LOT.

It's only more stable in the morning if your one of the 20%...If not, it doesn't matter. We give it at dinner, anytime between 6:30 and 8.

Are you still honeymooning? That is a reason an Endo may want the snack...If not, they don't need it when the Lantus is right. In fact, it screws up to give one unless it was necc. for some reason, like exercise.

[Judy&Alli]

I'm curious why you went with the higher dose, when you weren't giveing her a snack???

Your looking for the bgs to stay within 40 points of the three hour after dinner number...

Only about 20% of kids have a peak on Lantus. Seth gets it at dinner in the bootie, he has gone to bed annd woken up within 5 to 10 points A LOT.

It's only more stable in the morning if your one of the 20%...If not, it doesn't matter. We give it at dinner, anytime between 6:30 and 8.

Are you still honeymooning? That is a reason an Endo may want the snack...If not, they don't need it when the Lantus is right. In fact, it screws up to give one unless it was necc. for some reason, like exercise.

Hi Heather,
I'm not exactly sure why I went with 10 I guess my thinking was the higher dinner #. Last night was crazy. At 11:00 I saw Alli go to the bathroom. For her that only happens when she is extremely high she usually sleeps like a rock. I asked her to come down and check herself. When she did she was 486:eek: I was stumbling on how much to correct the number because nothing made sense all day!!! Dinner was late so could I be giving to much etc.... Any how I only gave her 2u of novalog, thinking that I would be checking her in 2 hours and I could reassess at that time. Her 2:00 am number was 130.:) Much better phew!
She wakes up this morning 160:). Only now she is home sick from school today with a sore throat and slight coughing. That to me explains the weird bg numbers. Anyhow I wanted to thank you for your posts you all are invaluable to me!!! I really appreciate all your knoweledge!!! I am going to talk to the endo as to why they insist on bedtime snack. It seems everyone is on the same page for that except me. As far as the changing Lantus til morning I think I'll wait until this cold thing is through and her numbers start to be a little more consistant. Thanks again Heather and everyone else too!!!!!
Judy:)

[wilf]

Thanks everyone for all your wisdom. I gave Alli the 10 units of lantus. I will skip her bedtime snack and do a 2:00am check. What kind of numbers am I looking for at 2:00 am? Sorry for the ignorance but we haven't done 2:00am checks since the first month of DX. Also today's numbers were completely whacked out. Along with the 66 at breakfast she went low at lunch 43. The lunch was later than her usual lunch because of no school and no 10:30 am snack that she usually has at school. We were out and about running around and couldn't keep the regular schedule. Then the dinner time comes and she is 370 ,What the heck:eek: The only thing I can think of is maybe she is coming down with something. Maybe your wisdom can figure this out for me too.:)
Thanks,
Judy:)

Chances are she went low as reflected by the 43 reading, and rebounded with insulin insensitivity afterwards (hence the 370).

Please let us know how the increase to 10 Lantus worked out.

Please also consider sacrificing some sleep to see what BG is doing overnight. On Lantus if you measure BG at YOUR bedtime, there should be very little change between that number and the morning number.

There is NO reason for a bedtime snack, unless your endo has her on a higher Lantus dosage that is pulling her BG down overnight (and then also during the day). If that is the case, then the snack would be critical.

No need to switch to morning Lantus unless your night-time readings show there is a problem.

Good luck.

[Heather(CA)]

I have just a couple of things to add for now...

First, if you can, run out and buy some Zicam. That stuff works, you just swipe it around just inside her nose and the cold will go away a LOT faster. I keep it on hand and I haven't had a bad cold in years...Get the swap (Q-tip) kind and tell her not to sniff it up. You have to go quickly though as the sooner you use it the better.

Second, Lantus is not for after dinner highs, if their high after dinner (within 3 hours), it's the fastacting that needs adjusting. Only use the three hour after dinner and the morning # to adjust the Lantus. If you try to bring her down, she could go low later.

Thrid, it's poss. she was 486 from being sick, but the fact that she came all the way down to 130 does point to a poss. rebound like Wilf said. Being sick is definately going to make this harder to figure out:( If you keep it the same tonight, I agree with Wilf again, test more often. Try to eat early, with easy to count carbs. Then, test through out the night and more often before bed.

When she was having the lows that were mentioned what times were the meal shots then the lows?

[Judy&Alli]

Hi everyone,
Even though my daughter has been diagnosed for a year and a half you will have to bear with me, I admit I have a lot to learn. I was not allowed to adjust my DD insulin on my own until about a month ago when I decided to just do it. I called the endo after the fact and they didn't seem to care. That being said is why I am so ignorant on this and basically new to even some of the terms you guys are using.


