Best way to stabilize at night?

[dqmomof3]

Here I am with yet another question! I can finally think straight...two days with no site issues. Hooray for the Silhouettes!

So, here was our day yesterday. Normal numbers 100-150 for the morning. At lunchtime she was 240. She ate and bolused based on the pump wizard - this was at about 1pm. At 3:30 she was 72. We were very excited about this number, actually - we haven't had a number this low since we started pumping!!

Anyway, she ate a snack as directed before gymnastics, bolused for 1/2 the snack, and went to the gym. Her numbers at the gym were 160-200. She is unhooked from the pump for this three-hour period of time, so I wasn't too surprised at the rise. She got home, ate dinner, bolused for the dinner, and went to bed at 9.

I woke her at 11 to get a bg reading before I went to bed, and it was 84. I debated on what to do with that, and finally decided to let it go, do a temporary basal decrease to 75% of normal for the night, and get back up at 2am to do another check (I check her at 3 normally anyway.) She fell back asleep and woke up in a sheer panic at midnight - came out of her room crying, "we didn't correct for the 84, I didn't eat!" So I brought her to the table and she had a 15g snack - a cookie and a little bit of milk. She was back asleep by midnight. I checked her at 2am and she was 268, which is about where she was at 8 this morning at wake-up.

So, my questions:

1. Once I fed her the snack, should I have increased her basal back to normal? I was afraid she'd trend low, being that it was after gymnastics, so I left it at the 75%.

2. Should I have skipped the snack altogether and just sent her back to bed with the decreased basal? Would I have been more likely to have seen better 2am and wakeup numbers?

3. Once I saw the 2am number, should I have discontinued the temporary basal and given a correction?

Thanks for any help or suggestions! I feel like we've wasted a week on the pump just trying to get a site that works - now I have to figure out the rest!

[momtojess]

DId you check her again at midnight before giving her the snack? She was probably coming up alittle already with the decreased basal.

I would have probably let her have the snack just to help calm her down, and then I would have se the basal back to normal.

This is one of the things that you learn what works for her after doing it for awhile.

Glad you are having better luck with the sites now.

[zeb'smom]

I would have done one or the other but not both. For a highish low like 84 I would usually just do a decreased basal so I don't have to wake him, unless of course he had a lot of activity and I am worried he will go lower. If he does have a snack then I don't do the temp basal as the combo will make him high, he gets very little insulin at night so any decrease means he's getting next to nothing. Last night he was 70 at 10:30 treated with 10g of juice and he was 113 at midnight 126 at 4am and 122 waking. Had that 70 been a 90 I would have gone the other way and just done a temp basal which sometimes works out really well but sometimes leads to a correction later in the night.

Good luck, getting good night time numbers took us a really long time and every time his needs change night time is always the hardest to get right. I can be so hard to find just the right amount that will keep them steady overnight, too much and your dealing with low too little and your waking up to highs which tend to mess up the whole day.

Robyn

P.S. This is why it's so hard for others on the outside of D to really understand, there is not set way to do anything and just when you get it right your dealing with growth spurts or changes in the weather.

oh, where is Swansboro? Maybe we aren't too far apart.

[dqmomof3]

Actually, we're on opposite ends of the state, LOL! I am five minutes from the ocean, and you're in the mountains :-).

And I think you're right...I should have done one or the other, but not both.

I HATE overnights, especially after gymnastics! She is so unpredictable.

[Mary Lou]

Hi Jennifer -- glad to hear your sites are finally working out. I think that sports and night time take a lot of trial and error and, as always, what works for one doesn't work for another.

Here are a couple of things you can try:

1. When Brian was first dx'd, unhooking for three hours did not cause any kind of rise in BG. Once we started to see a rise in numbers, this is what we switched too: half-way through the unhooked period, or at the end if it is easier, we replace 1/2 of the missed basal. So, if her total missed basal is .4 units, I would manually bolus for .2. I will often do a fraction of this "make-up" insulin before unhooking him for gymnastics if his BG is 180 or above b/c I know he will rise from being unhooked that long.

2. There is always a drop in BG after exercise. When and how much depends on the child and on the activity and excitement factor. Our D team suggested that we test every 30 minutes after activity to determine this time frame for Brian and gymnastics. it was a huge pain, but the information was invaluable.

3. With Brian, he drops the first couple of hours after going to bed on gymnastics days. We put him to bed with a 50% basal rate for the length of time he was at the gym. His work outs are usually 2 - 2/12 hours in length, and that is the length of time we set the temp basal for at night.

