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Do you correct for a Dawn phenomenon rise?

Discussion in 'Parents of Children with Type 1' started by Lisa - Aidan's mom, Mar 23, 2012.

  1. Lisa - Aidan's mom

    Lisa - Aidan's mom Approved members

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    We just recently started experiencing a morning rise with DS. As a background, last nights numbers were:

    9:30 pm: 121, 8 carb snack, 10.5 units Lantus
    1:30 am: 172 (I don't correct at 1:30 unless it's over 200)
    4:30 am: 108
    6:30 am: 99 - he got up early and just watched tv in bed - no activity, no food

    Time for breakfast:

    8:00 am: 179; 38 carb b'fast, 7.5 units Novolog (7 units for carbs, .5 for correction over 150).

    Lately, if I give 1/2 unit correction, by lunchtime he will be low. I'll have to see what happens at lunch today.

    Any suggestions that have worked for you?

    Thank you!
     
  2. Sarah Maddie's Mom

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    I'm wondering about his I:C ratio - it seems like a lot of insulin. Is his ratio 1:5? Perhaps that's what's driving the low prior to lunch?
     
  3. MomofSweetOne

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    I would correct a dawn rise like that, but I wouldn't necessarily do so by ranges. Do you know his insulin sensitivity factor? I would calculate the dose using that.
     
  4. Lisa - Aidan's mom

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    Sarah, yes - 1:5 for breakfast.

    I will have to figure out the insulin sensitivity factor; I'll search some old threads to investigate.

    Thank you!
     
  5. danismom79

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    I was going to point that out as well.

    Is this dawn phenomenon? My daughter needs more basal when she gets up, but I never considered it to be dp. Now, what we used to see was a sudden rise around 4am or so, and I had to work on timing her insulin (NPH at the time) to counter that.
     
  6. MomofSweetOne

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    When we were doing MDI, one thing our CDE said was that we might need to add in a 5:30 shot to prevent the dawn phenomenon.

    I agree with Sarah about his breakfast ratio being a lot. Our endo said 1:10 is typical for puberty.
     
  7. hawkeyegirl

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    That is an awful lot of insulin for breakfast for his age. My son is your son's age, is very very big for his age, and his breakfast ratio is 1:12. Do you predose 15-20 minutes?
     
  8. Amy C.

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    I would consider giving a shot when he gets up. This is will counter the dawn phenomena and perhaps allow you to give less insulin at breakfast.
     
  9. Suessigkeit

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    How low does he go? I take care of a third grader with the same I:C ratio, and she always goes low at lunchtime. Until the endo re-writes her orders, we've handled this by giving her a free snack of 8 to 12g carbs about an hour before lunch. It's a temporary fix, but it's working for now.
     
  10. Lisa - Aidan's mom

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    Thank you again, I'm going to have to chart and really look at his patterns closely.
    He doesn't always get up at 6:30 am.....he's usually up at 7:45 and eating b'fast by 8:00. I shouldn't have assumed it's dawn phenomenon, but it was technically dawn and his # went up ;)

    I do not pre-dose 15 minutes before...usually as the first bite goes in, he's getting his shot.

    The nurse said his lunch BG today is 119. He's been on the 1:5 ratio for b'fast for awhile now and hasn't seen many lows at all. He's average size for 7 1/2 years old, about 62 lbs.

    Thank you.
     
  11. MomofSweetOne

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    It may be that he needs more basal starting when he gets up but it is masked by his eating immediately with a low carb ratio. For those of us now pumping, we would have a higher basal setting during those hours and also more carbs per unit for bolussing. Either way, the goal is to have the insulin in him that he needs. If your ratio is doing it for you with MDI, great job!
     
  12. hawkeyegirl

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    I would start predosing and see what happens. I think his ratio is so low right now because it needs to be to combat the massive spike and resulting insulin resistance that comes with not predosing breakfast. Just a thought.
     
  13. tiger7lady

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    Like others have said it sounds like a lot of Novolog at breakfast. I'm curious what his basal/bolus ratio is. If you don't mind me asking how much Lantus does he get and how much Novolog (on average) does he get in a day? You might be seeing this rise because there is not enough Lantus and the breakfast ratio is covering for that.
     
  14. Lisa - Aidan's mom

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    Thanks again, I'll try the pre-dosing this weekend so I can monitor it better.

    He receives 10.5 units of Lantus around 9:15 pm

    B'fast I:C ratio is 1:5; usually gets around 6.5 - 7.5 units.

    Lunch & Dinner I:C ratio is 1:10, again around 7 unit per meal, so overall +/- around 21 units of Novolog, plus add in a correction dose here and there.
    His last A1C was 7.6

    I tried increasing the Lantus to 11 and he had consistent lows throughout the day however.

    Thank you again for all your help.
     
  15. hawkeyegirl

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    The Lantus dose doesn't sound too out of whack to me for his age. :)
     
  16. Lakeman

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    Those numbers look a whole lot like a lot of numbers we experience.

    It has not been uncommon for us to have a 1:6 ratio at breakfast and because that is so much insulin we need to limit the total amount of insulin to 7 units of humalog or there will be a low later.

    By eating earlier we have been able to use a ratio of 1:9 and worry less about the total units. We now eat breakfast at 6:30 instead of 7 or 7:30 and it is a world of difference. Things just work out much better to eat earlier.

    Tentatively, our morning problems (DP starting about 4:30 or a rise as late as 8) might be solved since we have upped the total amount of fat in her diet and increased the lantus at the same time. I wish I could say I knew this was the answer but there have been times before when I thought I had the answer and then some days later discovered it was just a fluke. The increased lantus seems to reduce the rise between 4:30 and 8am while the increased fat heads off the drop in BG between 1 and 4am.

    I don't know if it matters but the source of extra fat, spread out over the daytime, is high fat unhomogeneized whole milk and less worry about butter or olive oil...
     
  17. Lakeman

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    If you want increased lantus then the solution to lows during the day is to change the ratios so that he gets more carbs. Lows at night cannot be handled that way.
     
  18. mmgirls

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    My gosh that seems like allot of insulin for a 7yr old? If you do not mind me asking how much does he weigh?

    How are the night numbers? you give basal at night right? I am wondering if he does have a peak from basal that keeps his numbers at night OK, but it wheres off too soon and the reason for such low ratios.

    If he is at 1:5 now,what will his ratios be when in puperty?
     
  19. Lisa - Aidan's mom

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    MMgirls - yes Lantus at night - the full dose of 10.5 units at 9:00 pm - we've never tried splitting it - maybe I should explore this?? He's 7 1/2 years old, about 62 lbs., 49" and very active. He had two lows yesterday, he really pushed himself at basketball. Night time # are decent.

    Lakeman, thank you for your input!!
     
  20. hawkeyegirl

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    My son just turned 8 and his basal varies from 12-14 units a day. Ten units for a 7 year old isn't terribly remarkable. At age 4 my son was at 7-8 units of Lantus a day.

    I think the low breakfast ratio is because they're not predosing. Or the child could just have higher basal needs at that time and because they're on MDI, they have to compensate with the ratio.

    FYI, it's "puberty", not "puperty." :)
     
    Last edited: Mar 24, 2012

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