So noone told me that the three hours after dinner and the morning bg are the key to Lantus changes. That makes a whole lot of sense to me. What do I want her numbers to be? I know target, but how close to the same do they have to be for the lantus dosage to be correct. I think someone said 30 points from eachother, if you could just clarify. I do beleive the dosage is very close to correct prior to the weird low and now the sickness. Her numbers were textbook target just until the other day. I have ordered using and pumping insulin and soon wil have a better idea how this all works. Thanks for your patience and help!!!! Btw wilf I don't have a problem getting up for blood sugar checks. Just haven't had the need.
Thanks,
Judy

[Heather(CA)]

For the Lantus, you want the morning number to be within 40 points of the three hour after dinner number. I'll give a few examples...

Starting at 200. If she wakes up at 190, the Lantus is right.

Starting at 200, If she wakes up at 255, the Lantus is too low.

Starting at 200, if she wakes up at 140, the Lantus is too high, because she dropped more then 40 points. Does that make sense?

You use the dinner fastacting to raise or lower the three hour after dinner number. Lantus has nothing to do with it.;)

[twodoor2]

Again, if the Lantus has a peak, it can still corrupt this test. I really believe that, sorry. However, check the numbers as Heather indicates, and hopefully that will give a good indication on whether the Lantus is the correct dose.

[Abby-Dabby-Doo]

I disagree with the 3 hours after dinner ***SORRY*** Maybe this is just me (we only did shots for 3 1/2 months), I'm no expert with Lantus. :cwds:

I can tell you without a doubt, with certain meals that I wouldn't agree with this. Pizza for one.

[twodoor2]

I disagree with the 3 hours after dinner ***SORRY*** Maybe this is just me (we only did shots for 3 1/2 months), I'm no expert with Lantus. :cwds:

I can tell you without a doubt, with certain meals that I wouldn't agree with this. Pizza for one.

That's true, in particular if there is a longer duration of insulin action as well. I usually check at midnight, by then most of the insulin on board is gone from the body from the last bolus. Then check every two hours after that to see if it's stable. Make sure to give a low fat dinner. When you have all the numbers from each two hour check, you can post them on CWD so parents can chime in on what they think your next course of action is. It may also indicate if there's a peak there as well.

[Heather(CA)]

I disagree with the 3 hours after dinner ***SORRY*** Maybe this is just me (we only did shots for 3 1/2 months), I'm no expert with Lantus. :cwds:

I can tell you without a doubt, with certain meals that I wouldn't agree with this. Pizza for one.

Why do you disagree? Do you think it's waiting too long? Or not long enough? Pizza doesn't affect Seth like it does most kids, he's back in range within 3 hours even with pizza. There are always exceptions, but for the most part, the reason I wait three hours is that that's when the insulin is usually done working. YDMV:cwds:

BTW, we've been on Lantus for almost 5 years...Novolog for the first 4 years and Apidra since then...:cwds:

[twodoor2]

Why do you disagree? Do you think it's waiting too long? Or not long enough? Pizza doesn't affect Seth like it does most kids, he's back in range within 3 hours even with pizza. There are always exceptions, but for the most part, the reason I wait three hours is that that's when the insulin is usually done working. YDMV:cwds:

BTW, we've been on Lantus for almost 5 years...Novolog for the first 4 years and Apidra since then...:cwds:

I have to agree with Abby as well Heather, in our case Elizabeth doesn't stop dropping from Novolog until at least 4 hours. The duration of insulin action can vary among people, but I think it's safe to say that most of it is gone by 5 hours.

[Abby-Dabby-Doo]

Pizza doesn't affect Seth like it does most kids, he's back in range within 3 hours even with pizza. There are always exceptions, but for the most part, the reason I wait three hours is that that's when the insulin is usually done working.
BTW, we've been on Lantus for almost 5 years...Novolog for the first 4 years and Apidra since then...:cwds:

You said it, Seth isn't like most kids with pizza, his duration is 3 hours, and there is exceptions.
Most kids spike from a high fatty meal, our duration is 4 hours, and I hope she didn't eat cheesecake for dessert.
I personally would extend that time frame out to 5 hours so it fits MOST kids.
I'm NOT doubting how long you've been doing this Heather, or how long you've been on Lantus, if this were a contest I'd lose hands down.
You're right YDMV (your diabetes may vary), and IMO putting that time frame at 5 hours, fits MOST kids.

[Heather(CA)]

I think I usually say to wait "at least" 3 hours, I looked back and saw that I didn't this time, my bad...If it takes longer for your insulin to finish working then by all means wait until you feel it's done. If you don't it's not accurate. At about 4 years I had noticed that Seth's Novolog started to take longer to work, that's when we switched to Apidra.

Lanae, your reading into my post, I didn't think you were talking about a contest, and I'm not upset that you questioned my post. I really wanted to know if you thought the time was too long or too short. I'm thinking about starting a poll, It would be interesting to see how long it takes for different people.:)

[wilf]

DD still has about 15% of her Novolog to go after 3 hours, maybe 5% by 4 hours, and it's all gone by 5 hours.. For the record pizza with ice cream take DD all evening (maybe 4-5 hours) to digest.