4. We bolus fully for food if he is high coming out of gymnastics, but if he is dropping right away, we will feed him and bolus for 60 - 75% of his carbs.

It looks like, from the information you gave, she was 200 coming out of gymnastics, what was her 9 pm number? Assuming it was also around 200, she dropped to 84 within 2 hours. That's a significant drop.

Our endo says to always bolus something for food, even if it's just .1U. If this was Brian on a gym night and we had forgotten the temp basal, I would've given him a snack at 11, waited 20 minutes, and then bolused for some of the snack once his BG was no longer dropping. I would have cancelled the temp basal, and continued to check until numbers were stable.

I think you are doing a great job. don't worry, you will get this all figured out and it will become second nature to you.

[dqmomof3]

Mary Lou, when you said:

There is always a drop in BG after exercise. When and how much depends on the child and on the activity and excitement factor. Our D team suggested that we test every 30 minutes after activity to determine this time frame for Brian and gymnastics. it was a huge pain, but the information was invaluable.

Did you check him every half an hour from the end of the activity until the next morning? Or if not, how long did you check after the activity was done? For Jayden, it seems like her numbers the next morning after gymnastics are always really good, maybe a little low.

Thanks for the tip on the basal - I think we might try that. She had a rise of about 60 during the three hours of gymnastics.

[Kaylee's Mommy]

1. Once I fed her the snack, should I have increased her basal back to normal? I was afraid she'd trend low, being that it was after gymnastics, so I left it at the 75%.

2. Should I have skipped the snack altogether and just sent her back to bed with the decreased basal? Would I have been more likely to have seen better 2am and wakeup numbers?

3. Once I saw the 2am number, should I have discontinued the temporary basal and given a correction?



I think you could have done a number of things here, there is no 'right' answer.. A smaller snack with the decreased basal may have worked as well.. any of those things that you suggested would have worked..

where she is off the pump for three hours, she's missing 3 hours of basals.. in some kids that will make a HUGE difference later on in the day (starting 2 hours after the first missed basal and continueing through for several hours..) but she's also doing A LOT of exercise to counteract that missed basal.. I think its going to be something that will have to be trial and error at this point, seeing what works for her specifically..and you've got some great advice for others who do gymnastics:)

[Mary Lou]

Mary Lou, when you said:

There is always a drop in BG after exercise. When and how much depends on the child and on the activity and excitement factor. Our D team suggested that we test every 30 minutes after activity to determine this time frame for Brian and gymnastics. it was a huge pain, but the information was invaluable.

Did you check him every half an hour from the end of the activity until the next morning? Or if not, how long did you check after the activity was done? For Jayden, it seems like her numbers the next morning after gymnastics are always really good, maybe a little low.

Thanks for the tip on the basal - I think we might try that. She had a rise of about 60 during the three hours of gymnastics.

We checked him every 30 minutes after gymnastics until midnight, I think. It really sucked. I'm glad he sleeps through the BG checks b/c I would've hated to wake him up. I think that once you know when the drop happens for you child, you can plan for it and then ease up on the testing. If she wakes up good and her 3 am number is good (since you said you check her then), i wouldn't go though the night.

It would be great if what we do helps you! Nothing like re-inventing the wheel every week :D

btw -- before we did this crazy testing, our CDE recommended the 50% night basal and that worked like a charm to prevent the night lows. You might say the testing just comfirmed that this was a good plan for us.

[skimom]

How long is GYm practise? Does she snack during practise?
Numbers after exercise can go up or down - various reasons including depleting glucose reserves followed by glycogen release, or could be adrenalin.
Consider exercise as being able to eat without taking the insulin (free food so to speak).It is important though to be sure that your child is eating enough during the day and the day before activity.Highs can be explained by a glycogen release as their body has to access its own reserves - so please eat a snack immediately after finishing gym ((1-2 g carb per kg body weight) After activity, the metabolism stays elevated for quite some time (can be several hourse) so it is important to test periodically.
I try to be sure that if my kids have had a busy night that thier BG is around 8 (about 140) at least at bed - I have found they tend to stay steady throught the night that way. If they are lower, they get a small snack with no insulin and we test every few hours.We tend not to adjust basals too much rather give them snacks instead .My son gets postexercise lows (up to 12 hours later) while my daughter gets post exercise highs (last 4-6 hours) so we try everything.
It will take some time to get this figured so just try lots of strategies(but only one at a time!) and test lots.