Endo advice Night Checks...

[maddiesdad]

My daughter was diagnosed a month ago and is a very active kid so we have experienced several lows at nights despite my best attempts to carb her up, when appropriate. We have had her lantas adjusted from 20 to 18 to 16. Lantas given at 8AM. Today, my wife goes into the Endo and she says -- unless she's doing sports that night you really don't need to check anymore as long as she goes to bed above 110. Her througout the day numbers are almost all between 85 and 100.

I am not happy with this advice. I read the thread last week, and in my opinion ( looking at the charts from the ultrasmart monitor ) she tends to go down at nights. She goes to bed at 8 and there just typically isn't enough sugar in the system to hold her up all night. I have delivered juice, peanut butter toast, etc, on probably 4 occassions ( non sports nights ). Sports nights are another story. Tons of fun, but I love my daughter so whatever it takes. We keep trying new approaches/foods to tide her over.

Her really bad lows ( 40s ) have been big surprises on sports nights when she has gone over an hour from 180 to 43 ( I check almost every hour on sports nights ). That night, no Novolog was given after 5PM ( only one unit, then ) and over 200 carbs were required to have her wake up at 104. She went low twice that night. Despite recovering her into 150+ for a 2 hr period

The other lows have been 60s, which is below the threshhold they set of 70 but not way low.

Thoughts? Seems like irresponsible advice to me, honestly. She is definitely honeymooning as well, so that adds some variability to things.

-- FYI -- I'm going to check at night for much longer. :)

Mike

Maddie's Bio:
11 years old
Diagnosed 10/29/07
Lantas in the AM, Novolog pen during the day
Will be pumping early next year, hopefully
Superstar Basketball and Fastpitch Player :)

[Lee]

The endo isn't living with it - I say keep night checking. I do not do it every time, and Dad's house rarely (1 every couple of months), but I try to once a week unless I suspect something. You do what you feel comfortable with!

[kel4han]

Basal is way to high, and the Endo should have seen this.....they still left you at 16 units?

[Momof4gr8kids]

I'd think about the pump, honestly.

If that doesn't work maybe you could talk about dropping the lantus, and covering with extra rapid at meals, or maybe some NPH with breakfast.

I wouldn't however stop checking if you are seeing lows on non sports nights. That's insane advise. Sounds like a rushed endo.

[frizzyrazzy]

here's the thing - the endo doesn't live in your house. Do whatever makes you most comfortable. IMO, I'd be checking. I'm 2 years into this and I still check many many nights because there is so much variation.

[Amy C.]

The endo is giving you advice, not ordering you to stop testing at night. If you do not feel comfortable having her go all night without a test, by all means test her.

It looks as though you have sufficient reason to test.

When my son was on Lantus, I used the middle of the night reading to gage the amount of Lantus needed. The goal was to not have to eat a snack and be in range in the middle of the night. If she must have the snack, the Lantus is too high. It is not at all unusual to lower the insulin once released from the hospital, sometimes drastically.

My son has been tested just about every night for the past 8 1/2 years. When it seems as though we could stop, something happens to let us know to continue doing the test.

It also sounds like she needs to eat a lot to feed the Lantus on sports nights. Is there enough evidence to leave out the Novalog at supper? Plus, it sounds like she needs another supper before going to bed.

[Mary Lou]

I think you are right to trust your instincts. Many of us on the board have athletic children and their needs on "sports" days are just different. You will likely have noticed a drop in BG anywhere from 1 - 48 hours after exercise, we usually see a drop right at bedtime, but it can come at different times, depending on the type of exercise your child is engaging in.

My favorite, and most helpful book on the topic has been "The Diabetic Athlete" and it has helped us to understand how to manage sports and diabetes.

A tip from our nutritionist is to always have a "recovery snack" when the sports are over -- fast carbs, crackers of some sort, fruit, whatever she likes (we give about 15 - 25 carbs of something, regardless of BG coming out of sports). Keep BG a little high as she comes out and do your best to replenish the carbs used during the activity. Before sports, on Lantus, we fed Brian Reese's peanut butter cups (terrible, I know). Our CDE recommended them as they have enough fat and protein to extend the carbs out during activity. "Healthy carbs" like an apple just don't have the staying power. I recall one baseball game (on Lantus) that Brian needed about 10 PB cups just to hover around 100...all unbolused.