Bottom line is that to see if Lantus is set right, you need to start with an evening BG reading unaffected by either insulin still working or food still digesting - and then compare that to the morning BG before breakfast.

[Judy&Alli]

Hi everyone, so here is the update so far......

Last night Alli had 10 units of Lantus 8:00 pm
11:00 bg 486 corrected w/ 2 units of Novalog
2:00 am bg 130
8:00 am bg 161 Breakfast 30 cho 2 units of Novalog
12:00 Noon bg 130 51 cho 3 units of Novalog
4:30 pm bg 139 40 cho 3 1/2 units of Novalog At 5:07 pm (Dinner)
8:10 pm 10 units of Lantus
9:00pm bg 160
11:00pm bg 63 treated 4oz juicy juice 15 cho:eek:

Alli's ratio is 1 unit of Novalog/15 cho

I'll keep checking her and update you on that as well.

I don't know if any of you can make sense of this. She is a little sick. No fever, no ketones. The only OTC medicine she is taking is childrens chewable motrin. (2 tablets)
Thanks so much,
Judy:)

[saxmaniac]

Looks like you're on your way, a pretty good day! We have different I:Cs for different times of the day. You may need to adjust those on a per-meal basis if that after-dinner low keep happening. (Alex is prone to lows after dinner of all meals, tonight I post-bolused him by 20 minutes and it finally avoided it.)

[twodoor2]

Hi everyone, so here is the update so far......

Last night Alli had 10 units of Lantus 8:00 pm
11:00 bg 486 corrected w/ 2 units of Novalog
2:00 am bg 130
8:00 am bg 161 Breakfast 30 cho 2 units of Novalog
12:00 Noon bg 130 51 cho 3 units of Novalog
4:30 pm bg 139 40 cho 3 1/2 units of Novalog At 5:07 pm (Dinner)
8:10 pm 10 units of Lantus
9:00pm bg 160
11:00pm bg 63 treated 4oz juicy juice 15 cho:eek:

Alli's ratio is 1 unit of Novalog/15 cho

I'll keep checking her and update you on that as well.

I don't know if any of you can make sense of this. She is a little sick. No fever, no ketones. The only OTC medicine she is taking is childrens chewable motrin. (2 tablets)
Thanks so much,
Judy:)

Except for the 486, which could have been caused by what she ate (did she have something very high in fat), the numbers look pretty good. The 11:00 pm low could have been caused by a peak in the Lantus. I think that the 2:00 am and the 8:00 am are only 30 points apart is a good thing. If she stays level like that all night, every night, you probably have the correct dose of Lantus, or very close to it. Maybe you could adjust it by one unit down and see how that works, but considering that you're ending up with numbers in the 100's at most of your checks, I think that's great.

I think the 63 is caused by a peak because by 9:00 pm she was 160, and that was 4.5 hours from her last dose, so all of the IOB was gone from her system by then, or most of it, however, not enough to make her drop like a rock all of a sudden. Lantus peaks can start anywhere from 3 to 6 hours after taking the dose. You gave the Lantus at 8:10 pm, and the low occurred 3 hours later. It could be from the Lantus, but the juice helped. She may just be an early peaker.

What did she have for dinner, or her last meal before the 486 occurred?

[Judy&Alli]

Except for the 486, which could have been caused by what she ate (did she have something very high in fat), the numbers look pretty good. The 11:00 pm low could have been caused by a peak in the Lantus. I think that the 2:00 am and the 8:00 am are only 30 points apart is a good thing. If she stays level like that all night, every night, you probably have the correct dose of Lantus, or very close to it. Maybe you could adjust it by one unit down and see how that works, but considering that you're ending up with numbers in the 100's at most of your checks, I think that's great.

I think the 63 is caused by a peak because by 9:00 pm she was 160, and that was 4.5 hours from her last dose, so all of the IOB was gone from her system by then, or most of it, however, not enough to make her drop like a rock all of a sudden. Lantus peaks can start anywhere from 3 to 6 hours after taking the dose. You gave the Lantus at 8:10 pm, and the low occurred 3 hours later. It could be from the Lantus, but the juice helped. She may just be an early peaker.

What did she have for dinner, or her last meal before the 486 occurred?

Hi Marsha,
Yes the morning Lantus is looking better. I think I will assess a few more days/nights to see if this is a pattern and then call the endo. Also as to the what did she have for dinner it was Mc Donald's chicken nuggets, sm ff. lol That answers the weird night number??????? Thanks!
Judy:)

[twodoor2]

Hi Marsha,
Yes the morning Lantus is looking better. I think I will assess a few more days/nights to see if this is a pattern and then call the endo. Also as to the what did she have for dinner it was Mc Donald's chicken nuggets, sm ff. lol That answers the weird night number??????? Thanks!
Judy:)

The nuggets probably did it. Yes:)

[Heather(CA)]

JMO, I still think the Lantus is too high and needs to go down to 9. The numbers were not bad the night before, but having to do the correction makes it unreliable IMO....