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Significant Overnight Increase for MONTHS!

Discussion in 'Parents of Children with Type 1' started by Schleprock, Jul 21, 2009.

  1. Schleprock

    Schleprock Approved members

    Feb 13, 2008
    I originally posted back in March about problems with evening/night BG rises. His BG starts rising after going to sleep and it just climbs and climbs. I give him a correction, check 2 hours later, give another correction, and sometimes two hours later yet another correction!

    Now, this has been going on for over 4 MONTHS! Is there a possibility it is truly from a growth spurt being that this has been happening so long?

    I am totally lost, and his BG levels are very unsteady even when he was at school all day the nurse noticed the same thing, some days he seemed to run low and others high for no apparent reason. Which is one reason why I am trying to get a grip on at least the night time numbers.

    Can anyone offer any advice?:confused:

    He is almost 7 (next month) and he weighs about 48 pounds.

    Right now his basals are
    12AM .30
    8AM .40
    8:30 PM .55

    and numbers are

    7PM 236 (snack & correction)
    Bed 266 (correction)
    12AM 251 (correction)
    3AM 203 (correction)
    Breakfast 172

    7PM 284 (correction)
    Bed 315 (correction)
    12AM 214 (correction)
    2AM 158
    Breakfast 284


    7PM 198
    Bed 223 (correction)
    12AM 175 (correction)
    3AM 70
    Breakfast 148


    7PM 194 (correction)
    Bed 240 (correction)
    12AM 257 (correction)
    3AM 114
    5AM 134
    Breakfast 164


    Bed 163 (correction)
    12AM 301 (correction)
    2AM 263 (correction)
    Breakfast 189
  2. Christopher

    Christopher Approved members

    Nov 20, 2007
    What does his endo say? Have you tried increasing his nighttime basal?
  3. Schleprock

    Schleprock Approved members

    Feb 13, 2008
    Well, I sent the endo. a message yesterday but they have not replied yet. Not sure if it has anything to do with it or not, but, they are still upset with me for wanting to change pumps/CGM's which we had quite a heated discussion about.
  4. tandjjt

    tandjjt Approved members

    Sep 14, 2006
    If my endo delayed response because of something like that - they would get an earful of "HEAT" and I would find a new endo if possible...

    GGGRRRRR - Moma Bear is showing!
  5. mmgirls

    mmgirls Approved members

    Nov 28, 2008
    Mine does the same thing, once asleep she would climb upt to 300+ and I would correct and correct again. after getting on the CGM I was confident enough that it was not rebounds and that it was a basal issue. I finally worked her ging to bed basal up to .65 and then asleep basal to .85 till 1am then a swift drop to .25. I was so tired of correcting her and figured I am going to get up to check after a correction for a continuing high that I might as well BEEF up the basal and check for an impeding low or heaven forbid a night with numbers all under 200.

    besides basal hav you played around with the ISF and ratios?? After so many tweaks I think we sometimes have forgotten about the other things and get a bit unbalanced on our basal/bolus %ages. is basal at least 40% of TDD?
  6. Heather(CA)

    Heather(CA) Approved members

    Jun 18, 2007
    Sorry, I'm confused...Have you just been correcting all this time? Or have you been upping the insulin too?:confused:
  7. Amy C.

    Amy C. Approved members

    Oct 22, 2005
    I would raise the basal .1 beginning two hours before he begins the rise. He may not be getting enough insulin when he eats. Having the right basal makes a huge difference. After this is correct, you can work on getting more insulin in him at meals.
  8. WhyMyBabyGirl

    WhyMyBabyGirl Approved members

    Jun 8, 2009
    I'm new at this, so I apologize if I sound like an idiot.

    But why would you correct with numbers in the high 1oo's and the low to mid 2oo's while he's sleeping?

    Except for the few 3oo's which I agree are to high, the other numbers look okay for middle of the night?:confused::confused:
  9. emm142

    emm142 Approved members

    Sep 7, 2008
    I think it's because without very frequent corrections, the numbers would be a lot higher than that.

