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Help for the basal insulin during night (2years old kid)

Discussion in 'Parents of Children with Type 1' started by Manuel, Aug 3, 2016.

  1. Manuel

    Manuel Approved members

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    Hello!!! I'm new posting on the forum, but a reader since a couple of weeks.
    My son has 2 years and 3 months. He was diagnosed 2 months ago. During the days it seems that the basal and bolus are ok, he is in range between meals and the bolus are doing their job; the problem is the night we just can't get it right, he goes too high or has a tendency to go down, but never steady.

    He is using 3u of Levemir at 8AM, 1u of novorapid at breakfast, 0,5u of novorapid for the rest of the meals and 1u of Levemir at 4PM. And we are using dexcom g5.

    The problem we have is that it seems that the Levemir has a lot of peaks at night. We have to wake him at least 2 times every night to have a small snack because he start a tendency to go under 100 (we give him the snack before he go down more than 80, the dexcom alarm on 100 allow to avoid a drop under 80).

    If he is between 150-180 we don't give him a bedtime snack, if he is between 100-150 we give him a cup of milk before bed. But it is always the same problem, at 1am he starts to go down.

    We have tried without the 4pm Levemir, but that goes the other way. He will be with high values all night.

    During the day, he is doing well around 100 and 180. But it seems that the Levemir is not working for the night, it has too many peaks.

    We asked our endo to change to Lantus, but she says it is too strong for young kids.

    We don't know what to do, if 1 Levemir is too much and 0 is too little. What can we do?. We don´t want to give him a snack before bed in order to start the night with 250 and then start dropping, because in theory the basal should keep him steady, but the theory is not working with levemir!

    Any ideas?

    Thanks
     
  2. nebby3

    nebby3 Approved members

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    Toddlers are tough. You can try to estimate a half unit in a syringe. There are syringes with half unit markings. Is the pump an option? We found it very helpful with a toddler. They are unpredictable plus need tiny doses so it's tough without a pump. I don't think lantus would be much different than levemir. We used diluted humalog at first but I'm not sure you can dilute the basal insulins. My dd would drink juice boxes in her sleep so at least we didn't have to wake her up. I would think your toddler could learn to do that too.
     
  3. KHS22

    KHS22 Approved members

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    We had similar issues with my little girl when she was first diagnosed. We kept stopping insulin all together - thinking she'd be fine for a while because she was on so little and going low - but then she'd go so high!

    Have you tried a 1/2 unit? There is a pen that does a half unit!!!

    At one point, we were eye balling a 1/4 unit of lever actually! :) Because without it she would go shockingly high, but a 1/2 would make her go low!

    Or yes, if a pump is an option, then investigate asap. We were on a pump within about 4 months of starting insulin and it was the best thing because we were eye balling 1/4 units and diluting homolog. It was a nightmare!
     
  4. Nancy in VA

    Nancy in VA Approved members

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    My daughter was diagnosed at 25 months and she was on Lantus from the beginning. Probably what they are worried about is that Lantus lasts a full 24 hours so it is harder to get a dose amount that keeps them flat for that time. My daughter never stayed flat on Lantus - it was just the reality that her body needed a variable basal from the very beginning. So for us, we pushed to get on the pump as soon as we can so we could set those variable basals.
     
  5. cdninct

    cdninct Approved members

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    Hello! I think you've been given good advice. My son was diagnosed at 2.5, and I remember how small his doses were in the early days. As earlier posters said, we used the 1/2 unit syringes, too, so we could estimate 1/4 units, which worked well enough. Pumping really did work better for us, though, so we made the switch at 5 months in.
     
  6. kim5798

    kim5798 Approved members

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    I agree on the 1/2 unit syringes, even if you have to eyeball it. You could try the 1/2 unit at 4pm versus the 1 unit, or even tweak the morning dose at the same time. Try it for a few days. you can always change back. Go easy on yourself with such a small child with diabetes. It is a battle! If a pump is an option, it will be so much easier dosing. Our first 3 years we did with shots and once we convinced dr to let us put her on a pump, it was such a relief! Would have been so much easier in the days when she was smaller!!
     
    Last edited: Aug 4, 2016
  7. Manuel

    Manuel Approved members

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    Thank you very much for all your opinions. I think we will have to use a pump, the tubing thing is not very appealing, and Omnipod is not here in Chile, but it looks the best option.
     
  8. wilf

    wilf Approved members

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    I concur with prior posts - if 1 Levemir is too much and 0 is too little then try 1/2 unit. :cwds:
     

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