Looking for guidance/guidlines for night time checking

[somanybakers]

Hello, After reading through several threads I have decided to commit to check my son's bg regularly at night (something previous endos have not encouraged). Last night I checked Lucas' bg at 3 am (he went to bed at 11 with a 95) his number was 197. So he climbed 108 points in 4 hours. I would have liked it to be about 120. So Lucas' correction is 1u for 33 carbs. I was going to give him 2 units and that should put him at around 133. which seemed like a good safe number.

But, I froze. I was afraid to do it. I also wondered at that point if he had dropped and rebounded in those few hours or if he maybe needs more night time Lantus. (He gets 12 units L at night usually between 10 and 11 and the same in the am between 7 and 8.)

He woke up at 266. Should have corrected, and he still may have climbed. No doubt getting in a night time checking/correcting routine is absolutely essential at this point.

I guess my questions are:
1. Do you bolus the entire correction factor?
2. How low do you try and keep BG at night?
3. How long after a correction do you recheck?
4. Would you recommend trying for a higher night time BG at first and then work down to a tighter number?
5. Why is this so hard, after 7 years, why does this make me so nervous? (I know, only I can answer that one.)

Thanks for thinking about this with me.

MDI
C/I ratio 10/1
Correction 33/1
Lantus 24 units 12am/12pm

[Judy&Alli]

Hi Nancy,
I would do some basal testing first. It is a pain but it looks like he may need a lantus adjustment. Not knowing what he ate it is hard to tell from just one night.
As far as your questions here goes.

1. When on MDI we never did a full night time corection, she was very insulin sensitive at the time though. What is your night time target?

2. I like my dd with a night time number around 150.

3. I do my first check at 1 1/2 hours to see if there is any movement, I don't sleep until 4 hours after the correction.

4. Depends on what your number is now.

5. Hugs!!! It is hard.

[manda81]

When we were doing MDI, we would do half-corrections at night. With my son, Lantus was pretty unpredictable at night, so that worked for us. We generally wake up a couple hours before he does, so we would check again then & correct more if needed (so he woke up in range, if he wasn't already). We didn't have a set number target, but if he was in our range at that time 80-180 we were happy with it.

[Christopher]

When you say his correction is 1u for every 33 carbs, that sounds like a carb to insulin ratio, not a correction factor. I think the first thing to do would be to discuss a correction factor with his endo. But maybe I am just not understanding the terminology. A lot of this is experimenting with different things and seeing what works for your child. Some children, as noted above, are very sensitive to insulin at night. Danielle, not so much. So I do full corrections at night. I agree with the previous poster that you need to do some basal testing. Find out what is really going on at night.

To answer some of your questions:

Since I check Danielle often at night I don't worry too much about her going too low so I try and keep her in the 80-120 range at night.

I usually check 3 hours after a correction. If I check at the 2 hour mark, and she is still high, I am not going to give her any more insulin (that would be stacking insulin).

[wilf]

Originally Posted by somanybakers

.. Last night I checked Lucas' bg at 3 am (he went to bed at 11 with a 95) his number was 197. So he climbed 108 points in 4 hours. I would have liked it to be about 120. So Lucas' correction is 1u for 33 carbs. I was going to give him 2 units and that should put him at around 133. which seemed like a good safe number..

Before going any further with this, I'd recommend you test tonight and see what is happening between 11 pm (when he was 95) and 3 am (when he was 197).

If it is a steady rise, then you need to increase his daily Lantus dose.

It is possible that he went low though (maybe due to the midnight Lantus peaking) and then high. In that case he'd need less Lantus.

You need more information..

[virgo39]

1. Do you bolus the entire correction factor?

When we started doing nighttime corrections, we did not. We started out doing one-half of the correction. That did not work well for us, DD seemed spend the first half of the night rising and being somewhat insulin resistant. Ultimately, we split her Lantus does into two slightly different doses in an effort for her p.m. basal rate to be higher. Now that we are pumping, her basal rates during the first half of the evening remain the highest.

