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using novorapid to deal with night time highs on mdi

Discussion in 'Parents of Children with Type 1' started by shannong, Dec 29, 2012.

  1. shannong

    shannong Approved members

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    I know I have posted about this before - dealing with my son's spikes at night and I have received some great advice. Maybe I just need a little reassurance now. My son's b.g. does a pretty dramatic spike when he falls asleep around 8 or 9 pm, but then drops around 4am again. Any increases to his night time basal, sends him too low at 4am. So to deal with it, I give him a small snack and extra rapid for bedtime snack. Sometimes I again have to give him another shot of rapid at 11pm. I hate doing rapid, because it means lots of night time checks, but it is the only way I have found to get his numbers good for the night. I was talking to a woman I know in her 40's who has been a type 1 since she was 5, and she was totally freaked out when I told her I use rapid at night. She thought I was really putting my child at risk of having a low and advised me to speak with his endo right away. Interestingly, I asked if she checked herself at night and she said no, that she always wakes with a good number so has never needed to other than when she was pregnant. Anyway, am I crazy for using rapid like this?
     
  2. Christopher

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    There is nothing wrong with giving fast acting insulin at night to deal with a high blood sugar. The important thing is to check blood sugar levels often if you do give a correction at night.

    I think it is always a good idea to work with your child's endo when trying to figure out solutions to problems such as night time spikes.

    Each person will have their own way of dealing with diabetes issues that arise, and what is good for one person may not be good for another.

    The fact that your friend doesn't check at night and the reason she gives is because she always wakes up with a "good number" tells me she is not as educated as she could be with managing her diabetes. I would view any advice she gives you through that filter.

    Good luck.
     
    Last edited: Dec 29, 2012
  3. nebby3

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    You are absolutely doing the right thing. There is no reason not to correct nighttime highs. Honestly if I know my dd is in a regular pattern of needing a correction but then coming down nicely I don't always recheck. My dd would also go high the first part of the night when she was younger (ie your son's age). I think it is a typical pattern for younger kids and is often associated with a growth spurt.
     
  4. natallia

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    wow. this is exactly our story! we have been dealing with late night spikes since day one and I too, give him rapid. upping his levemir sends him down at 3 am like crazy. his bg always starts rising around 9.30 pm and if i dont correct he is 18-24 (300-400) for hours even though still waking up in range in the morning. its exausting! especially that i have to get upat 6 am to drive my other two kidos to school.
    we are starting on pump in a couple of weeks and I really have high hopes that it will fix this problem!
    our little t1 is 20 months old, dx-ed almost a year ago at 9m.o
     
  5. shannong

    shannong Approved members

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    Yes, exactly the same pattern! I can't wait until my son can get on the pump and I can use a temporary basal because that is the only way I can think to effectively manage this. But thinking about it, giving an extra shot of rapid would be about the same thing.

    I would discuss this with my endo, but honestly, I really don't like him. Until I find a new endo for my son, I pretty much get my son's A1C test results and leave it at that. I would love to have an endo that could help me figure out these difficult situations but I find him judgemental and frankly just plain inappropriate - he questioned me on why my son was allowed to play on the ipad (having waited 3hrs for our appt.) and when we told him that we wanted the pump for our son, he asked us "who's idea was that?" because he said our child might not want that. Well, my son is 6 years old, so yeah I think, we as his parents will make the best decisions for him (which of course includes paying attention to his feelings). Any way, just another frustration on this journey! However, I am fortunate I have this forum to vent and get advice and info.
     
  6. Deal

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    There are some very good pediatric endo's working out of sick kids in Toronto. Don't hesitate to move practices if you don't feel comfortable discussing these issues.
     
  7. natallia

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    Yes, you need to tell your endo this is what you need for your child. End of story. I think a lot of parents forget that a doctor is there to make his recommendations, not to control your decisions. This must be so frustrating.....
     
  8. JNBryant

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    I don't see anything wrong with using rapid at night to deal with stubborn spikes. I use NovoLog for my son, and I've never had an issue. We get those stubborn highs or sudden spikes at night when we go out to eat or order pizza, and I just give him a correction based on what he's at when I check him. His NovoLog seems to do it's work within three hours or so, and then for the fourth hour it might bring him down by 5 points or so. I just check him once an hour for two hours after the correction, and as long as he's not coming down too quickly in large intervals, I let him be. It returns him to his goal range and we're all happy campers.
     
  9. dshull

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    We correct at night probably 1-2 times per week. My son is close in age to yours and was diagnosed around the same time. Most nights he goes to bed (8 PM or so) with a nice number, and then when we check him before we go to bed (between 10:30-11 PM), he has risen a lot, sometimes 150+ points or more. When we do a correction when he is sleeping, we do a half correction. So if he would usually get 1 unit for a correction, we give .5. This makes us worry less about him dropping too low. We usually recheck him about 2-3 hours later.

    This was actually a much bigger problem for us about 6-8 weeks ago. And it sounds strange, but it was solved primarily by taking him completely off of the Levemir altogether. He had only been taking one unit of Levemir at bedtime. The CDE at our endo's office said some kids can be more resistant to the Levemir (or something like that, I can't remember the entire explanation). So now he is only taking Novolog with food. We did change all of his daytime ratios so he gets more rapid insulin during the day which seems to make up for the difference. I do love that he is not taking it because we can sleep more, but I also wonder how hard it will be to go back to the Levemir once he needs it again.
     
  10. Andy'sMom

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    I corrected my son just last night with Novolog at midnight. We always check again 2 - 3 hours later to make sure numbers are okay and we also use half or even one-third of the "normal" correction and that has worked really well. Would rather not have to treat with Novolog while he's sleeping, but that's the best solution for now, as Andy's night-time highs are usually random and are probably growth-related. As long as you test frequently, I think it's perfectly fine.
     
  11. 3kidlets

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    When Hana was mdi, I corrected at night all the time with novolog. Just like I correct now with novolog just thru the pump.
    I'm thinking the woman you are referring to who has D for 35 years is using old thinking. My father in law has had T1 for 35 years. He still uses the old time insulins and does not correct at night. As a matter of fact, he used those same words on me - that insulin at night could kill someone. I tried to explain novolog to him but he can't grasp the concept of novolog, lantus or pumping.
     

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