Hey guys, For the past week dd bs was great. But over the past 2 days I noticed around 3-4 am her bs gets high. Like Saturday predinner she was 122: give her 1 1/2 units of humalog she had 1 slice of pizza and 1/2 cup of milk. At bed time she was 118 that's around 9:30. At 3 am I woke up to the alarm she was 396 ugh on cgm! I checked she was 402. I never really give her pizza and i guess it can have a delayed absorption. Give her 1/2 unit. The next night predinner she was 105: she had chicken quesadillas with 1/2 cup of milk. At bedtime she was 140 the while night she was stable 130-150 range because I checked the cgm frequently but around 3 am the alarm want off and she was 300. Again delayed spike. Her carb ratio for dinner is 1:60 maybe this needs to change. What do you guys think is going on? Could it be the type of food or something else. Btw she get 1 1/2 units of Lantus maybe this needs to increase. I will call her endo office once they open but I just wanted to get some feedback. Thanks.
We do get delayed spikes from some foods, including pizza, but usually not dinner and 3:00 am. Any chance it's just a basal need? Both my kids have a natural rise in the early hours. For DD, she can jump several hundred points between 3:30 and 5:30. For DS, it's earlier in the night - around 12:00-2:00 and it's more subtle. We have their basals increased for those times - DD's is twice as much at 3:00 as it is at 2:00, so it's a big jump. On MDI, we countered it by splitting her Levemir and by doing a pre-dawn correction with Novolog to get her in range for breakfast.
I think it sounds more like a need for an increase in your basal dose overnight, since you tried out two different types of dinners and still saw the rise much later at 3am.
My daughter is 5 and has been on the same dose of lantus for about 2 years. 1 1/2 units. Of course everyone's different but I wouldn't think your daughter would need more than mine. With my daughter, we see a rise around midnight but a fall around 4am. Those foods will cause delayed spikes for my daughter.. we don't even do pizza because of those high high numbers. When we were pumping, i did combo boluses for tacos so I think quesadillas might need something like that too. Also, my daughter was dxd at 17 months but never had a carb ratio that high. It was never more than... 1:40 I believe? Again, different kids but that might need to change. Milk might have a delayed spike as well because of the fat in it. I don't think I'd give milk with those meals honestly. I don't think it's basal, I think it's fat spikes. With pizza, we see this about 4 hours after, pasta omg we see a spike like 8 hours after, it's crazy. I do believe the milk is making the spike worse though. Why not crystal light with dinner?
Thank you ladies for your advise and feedback. Waiting to hear from endo but I am sure it's the type of food that was causing the spikes. My dd is picky eater so we try to give her milk with dinner because that's what she likes plus she is a toddler and she loves milk. She only drinks milk and water and apple juice but if she is only low. I have never tried crystal light but I will look into it. Once again thank you for the feedback.
While I am really not convinced that milk is the culprit for a spike so long after dinner (particularly if it has not caused problems in the past), if it does turn out to be problematic, you might want to try milk with a lower fat content. Whole milk raises BGs later than 2%, 1%, or skim. We had to switch back to 1% and 2% milk after moving the kids to skim because the no-fat milk was contributing to spikes at the 1-1.5-hour range in the morning!
If she is truly spiking at 3am and not before, that is not a fat spike. You typically see a fat spike 3-4 hours after a meal, so if you eat supper at a normal time, around 10:00 p.m. It does sound more to me like a basal issue.
If shes picky, I guess you gotta do what you gotta do to get her to eat. My daughter is and always was the complete opposite, she would eat anything in sight. We use the 4C "crystal light" since it has splenda in it and not aspartame. I think it's a little more expensive- -at least in shoprite it is but I do feel better knowing there's no "WARNING CONTAINS PHENYLALANINE!" on the label. The 4C half &half (half iced tea half lemonade) and the fruit punch taste great! you wouldn't even know it had no real sugar in it, trust me. A meal I give to my daughter ALOT for dinner is grilled chicken seasoned with low sodium teriyaki sauce, brown rice and broccoli. Much healthier than the actual chinese version lol. If your daughter likes that, it's worth a shot because it doesn't give my daughter a delayed spike, it tastes delicious, and it's good for you.
Typically when blood sugar rises around 3-4AM it is due to growth hormones as this is the time when it typically presents ... you might want to keep checking and see if she needs to have her basal increased.
It could be the food but it could also be growth hormones. The way to test would be to have a low carb, low fat meal and see what happens. I would be very wary of comparing doses to other kids, even ones the same age. I used to babysit my friend's cwd frequently and even though our dd's were similar age and had been dx for years, their I:C ratios and correction factors are very different. They each need what they need.
Pizza and flour tortillas were notorious for us for delayed spikes, specially when our little guy was younger. I could just imagine this little paste ball of tortilla in his stomach taking hours and hours to digest. I wondered if maybe he wasn't chewing it up enough (I don't even know if that would make a difference or not). It doesn't seem as bad now that he's 4 (he was diagnosed at 13 months), but we also just don't eat that very much due to the unpredictability of digestion.
Thank you guys for all your feedback. Talked to our endo and they think it's growth hormone and they don't wan't to change anything since by morning she is coming down on her own. Since she tends to go low at night they don't want to increase her basal rate. So for now just have to continue monitoring her.