2. How low do you try and keep BG at night?

Our nighttime target as always 120, but it was almost never achieved.

3. How long after a correction do you recheck?

Generally, two hours, but sometimes sooner.

4. Would you recommend trying for a higher night time BG at first and then work down to a tighter number?

Yes.

But I agree that the most information you can gather, the better off you will be.

[Lee]

Originally Posted by Christopher

When you say his correction is 1u for every 33 carbs, that sounds like a carb to insulin ratio, not a correction factor. I think the first thing to do would be to discuss a correction factor with his endo. But maybe I am just not understanding the terminology. A lot of this is experimenting with different things and seeing what works for your child. Some children, as noted above, are very sensitive to insulin at night.

^^^THIS!

As a mom with a child incredibly unpredictable nights, I run her higher - 140 -200. But she has had overnight seizures.

[somanybakers]

Thank you, everyone, for your thoughts. I am going to get more testing data and see what his BG is doing overnight for a week, maybe two. I bet lack of solid information is what is making me so uncomfortable. i will only treat if it is over 280 for right now.

I could be using the wrong words here since I usually only talk to myself about D . By correction factor I mean that I give 1 unit of insulin to bring his BG down 33 points. So if he is 240 I would shoot for 110 and give about 4 units. It is fairly accurate most of the time.

Thanks again! Nancy

[Judy&Alli]

Originally Posted by somanybakers

Thank you, everyone, for your thoughts. I am going to get more testing data and see what his BG is doing overnight for a week, maybe two. I bet lack of solid information is what is making me so uncomfortable. i will only treat if it is over 280 for right now.

I could be using the wrong words here since I usually only talk to myself about D . By correction factor I mean that I give 1 unit of insulin to bring his BG down 33 points. So if he is 240 I would shoot for 110 and give about 4 units. It is fairly accurate most of the time.

Thanks again! Nancy

Hi Nancy,
Glad you have us to "talk" diabetes, lol. Anyway I don't think you will need 2 weeks. Just a couple of days would be good. Make sure you give a low fat dinner on basal testing nights. Get a number 3- 4 hours after dinner and then test through the night. Then come back and post his numbers and you will get some great info from our resident experts. Good luck.

[wilf]

Originally Posted by somanybakers

Thank you, everyone, for your thoughts. I am going to get more testing data and see what his BG is doing overnight for a week, maybe two. I bet lack of solid information is what is making me so uncomfortable. i will only treat if it is over 280 for right now.

I could be using the wrong words here since I usually only talk to myself about D . By correction factor I mean that I give 1 unit of insulin to bring his BG down 33 points. So if he is 240 I would shoot for 110 and give about 4 units. It is fairly accurate most of the time.

Thanks again! Nancy

What many of us do is use half corrections (because the insulin seems to work twice as hard at night), and correct to a higher target at night than in the day..

Tonight at our place provides a good example:
- DD has been running low for a week at least, as she has started track (and she had a practice this afternoon);
- we're dropping Lantus by a unit a day and still treating lows at night;
- she had a supper with lentils and brown rice, which often leads to rising BG levels later in the evening;
- then tonight 11 pm she's 250 (after getting into some chocolate) and wants a bowl of frozen mango chunks, so I correct with 1 unit (it would have been 2 units during the day) and bolus 0.5 unit (it would have been 1 unit during the day)
- target level for the correction was 150 (during the day it's 100)
- by lucky coincidence everything worked out and she ended up at 110 at 1 am..

Note that DW tested at 12:30 and 1 am, and I did too when I got back home at 1:30 am to confirm she was staying over 100 (she was). And I'll test once more at 3 am before calling it a night.

I would not be testing as often if she'd hadn't been running low and had the practice, but still would have tested at 1 am and 2-2:30 am..

So that's how our family does it..