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Morning numbers are better with PM Snack

Discussion in 'Parents of Children with Type 1' started by Charmed7, Feb 24, 2009.

  1. Charmed7

    Charmed7 Approved members

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    My son doesn't usually have a PM Snack. After dinner he gets his lantus and sent to bed. But I thought this was weird. Here's what happened:

    Last night I treated the kids with a donut for dessert. Of course this kid gets the boston creme! I counted 30 carbs and gave him 2 units. Plus I gave him his lantus at 11 1/2 units. He woke up this morning 168.

    But the night before I just gave him 11 1/2 units Lantus and no snack. He went to bed at 116 and woke up 320.

    I almost increased his lantus to 12 (I'm in adjustment period because of new med, we started at 10 units at the begining of last week) last night, but decided to hold off since it was an odd night with the donut.

    I was just wondering if anyone had any insight as to why he has a better AM number with that additional food/insulin. I don't think it's a low rebound, because a few nights ago, when he was at 11 units, he was waking in the 400's. And all of his premeal numbers are on the high side (200-300). IDK.

    Charmed
     
  2. emm142

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    Could your I:C ratio be too low (giving more insulin than needed for carbs) and your basal too low, so that when you give a bolus it compensates for the fact that the basal isn't enough and helps to keep BG in range? I'm thinking perhaps your basal/bolus balance just isn't quite right, and that maybe once you've moved the basal up to the right level, you'll need to back off on the boluses a little.
     
  3. hawkeyegirl

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    I think this sounds as likely as anything.

    It sounds like he's high a lot right now. Sounds like time for a basal increase to me.
     
  4. Charmed7

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    I know the basal (Lantus) isn't right. I'll have to check to bolus ratio, but I know I have increase the bolus ratio and he's gone low at night.

    I'll run some tests the next few nights. Thanks.
     
  5. Heather(CA)

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    This looks like a rebound. If the 116 was at least 3 hours after the dinner bolus. I think you should LOWER the Lantus by 1 to preferably 1 1/2 units. Do you adjust by halves? At his age Lantus is normally adjusted by 1 unit at a time..I think I would go down to 10 then adjust by one unit at a time after that, I would also do basal testing tonight just to be sure:cwds:


    If you go to 10 you can always put it back up, and hopefully you wont have to wake him to give juice...
     
  6. Becky Stevens mom

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    Steven always gets a snack at about 7:30 at night, he was on NPH for the first 4 years so he had to have one we've just kept it in place. Steven gets 9 units of lantus a night in the past few weeks if I try to give him 9 1/2 he'll go low at night, as low as 55 and he'll wake up in the 300s so i think sometimes it is a rebound not absolutely sure though. I also think that lantus sometimes but not always does peak.
     
  7. wilf

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    Looks like he went low followed by rebound (on the night with no snack) to me too. If you've not been testing at night you have no way of knowing what is happening..
     
  8. Rusty

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    I agree, sounds like a rebound to me. London was waking up high and i found he was rebounding in the very early morning hours. I decreased the lantus dose and waking numbers got very good.
     
  9. Charmed7

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    At the beginning of the week last week he started at 10 units lantus, and he was waking up in the 400's and was 300's all day pre-meals. So I increased it to 10.5 (yes we do half increases) and it was 350-380's with 250-290's pre meal. So I keep increasing it. Last night, with the donut snack, he woke up 168, lunch number was 125 and dinner was 134. That's the first time since he started this med that he's had good numbers all day. I'm going to do no snack tonight, and check him every hour until I go to bed to see what he does. It's also good I'm starting with a good number pre-meal. So I'll be able to check his dinner ratio too.

    Thanks everyone.
    Charmed
     
  10. Heather(CA)

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    Sounds good! Doing more checking is a good thing, I don't know what time you go to bed but you might want to do a couple of more too. Lantus is not for daytime numbers except to keep them steady.

    Also do a test at 3 hours after his last fastacting shot or later if you think his insulin lasts longer, then post the numbers tomorrow if you want help:cwds:
     
  11. Charmed7

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    Well, maybe that night was just the first night his lantus dose was right and worked. Here are his numbers:

    6:00 PM - Dinner 72 carbs 4.5 units
    134

    7:30 PM
    221

    9:45 PM
    138

    12:00 AM
    115

    6:30 AM - Breakfast 99 carbs 7.5 units
    181
     
  12. Heather(CA)

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    Pretty darn good:D Where did you give the Lantus shot? Was it the bootie? Or somewhere else? I'm curious:cwds:
     
  13. wilf

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    Without a 3 am test to provide more info you are flying blind..
     
  14. Heather(CA)

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    Why you you think a 3am check is so important? Just curious again:cwds:
     
  15. Charmed7

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    I either give it in the butt or stomach. Sometimes he'll do thigh, but dr's orders, no more arm. :(

    And really, flying blind? That's a bit extreme. Maybe a little fuzzy eyed, but I don't feel like I'm in the dark. I have confirmed I have his dinner ratio right, and he woke up in target. Can't really ask for much more.

    Thanks everyone, it looks like i just spoke too soon. He woke up this morning at 178.



    Charmed
     
  16. wilf

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    Sorry, that was a poor choice of wording.

    What I was trying to say is that without a 3 am number on the night in question, you can't determine whether he kept dropping then went low and then rebounded (meaning he needs less Lantus) OR whether he slowly drifted up all night (meaning he needs more Lantus) OR whether he was good overnight and just has a strong dawn effect (in which case the Lantus is probably set about right)..

    I'm not suggesting 3 am testing every night, but when you're trying to puzzle out what's happening with Lantus overnight there's sometimes no way around actually getting an overnight number.
     
  17. RosemaryCinNJ

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    Absolutely the same thing here too!
     
  18. Heather(CA)

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    Rebounds almost always mean a 300+ so unless he was sky high at lunch, I would say he drifted up:cwds:
     
  19. wilf

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    For us there's Novolog rebounds (to 300+) and Lantus rebounds (to 150-200). Seems the faster and harder Dd's going down, the sharper and higher she rebounds up.

    May be a YDMV thing.. :)
     
  20. Heather(CA)

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    So, I have a couple of suggestions, since he can only/mainly have shots in his belly and his bootie...I suggest that you ALWAYS give his Lantus in the bootie, then pick one other time of the day to give his other shot in his bootie. The bootie is not a great place for fastacting because of the slow absorbtion, so if you do the same shot like breakfast for example, if will be easier to adjust.
     

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