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Good golly molly, how do you guys with teens handle MDI?

Discussion in 'Parents of Children with Type 1' started by nanhsot, Jun 21, 2012.

  1. nanhsot

    nanhsot Approved members

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    Not being judgmental, asking a true question. My son's dawn phenom is a BOSS! He took his pump off in advance of camp (he chooses to go on shots at camp, most kids do, easier than messing with filling and swimming and etc), rather than fill a new cartridge he just pulled it last night and took some lantus. Checked at 1am, all well, checked at 3am and Dex said 87 so I woke him to verify, he was 122. Perfection. Didn't amble back in there until 7 and holy moley, he had an up graph starting right around 5a that was almost linear and he was 312 or something. Crazy hormones/cortisol/whatever.

    So is the trick now to wake at 5 and give a correction? Or is there another trick I'm missing to offset this lovely rise that's sure to happen again? His 2a basal is double the rest of the day, so it's not surprise, just not sure how MDIers with a teen and/or dawn phenom handle this.

    He's a bear when he wakes high and it messes up our entire day, so it's worth whatever loss of sleep I have to suffer. He leaves for camp on Sunday so it's only a few more days and then he's their problem! He tends to go low at camp due to activity so I'm not worried about that anyway.

    Thanks!
     
  2. TheFormerLantusFiend

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    I take about four units of insulin within ten minutes of waking up around 6 AM (I wait to see a small rise on the Dexcom), then inject again around 7:30 for breakfast.
    I also am aggressive with Lantus dosing.
    I've still had weeks that didn't work, or where I just was waking up and injecting every morning around 4. But mostly it's okay.
     
  3. Joretta

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    On MDI we always have to get up early to check. Only on the pump do we have freedom to sleep.
     
  4. emm142

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    Personally I might be inclined to raise the Lantus dose so that it works better for the AM. You would then likely have to give less insulin for meals and give an uncovered snack before bed (and possibly during the day) but uncovered snacking would drive me less crazy than that kind of spike! The best option might be to bolus some at 4-5AM, but that's such a pain.

    I think your son has pretty extreme dawn phenomenon. It's certainly more extreme than anything I've ever seen on a regular basis in my years with D.
     
  5. nanhsot

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    Well, given we are on day 1, I'm reluctant to make changes in the lantus, doesn't it take a few days to build up (I know it takes a few days to ramp down)?? I'm also reluctant to send him to camp needing his insulin fed, as he isn't in control of the food pantry like he is at home. :p

    We'll see what tonight brings, he definitely has an extreme rise, is it unusual? I thought it was common in teens, but I guess not??
     
  6. Gwyn

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    I'm looking forward to more suggestions to combat this problem as we have been doing the 4AM thing for a while now. For us, raising the Lantus just brought lows in the night and didn't make a dent in the spike.

    If we skip the early am shot (ie are too tired to hear the alarm) one way we found to avoid the "high all day problem" is to get up before 7, have a regular breakfast with regular insulin (no correction) and go for a relatively strenuous workout session--for us that might mean running a mile and biking a few more--That usually brings things right down and seems to put the day back on track.
     
  7. Lee

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    Luckily, DP ended for us once puberty was in full swing. But we did give more Lantus and just an uncovered snack and a 3am check.
     
  8. mmgirls

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    we went unteethered a few months ago and yes it does take a few days to get Lantus up to speed.
     
  9. hawkeyegirl

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    Would he think about wearing the pump just at night so he could get that extra early a.m. basal? Just a thought.
     
  10. mmgirls

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    I think he is going to camp and will not be having his pump and they are trying to figure this out before then,but I could have it wrong.
     
  11. nanhsot

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    MMgirls is correct, he's leaving for camp so this is very temporary. He's already yanked his site and leaves on Sunday, wish I had asked yesterday because that's a really good idea.

    I've often thought of this as a semi-untethered option though, and I do think it could work for him if he wanted to be disconnected more during the day.
     
  12. hawkeyegirl

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    Right, I got that, but I assumed (perhaps wrongly) that the main hassle that pumping presents at camp is during the day and maybe he wouldn't mind hooking up at night. But if he doesn't want to, I think he's pretty much stuck correcting in the morning.
     
  13. nanhsot

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    For whatever reason it's never been an issue at night at camp. He fights lows and ends up with a much lower lantus dose actually...all the activity I suppose. At camp he has woken up high a few times there, but the exercise/activity is pretty intense all day so I think maybe he is able to bring it down more easily.

    I'm just trying to get through the next few days without snarling at each other, once he's high in the morning it's tough to get him down, and he's pretty grumpy high.

    I think I'll suggest the early morning workout someone mentioned, that could work, plus a 5am correction if needed. I'm up at 5 for work tomorrow anyway.

    edited to add that he enjoys the break from pumping that camp presents. He likes being totally disconnected, nothing connected to his body, no sites, and having his meals all figured out, etc. They do lots of education there but it's also somewhat of a mental break from things as meals are precounted and insulin predosed, so having a pump would mean changing sites and dealing with filling cartridges, and just the general hassle of it all.
     
  14. Lee

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    No ketones, right?
     
  15. nanhsot

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    Nope, he's one of the lucky ones that doesn't throw ketones easily. I think we've seen min to mod ketones once since diagnosis and that was when he was actively trying to lose weight and going VERY low carb (and therefore low insulin).
     
  16. hdm42

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    We started seeing a nasty dawn phenomenon this year, with the rise usually starting around 4-4:30am.
    We ended up switching to Levemir for our basal and doing a split dose with 2/3 in the am and 1/3 before bed. It has really helped to even out the nighttime numbers.

    I know you're using lantus, so my response may not help you at all. I do know there are some folks that split lantus for this reason too. Maybe ask your endo about that option?
     

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