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Help!

Discussion in 'Parents of Children with Type 1' started by Ndidi Nwosu, Jul 7, 2020.

  1. Ndidi Nwosu

    Ndidi Nwosu New Member

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    My daughter is 8 diagnosed with type 1 at 3. Currently is on lantus because of insurance switch as of Thursday. She was on basaglar before. Originally on lantus at initial diagnosis. She spikes in the middle of the night . She went to bed at 192 after correction dose for dinner . She gets her insulin 8pm , by 2am she was 250 and 5 am she was 260. She is on 5 units and doc says to just increase basal as needed. Can someone explain what basal is supposed to do because I thought it's supposed to slowly decrease her fasting sugars at night? Also does anyone know about splitting dosage for basal half at night and half on rising ?
     
  2. MomofSweetOne

    MomofSweetOne Approved members

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    Welcome to CWD! I'm sorry you're having to deal with an insurance insulin switch and adjustments. Does the Lantus hurt your daughter? My daughter said it burned from one injection until the time she got the next injection the following evening. After switching to a pump, she has never wanted to go back to Lantus. I don't think that everyone gets the same burn, but I had no idea how bad it was until she was off of it. She went through a year of misery during which had I known what I know now, I would have been begging for levimir.

    Basal insulin is supposed to match the glucose being released by the liver in-between meals. Ideally, it should not go up or down by more than 40 points if adjusted correctly. However, as you know, many, many factors come into play.

    As I look at the numbers you posted, I would first want to see about three nights' numbers before deciding what I would do. Your daughter spiked high between bed and 2 a.m., but then she stays steady until 5 a.m. I, personally, would not be comfortable increasing her Lantus when I'm seeing a steady in the middle of the night while you're sleeping. Even if she wears a cgm for back-up monitoring, an alarmless night is a wonderful thing.

    Things that could be causing the bedtime to 2 a.m. rise are:
    1) Fat/protein delayed spike from dinner. If the food digests slower than the insulin works due to its composition, you will see a rise 4-8 hours after the meal. This could be dealt with by using Regular insulin rather than her fast-acting for the evening meal; it's slower release of 6-8 hours would cover fat/protein digestion if this is the cause.
    2) Growth hormone released when they fall asleep often causes spikes. This can be really inconsistent and cease with the growth spurt.
    3) The Lantus might not be lasting a complete 24 hours. If this is the case, a split dose would help. Do you dose in the morning or the evening? For us, my daughter initially started dosing in the morning to avoid risk of nighttime lows, but when the CDE observed she was climbing during the night like your daughter, we split-dosed changing by a unit per day until the entire dose was then given at bedtime. This helped.

    At 8, this shouldn't be an issue yet, but for us, the decision to switch to a pump was caused by puberty hormones. The amount of basal my daughter needed during the night was so significantly more than what she needed during the day, she was either high all night and then felt miserable all day, or if we had her in-range during the night, she ate to avoid lows all afternoon. We might have been able to overcome this with a split dose, but I didn't know about such options.

    Good luck and keep us posted. We're aware that once you figure something out, something else will shift demanding more adjustments. Don't forget to take care of YOU as well.

    Editted to add: I just reread your post and saw that you dosed at 8 p.m. If I understand correctly, you put her to bed at 192 but also gave her insulin to correct that high? So the actual climb would be much more than 60 points without a correction?
     
  3. Ndidi Nwosu

    Ndidi Nwosu New Member

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    Hello,
    Thank you for the insight. I think it's the protein because she loves chicken wings and all week she has had them . I didnt take into account it may be digesting slower because last night she had a turkey burger and she didnt spike at all. I'm going to continue this for a little while and if this is the case I will ask her doc to switch her to regular insulin
    Her lantus doesnt burn thank god I'm sorry your daughter had to go through that.we have also started to pre bolus as of yesterday to prevent spikes after a meal. She was diagnosed at 3 and the docs in the hospital said to bolus afterwards because she may not eat everything on her plate but she was eating everything back then but I followed their direction. Now 5 years later and having a new endo and hearing people with kids that are diabetic everyone is talking about pre bolus and i wish a doc would've told me this is mainly suggested for small kids but as she gets older it could change . My daughter could've avoided many highs just from pre bolusing. I'll continue to monitor her but that protein insight really is sticking out to me . Thanks so much
     
  4. MomofSweetOne

    MomofSweetOne Approved members

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    Here are some articles on fat/protein and insulin:

    https://insulinnation.com/treatment/dosing-insulin-for-protein-when-it-matters-why/

    https://insulinnation.com/treatment/dosing-insulin-for-dietary-fat-when-it-matters-why/

    Regular is available at Walmart relatively inexpensively. I wouldn't look at switching but rather as adding it to your toolbox for those meals where it might be a better match to watch she's eating. Your doctor would have an idea of dose ratios, I hope.

    Striking the Spike is HUGE. It makes such a difference on how they feel and their ability to focus on their schoolwork. My daughter and I worked out a system where I would tell her in advance what we were having, and she would tell me how many carbs based on how hungry she was. She was older than your daughter at that point, but she had a knack for carb counting I never gained. ( I loved the scale.) But her estimate would let us calculate and dose her before the food was ever served.....and if she was hungry, she could always have more insulin and we didn't worry about prebolusing that.
     
  5. rgcainmd

    rgcainmd Approved members

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    Being able to set different basal rates at different times by using an insulin pump could be very helpful with your particular situation.

    I wish you the best of luck with whatever you decide to do!
     

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