    I'd up the basal by 0.1u/h throughout the night. Your son's basals look a little bit like mine, in that he seems to need a lot more in the evening. Mine didn't always look like that, but now I'm going through a growth spurt (possibly combined with more dying beta cells) my night time basal has gone from 0.15u/h to 0.8u/h (and it's looking like it needs raised again).
  10. Mom2Boys

    Mom2Boys Approved members

    May 31, 2008
    Yeah, I agree with everyone else--looks like he needs more basal. It also looks like his dinner ratio could be off, but I'd start with the basal and see what happens.
  11. Mary Lou

    Mary Lou Approved members

    Aug 17, 2006
    Our rule of thumb is this:

    If BGs are high within 3 hours of a meal, reduce the meal ratio by 10% (thereby increasing the amount of insulin for the meal). For example, if dinner ratio is 1:25, decrease to 1:22.

    If BGs are high beyone the 3 hour mark, increase basal rates by 10% beginning 2 hours prior to the time BG rises, and increase in 4 hour blocks.

    In both or either case, wait 3 - 4 days after making changes to make additional changes.

    Now, rules of thumb are just guidelines. There have been MANY times throughout both of my boys' D life that we have increased basals around the clock. It happens. Kids grow. Insulin needs change. don't worry about how much they are getting, just get them the insulin that they so clearly need.

    Sometimes there is no why. Sometimes the why doesn't matter. If you see a pattern of high BGs, you need to increase insulin. For us, a pattern is established if BGs are high 3 days in a row.

    Best of luck. If you are unsure of how to manage BG patterns, please contact your endo/CDE for information.

    Personally, if your numbers were my boys' numbers, I would decrease the dinner ratio and then increase basal rates beginning at 10 pm and stopping at 2 am. I would increase by 0.05 U/H, so from 10 pm - midnight, the basal rate would be 0.6 U/H, and midnight through 2 am basal rate would be 0.35 U/H).

    As always, please check with your endo. This is what I would do for my kids, based on my experience and knowing how their BGs fluctuate during the night. YDMV.
  12. hawkeyegirl

    hawkeyegirl Approved members

    Nov 15, 2007
    The OP is on a pump and CGM. That makes it easy and safe to correct at night. We correct anything over 130 at night.

    To the OP - instead of doing the constant corrections, I'd simply raise basal. It may not be a permanent increase - we find that a couple of weeks later, we'll often have to reset basal back to where it was before the increase, but you have the CGM, so you'll catch it.
  13. Colleen

    Colleen Approved members

    Apr 18, 2008
    I agree with changing the basals, but if the corrections are not working either you may need to look at the ISF.
  14. simom

    simom Approved members

    Jun 2, 2008
    I had posted about this about 6 weeks ago, and did hear back from others who had similar situations.

    We have been experiencing the same thing - and what we eat for supper or whether or not he has a carb snack as a bed time snack have made no difference. This has been going on since April - we've gotten it "right" a few times, and then it increases some more. Just yesterday, I raised his "max basal" to accomodate another increase in the evening time frame. We are fairly flat after dinner, and around 8-9 pm we get a meteoric rise.

    Like another poster, we take a swift drop in the early morning hours (2 am) to less than half the basal for the previous hours. Then, a few hours later we start jumping up again to fight the A.M. insulin resistance.

    Based on last night's CGM, I might have "overshot" slightly, but with a five gram carb snack around 2 am (he was getting lower than I was comfortable with) he woke up at 99 this morning. We haven't seen 99 in weeks. A bit more tinkering to make sure the drop is not too precipitous after midnight - but we're getting there (I hope:cwds:).

    All of this to say - seems to be a common occurrence in young children. Whether it's growth hormone on a constant basis, or simply some sort of night time basal need - I don't know.

    These are the times when I wish I had a research endo "on staff" to assign to figure out our particular needs.;)

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