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Options for fighting growth hormone spike on MDI...

Discussion in 'Parents of Children with Type 1' started by jcanolson, Nov 26, 2013.

  1. jcanolson

    jcanolson Approved members

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    Haven't been on for awhile, but I seem to have come back from the endo with more questions than answers this time. Not her fault. She's just offering options. I'm just wondering if anyone has tried the options she mentioned. I hate to waste co-pays and time on experimenting, so I thought I'd ask the experts.

    After 8+ years on the pump, DD has switched to MDI and has no interest in switching back. Overall her numbers are great and the first a1c after switching is down. The only problem is her waking up numbers are typically low 200s. She's fine until about 4 AM, and then they start to creep up. Her endo mentioned 2 options that we could try.

    1. Switch from Lantus to Levemir. Since Levemir is more of a 12 hour insulin, we could dose higher at night.

    2. Continue to use Lantus, but add a small amount of NPH at night. It should spike about the same time the cortisol hits.

    Thoughts? Anyone use/tried one of these options?

    Thx
     
  2. nebby3

    nebby3 Approved members

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    I can't believe we have so much in common-- homeschooling, a child who refuses to pump any more and early AM highs!! We do use Levemir and I think that's a good first step. Some people also give lantus twice a day but levemir is made for that. But mainly what I do is wake up at 6ish and bolus my dd in her sleep. Even if she is 90 I will give half a unit (more if she is higher) and that helps hold her steady till she wakes up.
     
  3. jcanolson

    jcanolson Approved members

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    Too funny!
    We do split the Lantus dose. It was only lasting 22-23 hours for her.
     
  4. mom2ejca

    mom2ejca Approved members

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    When we were on MDI we gave NPH with the dinner shot to cover increased basal needs in the hours right after bedtime. It also allowed us to lower the Lantus a little to help with lower daytime basal needs. It suited our needs very well.
     
  5. Lakeman

    Lakeman Approved members

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    We have always been on MDI and have always had early morning increases in BGs until more recently.

    Splitting the lantus dose definitely helps a bit.

    Maintaining really good numbers all day long as well as at night (I know it is far easier said than done) more often than not results in good waking numbers. IMO this means that highs cause insulin resistance and that is one reason for high waking numbers. Fighting for good numbers all day long has lasting benefits beyond just the good numbers at the moment.

    Including metformin or turmeric in your routine is something you could discuss with your endo. It helps us.

    I had considered waking about 4:30 and dosing for the high that was expected to come, but 1) the high did not come about 20% of the time back when it was a problem for us and 2) I wanted to try other things before committing to waking up early every single morning.

    Not saying this is the answer for everyone - who knows our morning highs might just return at any time (fingers crossed and thankful for now)

    Speaking of being thankful tomorrow is Thanksgiving and I sure am thankful for insulin.
     
  6. nebby3

    nebby3 Approved members

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    Lakeman -- how do you use turmeric?

    I would be skeptical about NPH helpIng since it peaks soon and these spikes are at the end of the night.

    I don't know what the OP's situation is but for my dd she often spikes towards AM but it is not 100% so it is hard to just increase basal insulin because on some nights that could mean lows.

    We are in the process of trying to get the Dexcom (though she still refuses to pump, my dd has finally agreed to this) so that should help.
     

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