Interesting approach to night-time highs if you have a pumper

I just read this article - it is a little dated, but still an effective strategy for some parents, in my opinion.

I am intrigued by this idea for dealing with highs at night - and parents who are sleep deprived. This might really help some moms or dads who need to skip the 3 am check to get sleep in order to function at work the following day.

http://www.diabetech.net/challengediabetes.diabetech.net/2009/08/18/the-sleep-bolus/trackback/index.html


Any thoughts?

 

That really makes total sense. Our CWD is on a CGM though, so that takes away the worry for us when we do have to correct a high at night. CGM = best thing ever for diabetes!

 

I checked it out and understand the concept but don't really "get it". If a parent is inclined to check at 3am, I don't see how this alleviates that. it seems the upshot of this strategy is just to run them a bit higher than usual? What if they go too high? What if insulin needs change and a low occurs? There are no certainties in D management, which is why many parents night check. Not sure how this changes that.

 

A few months ago, I found a CWD post from a while back, that talks about this concept. I have the page bookmarked. I have tried this approach a few times. But we really deal with highs in the day time. Night highs usually mean a fatty supper was consumed or it is Wednesday. (-; http://forums.childrenwithdiabetes.com/showthread.php?56696-Night-bolus-tip!

 

Dr. Ponder rarely has med staff do night checks at camp. The "sleep bolus" works very well for keeping overnight lows away. You have to remember these kids are on a camp schedule that keeps them constantly physically active. They're also on a fixed carb meal plan the entire time. My dd attended TLC for 4 years. I can't say how this worked on her during camp because she usually spent the week battling lows. I can't remember seeing a single correction on her camp logs. It works quite well for us at home, & has since we learned about it shortly after she started pumping.

You're giving the same amount of correction, but extending it out instead of giving it all at once. Unless she's had a really high fat meal (rarely happens), & as long as pump settings (DIA & ISF) are relatively accurate, she comes down slowly & by morning will reach her target BG. No massive 3am drop. No missed sleep.

 

I read about that this time last year on his facebook page. It is an interesting concept and I could see it working, but I almost think that your child has to be at her absolute highest for it to work really well without checking again that night. If you are correcting a 230, but whatever it is that is making her high would without intervention, reach 340, you may end up high all night.

 

Exactly.

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Thanks for sharing. When my daughter is high at night it seems like I have a hard time getting her down until 3-4am, and then she tends to go low during the early morning hours. I wonder if extending the bolus might help that. I'm sure I'd still set my alarm for 3am though.

 

This would be my worry. Since you're extending that bolus, I'd be worried that the ultimate low at 5 or 6 am would just be exacerbated.

I also agree with mamattorney; my son would have to be at his highest for this to really do anything. For us, most of those night highs are not easy highs to bring down and require far more insulin than would normally be necessary. Trying to extend a bolus would not be giving enough insulin up front, where it's needed.