I think it's great that you're looking at the pump for next year (early I hope!), but we were on Lantus for some time and made it work, too. From the information given, I'd say she's getting too much Lantus. Does she vary on non-sports nights? Do you always need to give her so much to eat?

I hate advising people to disregard their endo's advise, but is there another endo you could go to for a second opinion?

FWIW -- our best nighttime snacks on active nights are those with lots of fats and proteins. Ice-cream works well for my boys, and they will *always* eat that :D

BTW, I am very sorry for your child's diagnosis.

[3js]

You need to do what feels safe for you- and personally I`m feeling the same as you- too scary not to check!:) We check every night, and I will continue to do so- because my son has been low/high unexpectedly, and then he also has 3 very active days a week.

Have you looked at the carb ratios? We have different ratios for different days/and times of days.

Yesterday we changed my son`s as he has been having a lot of lows during the day, but his am bg is good( he gets his Lantus at bedtime).



Perhaps a higher carb ration on sports days, gym days- for all or most meals and snacks, then a higher ration at bed/dinner every night? I am new at Lantus too- just some thoughts. Good luck:)

[Boo]

That's exactly why, after 3+ years, I still CHOOSE to check my son every night. The endo said it wasn't necessary, but then she also admitted that we should keep doing it if it is not cramping our lifestyle. For those of us with very active children, or for those of us with erratic schedules (or both), it seems the safe way to go.

[Schpoodle's Dad]

Wow. Good luck. If it's any consolation, I think most of the Endos tell the parents not to worry about checking at night - but most of us still do - at least when things aren't stable.

You have a very tough situation - newly diagnosed, honeymooning, high activity and lots of insulin. You might want to look into a CGMS, but I don't know how much it would help because of the rapid drops. Someone around here that's using one may be of more assistance.

If this were us, we would talk to our Endo about cutting way back on the Lantus until things stabilized and especially on days with high activity (but remember - YDMV). At least phone your Endo and specifically ask him about it. When we have disagreements, we've found that they either have a good reason for recommending their treament or they don't have a complete picture. Very rarely have we disagreed with them once we know their side and quite often they will agree with us when we give them all the details and concerns.

And if this were us, we'd be up all night checking too.

[maddiesdad]

Makes me feel more comfortable with how I feel about things. I am going to call and talk about Lantas levels one more time and ask about not giving the full dose on practice/game nights.

We are hoping to go to omnipod in the first portion of next year.

As for carb ratio, she was 15 to one when she left the hospital but is not 20-1.

As a followup question, for those of you who don't check often at night and use injections versus pump, what # are you typically shooting to put your child to bed at? In my brief experience if I see around 150 or so on non-activity nights she wakes up just perfect.

Would you always check if she went to bed at 100? Would you give her carbs before putting her to bed at 100? I know I do. For Maddie, even 110 is not ever high enough ( on non-sports nights ) to keep her levels over night. She goes to bed 8ish and wakes up 7ish. ( MAN WOULD THAT BE NICE! :) )

[Abby-Dabby-Doo]

I like the statement that diabetes doesn't go away at night, because that's it's how I feel about it personally. We've checked every night since dxd, and will continue to check until I/we feel other wise.
I agree I would not put my child to bed with a blood sugar of 100. My daughter always has something to eat before bed, and my night depends on her 3am number. I like to see between 140-180 when I check at 3am.

Have you tried the cornstarch trick that Heather(CA) suggested in your last post? Her son is very active (soccer) and she has A LOT of experience in that area.

[caspi]

Makes me feel more comfortable with how I feel about things. I am going to call and talk about Lantas levels one more time and ask about not giving the full dose on practice/game nights.

We are hoping to go to omnipod in the first portion of next year.

As for carb ratio, she was 15 to one when she left the hospital but is not 20-1.

