Night readings & morning numbers

fdlafon · #1 05-13-2009, 08:10 AM

I just don't understand . . .
We have spoken to Jordan's dr on several occasions about his night reading (which is right before he goes to bed each night and we don't have to check throughout the night unless there is reason to do so)
She explained that if he is a little high, NOT to correct, because he is still 'honeymooning' and his body will correct itself. He is regularly high at 10 p.m. before he goes to bed, not every night, but what I would consider more than what he should be. Now, it isn't terribly high, but it ranges from 140 - 180's. Like last night it was 168. He did no correction and said, lets take bets on what it will be in the morning. I guessed 76, he guesses 80 something, and his dad guesses 105. He wakes up at 66. Which is low, then he needs to boost. GGGRRRRR. . .
ok, so when do I know when we should correct and when we shouldn't? Will the pump help correct these inconsistencies? I placed a call to his dr late yesterday asking them to call me today. I'm requesting he start pumping sooner than later.

Lee · #2 05-13-2009, 08:16 AM

Honestly, you need to get a good handle on what his #'s do overnight before you can decide to correct or not. I recommend testing for two nights, at a minimum of midnight and 3am.

It could be that he is going to bed with a lot of active insulin form supper/snack that could be dragging him down.

And three years in, we are not supposed to correct anything under 200 (But we do 170) at nighttime.

julieann · #3 05-13-2009, 08:22 AM

We don't do any corrections unless associated with a high before a meal. Also, Lewie was diagnosed last month and we absolutely check at midnight and 3 a.m.

I think you need to see how his numbers are doing overnight, and then decide on your next move.

Christopher · #4 05-13-2009, 08:34 AM

In my opinion, I don't think pumping is going to help you with your current issue. As others have said, it is a trial and error situation. The reality (IMHO) is that there is no magic number or formula you can use to get predictable results every time. Diabetes doesn't work like that. The other issue is that you are in the early days and if his pancreas is still working it makes things even more unpredictable. However, you can gather information and try and use that to help you make the best guesstimate you can. In this particular situation I would have left him at 168 at bedtime and not corrected. I would have tested him several times throughout the night to prevent him from going much higher or, as he did, going too low. Since I am checking my daughter at night I am comfortable putting her to bed with lower numbers because I know I will be catching lows (or highs). I will correct her at night if she is over 200, and I have taken into account all the other variables. Please remember that each child is different and this is only what I choose to do, not what you should do for your child.

As far as the doctors advice that his body will "correct itself", I would not count on that as a given every single time.

As others have said it also depends on how much insulin he has on board, what the duration is, what he has eaten before bed, etc. Nighttime can be a scary time for CWD and their parents and it does take some sacrifice, but over time you will be more comfortable dealing with it.

Hang in there....

wilf · #5 05-13-2009, 08:34 AM

Quote:

Originally Posted by fdlafon

I just don't understand . . .
We have spoken to Jordan's dr on several occasions about his night reading (which is right before he goes to bed each night and we don't have to check throughout the night unless there is reason to do so)
She explained that if he is a little high, NOT to correct, because he is still 'honeymooning' and his body will correct itself. He is regularly high at 10 p.m. before he goes to bed, not every night, but what I would consider more than what he should be. Now, it isn't terribly high, but it ranges from 140 - 180's. Like last night it was 168. He did no correction and said, lets take bets on what it will be in the morning. I guessed 76, he guesses 80 something, and his dad guesses 105. He wakes up at 66. Which is low, then he needs to boost. GGGRRRRR. . .
ok, so when do I know when we should correct and when we shouldn't? Will the pump help correct these inconsistencies? I placed a call to his dr late yesterday asking them to call me today. I'm requesting he start pumping sooner than later.

66 is not a low you need to treat - he could just be given breakfast..

As for bedtime readings, in and of themselves they tell you nothing more than where's he's at at bedtime. You need to know what is happening overnight, and the only way you'll know is by measuring.

Oh and I have a question for you - when does he get his Lantus?

fdlafon · #6 05-13-2009, 09:00 AM

I would be happy to test him thoguhout the night. He wouldn't, but I certainly wouldn't mind to get a better handle on this.

I think at his June 5 appointment we are supposed to be taking a class on learning how to start making adjustments ourselves. Noone at home makes adjustments on Jordan's insulin regimen. We contact the dr's NP once a week with readings and she contacts me back about what his adjustments will be. If we have problems or concerns, we contact her as necessary.
So, I think that is the problem. Because we don't make the adjustments.

It has been explained that we no longer need to wake him up at night unless there is a reason. It was our understanding from the day we were released that she only wanted us to test him at night for 3 - 5 days. He was so ready to not have to be woke up in the middle of the night by the 5th night.

CButler · #7 05-13-2009, 09:01 AM

And don't forget that more exercise in the day can cause the numbers to drop at night.

fdlafon · #8 05-13-2009, 09:05 AM

He gets his lantus at 9 p.m. each night

fdlafon · #9 05-13-2009, 09:11 AM

Quote:

Originally Posted by CButler

And don't forget that more exercise in the day can cause the numbers to drop at night.

Well, he is extremely active with baseball and plays basketball all the time at home with neighborhood kids.

Why would it effect him after he has gone to bed though?

Please don't think I am an idiot, I just don't understand all of this yet.

Christopher · #10 05-13-2009, 09:18 AM

Quote:

Originally Posted by fdlafon

I would be happy to test him thoguhout the night. He wouldn't, but I certainly wouldn't mind to get a better handle on this.

I think at his June 5 appointment we are supposed to be taking a class on learning how to start making adjustments ourselves. Noone at home makes adjustments on Jordan's insulin regimen. We contact the dr's NP once a week with readings and she contacts me back about what his adjustments will be. If we have problems or concerns, we contact her as necessary.
So, I think that is the problem. Because we don't make the adjustments.

It has been explained that we no longer need to wake him up at night unless there is a reason. It was our understanding from the day we were released that she only wanted us to test him at night for 3 - 5 days. He was so ready to not have to be woke up in the middle of the night by the 5th night.

I understand what you are saying and I think things will be better once you feel more comfortable (and are allowed by the doc) making changes on your own. As for testing him at night that is a very personal decision and you should do what makes sense for your child and family. In the very beginning, Danielle would wake up screaming every time I went to test her at night. After a little while she stopped waking up and now (most of the time) doesn't even stir when I check her at night. Sometimes she doesn't even wake up when I do a correction shot.

Your endo said you don't need to wake him up unless "there is a reason". My question to them would be, how will I know if there is a reason???

No one here thinks you are an "idiot" for asking these questions. As for the activity, some children find that when they are very active during the day it can effect them later in the evening, even many hours later, making them go low. I have never personally seen this with Danielle, but I know it happens with other children. Danielle will go low usually during the activity.