View Full Version : nightime highs and nph
my son is having highs at night- not every night but more than not. he gets nph and nr at dinner, and when we test before nightime snack he is high, then just gets higher. we were worried that it was due to rebound from lows (we were alerted to the highs from bedwetting and 1 bg check a night).
so we have been testing 12 and 2am , or 1 and 3am. he is high (sometimes 18`s). by am he is normal-5`s- 6`s.
i am wondering what is done for this situation?:confused:
the endo said we would not switch to bedtime insulin until his am #`s were high.
he is not high at bedtime EVERY night, so i don`t want to increase the dinner insulins (i do if he`s high AT dinner).
i hope this makes sense. :confused: any help would be appreciated.
Wendy12571
08-14-2007, 12:18 AM
Hi Mom,
My first recommendation is to ask the endocrinologist about moving the NPH shot to bedtime instead of at dinner time. This may help with the highs occuring overnight. I am going back many moons on that one since I have been pumping for almost7 years now.
Wendy
Momof4gr8kids
08-14-2007, 03:42 AM
What about switching to a combo of Novolog, NPH, and Lantus? You take the lantus, and use the NPH in the am to cover lunch, and inject the lantus with the dinner shot. Still 2 shots per day, and those that use this seem really happy with it. With the over night spike it would scare me to raise NPH to much to quick, so if that is how you end up getting it done, take it slow.....
nebby3
08-14-2007, 08:35 AM
We had the same problem on NPH. My dd would be in the 300s the first part of the night but come down by morning. We couldn't just increase the NPH or she would go low by am. We ended up switching to ultralente (which I think may no longer be available) overnight which helped some. Maybe try lantus or another insulin overnight? Also, is he getting a bedtime snack? If so, I would look at cutting that way down or out altogether. Changing the timing of his evening NPH is another option. Or of course pumping. Basically, what he has now is just not working well for him. I wouldn't be content with these highs every night though it sounds like your endo may be.
flabby_abi
08-14-2007, 11:33 AM
check out these web sites: www.gr8ful1.org , www.heavenscentpaws.com
i am getting a dog that will alert me when i am high or low! this would be great for in the middle of the night!
madde
08-14-2007, 11:53 AM
Do you think his honeymoon could be ending. Nighttime hi's or hi's before lunch are indicators that the honeymoon is coming to an end.
We also uses nph. I have noticed Madison runs higher before bedtime on evenings when she is less active. I have learned to increase nph dose at dinnertime when I know she isn't going to be as active. (rainy days for example) If it is nice outside, then I keep the nph the same. This really works for us.
Or, i just give her a snack with fewer carbs before bedtime.
What about switching to a combo of Novolog, NPH, and Lantus? You take the lantus, and use the NPH in the am to cover lunch, and inject the lantus with the dinner shot. Still 2 shots per day, and those that use this seem really happy with it. With the over night spike it would scare me to raise NPH to much to quick, so if that is how you end up getting it done, take it slow.....
thank you all so much for your replies :)
jmeb78, i am going to ask for this today. it sounds like it would be perfect- i am really worried about changing the nph at night. i didn`t know that you could take lantus at night, and nph in am.
so i decided to give things a shot before calling endo. i changed his am nph +1 unit. we did a sugarfax to the endo the next day. the nurse agreed with that change, and upped the sliding scale for the novorapid.
he has had much better #s at dinner and bedtime, but he is still high at bedtime (altho sometimes in range) and VERY high at 1am and 3am. i`m talking 19-24 (this is x18 for US but i don`t have my calculator handy:o).
the recommendation was to send sugar fax tomorrow and possibly split up the nph between am and bedtime. presently he is getting 22nph am, 2dinner. plus 4-7units novorapid am, 1-4units novorapid dinner.
i have heard that this higher dose at bedtime presents a greater risk for lows at night. he is going down by morning on his own right now, altho those am #`s have been higher lately, with several out of range,
any info on bedtime nph, or ideas, plus more info on using lantus at night and nph in am would be greatly appreciated.
i know that this regimen is NOT the best, but i`m not pushing until i feel i have to because there is more going on healthwise with my son than just the d. he has had depression and has an anxiety disorder, plus asthma.
so my overall wish is to see my son have the least "invasive" regimen as possible, and this is my endo`s thinking as well. the mealplan for nph doesn`t bother my son at all- except once when sick, and at the fair lastweek when i screwed up his insulin. in may we can start pumping- my son wants to and endo ok`d it.
but his safety is #1. if that means changing insulin i`m ok with it.
any info on bedtime nph, or ideas, plus more info on using lantus at night and nph in am would be greatly appreciated. or any personal experience.
also, would the i port be a viable solution?
thanks for reading:)from a stressed out mom!
allisa
08-27-2007, 04:05 PM
What about switching to a combo of Novolog, NPH, and Lantus? You take the lantus, and use the NPH in the am to cover lunch, and inject the lantus with the dinner shot. Still 2 shots per day, and those that use this seem really happy with it. With the over night spike it would scare me to raise NPH to much to quick, so if that is how you end up getting it done, take it slow.....
and the second quote ......
My first recommendation is to ask the endocrinologist about moving the NPH shot to bedtime instead of at dinner time. This may help with the highs occuring overnight. I am going back many moons on that one since I have been pumping for almost7 years now.
Wendy
My endo recommended doing what Wendy said ( changing the time ) and if that didn't work doing the nph.lantus.humolag ( 3 insulin) .....well the first worked and is what we have done.....
I think both these solutions are great..............
Amy C.
08-27-2007, 04:08 PM
When my son was on NPH years ago, we had much better luck with doing two shots of NPH rather than one. These late night highs would be helped by a bedtime injection. Keep in mind, he will be getting the same amount of insulin a day, it will just be distributed better to match when he needs it.
That being said, Lantus and a short acting insulin is much better at matching what the body needs than NPH/short acting. I never did think NPH worked very well and was convinced once he was on Lantus.
The Lantus/short acting regmine is much more predictable and your son will probably feel better -- I know my son did.
and the second quote ......
My first recommendation is to ask the endocrinologist about moving the NPH shot to bedtime instead of at dinner time. This may help with the highs occuring overnight. I am going back many moons on that one since I have been pumping for almost7 years now.
Wendy
My endo recommended doing what Wendy said ( changing the time ) and if that didn't work doing the nph.lantus.humolag ( 3 insulin) .....well the first worked and is what we have done.....
I think both these solutions are great..............
allisa: did you have more lows at night with the nph being given at bedtime instead of dinner?
quote: amy
When my son was on NPH years ago, we had much better luck with doing two shots of NPH rather than one. These late night highs would be helped by a bedtime injection. Keep in mind, he will be getting the same amount of insulin a day, it will just be distributed better to match when he needs it.
"That being said, Lantus and a short acting insulin is much better at matching what the body needs than NPH/short acting. I never did think NPH worked very well and was convinced once he was on Lantus.
The Lantus/short acting regmine is much more predictable and your son will probably feel better -- I know my son did.
did your son have lows with the lantus? were you doing lantus/short acting, and no nph?
this is what i want- predictability. i guess that`s what we all want!!!:rolleyes:
Amy C.
08-27-2007, 08:30 PM
did your son have lows with the lantus? were you doing lantus/short acting, and no nph?
Every diabetic who takes insulin will have lows. You have to test enough to catch them. He has lows on the pump.
With Lantus, I was better able to discern patterns and head off lows and highs before they happen. I do the same on the pump.
He dropped the NPH completely when on Lantus. He would go low at 11:30 when lunch was a 12:30. That was a problem.