As a followup question, for those of you who don't check often at night and use injections versus pump, what # are you typically shooting to put your child to bed at? In my brief experience if I see around 150 or so on non-activity nights she wakes up just perfect.

Would you always check if she went to bed at 100? Would you give her carbs before putting her to bed at 100? I know I do. For Maddie, even 110 is not ever high enough ( on non-sports nights ) to keep her levels over night. She goes to bed 8ish and wakes up 7ish. ( MAN WOULD THAT BE NICE! :) )


You're going to find that your insulin needs will dramatically change within the first few months of dx. Cameron was taking 14 units of Lantus at night and is now on 6. Our C:I ratios have also dropped from 40:1 to now 20:1 and 25:1. And I'm sure these will change again soon!;)

Cameron is an active child who plays soccer. During soccer season, we don't put him to bed unless he's at 180. He loves that extra cup of milk with his ice cream!:) Now that soccer is over, we've found that 120 is a good # for us.

The most important thing we've found with Cameron is that he has to have ice cream as his night time snack to keep him level all night. I guess the combination of fat & carbs seems to work for us. Then again, YDMV........

[Charmed7]

I don't know if this is helpful, but I thought I would just put in my experience to more make the point of how different everyone is and how you will make your own decisions as you "learn as you go"

We recently switch to lantus around June. We started out with 16 units of Lantus. We had lots of lows and a few in the middle of the night, but my son will wake up and test on his own when he feels low. One of his first signs is the feeling of hot and that wakes him. Now we're down to 11 1/2 units in the AM. His sugars are much easier to manage once the Lantus is at the right dosage.

It sounds like you should have two Lantus amounts. One for high activity and one for low. My other suggestion is to keep looking for the perfect night time carb. I've heard a glass of milk is good. Or maybe a pasta. Keep experimenting with one thing at a time.

Good luck, you sound like you're on the right track.

Charmed

[twodoor2]

I'm one of those parents that questions EVERYTHING the endo does, and she's a decent doctor. She even told me today that she knows that I don't always follow her advice 100%, but she said that I'm the one who lives with my daughter, and I know her best, so that's okay.

For example, she is telling me to change her carb factors to 1/40 for dinner and at bedtime, and I will probably just start out and only change the dinner number, and leave bedtime at 1/50, and I'll see what happens.

I also told her that I think the Lantus is just right and I explained why, and told her I didn't want to raise it. She abided by my wishes because it made sense to her and I try to make an educated decision. It is your right to check your daughter 100 times a night if you wanted, I totally agree with you, and again, the endo doesn't live with her, you do. I think based on what you told us, you would be foolish not to check her!!

[Twinklet]

We've been at this for 18 months and still check at night, most nights.

I also agree that the Lantus dose may be too high. As someone already mentioned, you'll see MANY dosage changes in the next few months. At diagnosis, most people are somewhat insulin-resistant. This changes dramatically over a period of a few weeks, usually.

Your last question about what number to put your child to bed at: Emily is on the pump and we tweak her hourly basal rate so that she's 90-120 at night, ideally. This is not possible when she's growing, however. When she was on Lantus, we shot for 120-150, IIRC.

It sounds like you're doing a fabulous job with your daughter! Keep encouraging her to shoot for her goals and keep living as normal of a life as possible.

[thebestnest5]

Our Endo doesn't feel that we need to test every night. DH and I disagree and so we test. I have seen Liv drop in BG quite dramatically for now apparent reason.

For us, the benefits outweigh so much of anything else on this matter.:cwds:

[jdr]

I would no doubt keep testing at night.I do think that when you get on the pump it will help you a lot.We always had problems with excerice and Lantus. The pump will not totally do away with the lows,but it may help you avoid a lot of them.

[LJS118]

my son has had d for 9 years now...at about 8 years my endo said i could stop checking in the middle of the night as well...but here i am at 9 years still checking EVERY stinkin night!! I need the reassurance that he'll be fine when I wake up in the morning...no matter how much the doc says i can sleep i just can't.