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Bedtime highs

Discussion in 'Parents of Children with Type 1' started by lcblk27, May 7, 2012.

  1. lcblk27

    lcblk27 Approved members

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    I've been noticing that Ethan's bg numbers have been pretty good durring the day but his after dinner/already in bed numbers have been really high. We usually end up finishing dinner about 6:30-7pm and he goes to bed at 8pm, so I havent been checking him before bed as I know his bolus will still be working (he gets lantus along with his dinner shot also). I do check him before I go to bed around 12 or 1am and recently his numbers have been high. Like 300's or 400's. I usually end up giving him a correction at that time and by morning he is back in range.

    So, Im thinking his ratio for dinner time needs to be raised? Where I am not sure is how much to raise it. Right now he gets 1 unit per 20 carbs. Is 1 unit per 15 carbs too drastic of a change? Not enough?

    Id appreciate any advice :)
     
  2. danismom79

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    I would start by checking around 10pm to see where he is.
     
  3. MomofSweetOne

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    I would check about 4 hours after his insulin (assuming his duration is 4 hours) to know whether I'm seeing a basal issue or a bolus issue, and then I would probably only inch the bolus ratio down by 2 per night and then keep doing it until I found what seems to work.
     
  4. Christopher

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    I agree with the 2 posters above. Also, are you pre-bolusing dinner? Just to clarify, you are not mixing the Lantus with the Novalog, right? And if it is two seperate shots, are you injecting into two seperate places?

    Also, if you are doing a correction around midnight, are you checking him 2 or 3 hours later or just going to sleep and checking him in the morning?
     
    Last edited: May 7, 2012
  5. lcblk27

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    No, I give him 2 separate shots in 2 separate places. I dont pre-bolus, I bolus after he eats because Im never sure how much he will eat. If I correct him around 12 or 1, I usually just check him when I get up in the morning. At first I was checking him again a few hours later but it never dropped him too far so I feel safe just checking him at 7:30 when I get up.
     
  6. kellykate

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    We had this same issue recently and moved the ratio too much (5 carbs) causing a scary low(37!)! Of course being the spunky, little toddler she is, she was running around the house happy-as-could-be during the whole thing! So, that being said... if you move it I would go a carb at a time and check at 10, 12 and 3 to see what is happening.
     
  7. jessicat

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    We have always been told by endos and educators alike that it is ok to mix the 2 to save the child from 2 shots.
    Obviously, do what works best for your little D and do what the endo says, but you may want to ask about that.

    I might consider pre bolusing and trying to get better about eating the # carbs you have served for consistancy.

    YDMV
     
  8. lcblk27

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    We use pens, not syringes, so we dont have the option of mixing the 2.
     
  9. lcblk27

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    Thats really good to know that 5 carbs was too much, I will be sure to go slower than that.
     
  10. TheFormerLantusFiend

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    What I do is think about how much insulin would have been the right amount by figuring the right amount would be the amount that was given plus correction needed and go back and see what ratio that would have been.

    For example, let's say one night he ate 80 grams and got 4 units, had a blood sugar that needed correcting with 1 unit, then an initial dose should've been about 5 units: 1:16. If that happens twice in a row, then I try the 1:16.

    But if we're talking that he's eating 100 grams, taking 5 units, and needing a correction of 1/2 unit later on, then I figure he needed about 5.5 per 100 which is about 1: 18.
     
  11. sheeboo

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    Jonah, this is a really helpful way to look at it. One question: which reading would you base this decision on? 3, 4 or 5 hours after eating/dosing? I'm guessing it would depend on the DIA in your child, yes? Would you need to wait until the previous dose was all used up to get a good idea?
     
  12. TheFormerLantusFiend

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    That's generally hard to figure out but in this case easy. If you were picking the wrong time, the corrections you've been giving wouldn't be landing his blood sugar in the right zone. Whatever time it is that you can use the blood sugar to decide a correction, that's the time to base the decision on.

    I think whether you need to wait out the DIA depends on how well you can predict how much of the insulin is still active, and how much of the food is still digesting, at various amounts of time after eating and injecting.
    But waiting out the DIA is certainly a safe possibility.
    The only danger in waiting longer is that the longer you wait, the more likely it is that fluctuations in blood sugar that have nothing to do with the meal will mess up your calculations (for instance, too high or low basal insulin dose, exercise, etc).
     

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