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Nonresponsive lows at night?

Discussion in 'Parents of Children with Type 1' started by tina, Aug 4, 2012.

  1. tina

    tina Approved members

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    Hello Everyone!

    My little boy Nyj is five and has been diagnosed type 1 for 1 year.

    He is not on a pump, gets 1 unit/20g carbs, and 05 units for every 50 over 150 as a compensation does. He has been on 3 units of lantus. We give humalog before each meal. We got a CGM two weeks ago.

    During the day we have been doing much better in terms of controlling highs and lows, but about 2/3 of the time he has a huge spike at 6-8 am pushing him to 300 to 400.

    During his last endo visit, they requested that we increase lantus to 3.5 and then if after a week, we still see the morning high, to increase to 4 U.

    • We are about a week in and last night was a bit of a nightmare. He went to bed at 9:30 at around 150
    • At 10:45 the CGM alarm went off as he dropped from 150 to 50 in fifteen minutes. We verified with finger sticks and then gave him 15 g juice
    • At 11:15 the CGM had not changed from 50 and we finger poked again and he was at 55, so we gave another 15 g of juice.
    • At 11:45 we finger poked again and he was slightly better-up to 89
    • but By 12:15 he dropped back down to 60 again half an hour after that so we gave another 15 g of juice which brought him over 100.
    • At 1 am, he had dropped back down to 87 but seemed stable
    • At 3 am he started the normal early morning rise, so by 6 am was at 400.

    How do you guys typically handle these high early morning rises?

    Have you noted un responsive nightime lows like this and how should they be handled?

    It seems like each time we change the lantus, it seems to make the morning highs worse and his daytime fluctutaions worse than you might expect, given it is should be stablizing things-is this common with changes in lantus and does the advice my edno gave seem like a reasonable soultion, given the variability we are seeing?


    All advice is greatly appreciated!!!
     
  2. Sarah Maddie's Mom

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    When is your son getting this lantus? If at night, you may be seeing a peak 5 odd hours in.
     
  3. TheLegoRef

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    Other than the juice, was he given anything else? Like when my son is low during the night, we still give him juice and something else like crackers.
     
  4. Helenmomofsporty13yearold

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    I would suggest giving Dex instead of juice because it works so much faster. Was your child very active that day? If he was, he may have needed less Lantus last night. Also, we found (and our endo recommends) that a pre-bedtime snack with protein, fat and carbs (like a 1/2 peanut butter sandwich) helped prevent these stubborn lows. Some children are more sensitive to insulin and exercise than others. Keep in touch with your endo daily until you figure this out.
     
  5. Christopher

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    I understand this line of thinking and I am sure it works for some, but in a sense, you are "feeding" the insulin and a better approach may be to determine a better dose of insulin to avoid the lows themselves. Also, eating before bed is not a great habit to get a child used to.
     
  6. Lovemyboys

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    Yes, we have seen unresponsive lows at night.

    It seems that once my little guy (3 yrs. old) goes to sleep, his digestion seems to shut down. During the day he responds to glucotabs (Dex4) pretty rapidly, but once he's sleep it takes a LONG time for him to come up, mainly during the first 2 hours after he goes to sleep. If we have to give him glucotabs in the early night (say 10-12pm) then they seem to sit in his stomach and then about 4-6 in the morning he really starts to rise (probably due to overcorrecting to try to get him up earlier). It's actually a scary time of night for us because he doesn't really respond to carbs well. On nights we don't have to give him any glucotabs after he's asleep, we don't see that rise in the morning. For us, I really believe that it's delayed digestion. I don't really have any advice, but just wanted to say that we see that too. We try to eat early enough that he doesn't have any active insulin (besides basal) when he goes to sleep.
     
  7. tina

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    Typically he gets lantus right at bedtime-so aroun 9 to 9:30.

    The juice is very easy, as we dont have to wake him up to give it-he has learned to drink while asleep I guess :)

    I dont think he was particularly active during the day-we can try the fat/protein/carb solution this evening. I wonder if there is a more complex carb drink I could give him besides juice fro late night lows...will check that out...

    This sounds similar to what we are experiencing. I went back to the pink panther book and it actually suggests giving lantus first thing in the morning, to avoid any insulin overactivity issues in the middle of the night...I am am going to reach out to our endo and see if this might be something we should consider.

    Thank you all for your suggestions!!
     
  8. Helenmomofsporty13yearold

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    Our endo suggested Carnation Instant Breakfast to keep her up. She can slurp that through a straw with barely waking up. She only likes the chocolate one that comes premixed as the type you mix yourself can be lumpy.

    Taking the insulin earlier in the day is a great idea. Hope you and your endo figure it out so you can get some sleep.
     
  9. Melissata

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    I would ask about splitting the Lantus dose rather than giving it in the morning. For most people it does not give 24 hour coverage and you already have a problem with battling 400's in the early morning. That would be the time the Lantus is at it's lowest, so would probably be a disaster.
     
  10. TheFormerLantusFiend

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    I think most people do get at least 24 hours of coverage and definitely most people on here using Lantus are not splitting it.

    I think changing the timing of the Lantus dose is a good idea- but maybe moving it to supper time would be a better idea so that the "snack" for the Lantus is instead subtracted off the insulin given for supper.
     
  11. timsma

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    I know for many adults that splitting lantus is ideal as it doesn't last the full 24 hours or even near that. I think it's worth a try to split the dose. I know when Tim was on it many years ago he also had overnight lows due to it, but we didn't know about splitting the dose way back then or I would have tried that. Giving the shot at about midnight might work to also offset the dawn phenomenon. But who wants to do that?
     
  12. NomadIvy

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    When ~K was on Lantus the only thing that worked (well, kind of) for her was splitting the Lantus. Her tendency was also to go high between 9pm and 12am ... it took a bit of courage to give an extra unit or 1.5 u of Novolog to avoid the spike as soon as BG started going higher. Once she was over 250, it's harder to bring her BGs down.

    If we gave her the full dose of Lantus at night, she would always go low at 2am. And if we decreased the Lantus, her numbers the rest of the time would be higher. So we started giving most of it in the morning, and gave a couple of units at night. At least that's how I remember it.
     
  13. Sarah Maddie's Mom

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    This is what I was getting at.
     
  14. Meredithsmom

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    Before Meredith started pumping, we had split her Lantus doses. I think in younger kids when it's harder to predict how they metabolize insulin, splitting is a way to get better control.

    That being said, we have had many nights like the one you described. Exercise is sometimes a factor. I hate it because I feel like I'm force feeding her all these carbs and calories in the middle of the night. That can't be good in the long run. I don't know what the answer is, but I do know that I wouldn't adjust Lantus because you see a rise in the numbers when there have been lows in the night. That rise can be attributed to the treatrment of the nighttime lows. At least it could in our situation.

    Talk to your endo. Everyday if you have to.
     

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