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Can we talk about nighttime basals

Discussion in 'Parents of Children with Type 1' started by wearingtaci, Dec 26, 2013.

  1. wearingtaci

    wearingtaci Approved members

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    Nights are driving me batty. It is obvious from the stubborn nightly highs she needs more basal. She eats dinner at 5,bed at 8 and as soon as she is asleep her BG goes up well into the 200s.
    From what I understand it would be a good starting point to increase her basal 10% starting 2 hours before bed?
    Are there better tips. I sent an email to our CDE,but she is out of the office until the first of the year,and I really don't want to wait that long to make changes
     
  2. TheFormerLantusFiend

    TheFormerLantusFiend Approved members

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    My endo says, think about absolute differences in basal, not just percent. Think about how much more insulin you're actually giving, and how much that amount actually lowers your bg. He said to me, a lot of people raise or lower it by too little and it makes no difference.
     
  3. coeen

    coeen Approved members

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    My son does the same thing. Starting at 8 till 11 I have his basal rate doubled. It is one of his highest rates. I had to increase it a little by little till I found the right rate. Took me a while but I found it. Good luck.
     
  4. mamattorney

    mamattorney Approved members

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    Our kids are pretty close in both age and diagnosis date. I've gone two routes to treat nighttime highs and honestly, both have worked.

    First, and what makes most logical sense - you could try running some temporary basals at night until you figure out what will get her BG back in range during that time frame and then use that information to change her regular basal.

    Second, this was recommended by our CDE when we had nighttime highs that were being treated with 140-175% basals - and why this worked for my daughter I'm not sure . . . upload her data to t:connect and see what her basal/bolus percentages are. If they really skewed from 50/50 in favor of boluses and you have a lot of correction boluses, you can try raising her basal by 10 - 15% overall and allocating it across both day and night basal segments. I was skeptical because it seemed to be a much smaller increase than she needed overnight, and she didn't seem to need it during the day - but for whatever reason, that little increase didn't seem to affect her daytime numbers much, but it did affect her nighttime numbers enough to bring her back down.

    Whenever I download her pump, I always check the percentages now to make sure they don't get back into that 70% bolus/30% basal where they had gotten before the CDE made that suggested change.
     
  5. nanhsot

    nanhsot Approved members

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    Personally I would do a good overnight basal test to see where the rise starts. You don't really want to randomly raise it, there is likely a specific time the cortisol kicks in and you need to target that time.

    For example my son still has a fairly low basal at midnight but then it doubles at 2, for the rise that begins at 4. You do want to raise it 2 hours before the rise, but only if you know when the actual rise begins.

    In the absence of a CGM, do a good basal test. EDITED: so I went back and saw you have a G4, so never mind my advice, lol. If you know when the basal rises, yes, go 2 hours in advance. Not sure I'd do that across the board though, I'd target first wherever the big rise begins and go 2 hours back. See how that helps for a night or two then look again. I find that if I stop one rise the others are dampened and for us there is generally one big one that we need to tackle.

    For my son insulin resistance is hugely affected, once he's high it's not that he's rising anymore, it's that the insulin isn't being effective. So I'd still give the advice to target the peak first.
     
  6. wearingtaci

    wearingtaci Approved members

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    Sophie is the same way. If she goes up to 200,the rest of the night is huge temp nasals and lots of corrections. She will finally come down around 5am
     

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