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Highs overnight

Discussion in 'Parents of Children with Type 1' started by susanlindstrom16, Mar 28, 2014.

  1. susanlindstrom16

    susanlindstrom16 Approved members

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    Hi everyone! I need some help troubleshooting what's going on with my daughter the past 2 nights. She has been going super high (300s), starting somewhere between 8pm (her bedtime) and when I check her at 10. Two nights ago, none of the corrections or increased temp basals I set did anything at all, I did a few throughout the course of the night. I figured the site was going bad as we were due to change anyway, so I changed out everything, insulin, tubing, and site yesterday morning. she was in range most of the day, except a 230 after school, which she later informed me was because she ate some of her friends grapes at afternoon snack, oy. But the rest of the evening all was fine, she didn't eat anything unusual and everything was bolused for. Bedtime was 140. Then she was 280 at 10pm, which I corrected for. At 3am she was 356!! I did a correction and then decided to check her pump and i thought I saw some air bubbles, so I re primed the tubing and then set a +30% temp basal. She was 167 at 6:30am.

    Any insight from the experts?? Are her basal needs increasing? Or do numbers that high indicate problems with the delivery (ie air bubbles)? Also, I'm wondering if the ISF is not right. When we were on MDI, it was 1unit:100pts. This is what we have the pump set at during the day, but the endo's office had us set it for 1unit:200pts at night, i'm wondering if we should change it to 150 or 175.

    I'm dreading the same thing happening to her tonight.
     
  2. MomofSweetOne

    MomofSweetOne Approved members

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    We have a CGM, and during growth spurts, I have seen BG climbs of 100 points that start almost the minute my daughter falls asleep. You can check ISF by giving her a correction dose and seeing how close to target she comes, but if her basal rates aren't correct, you won't really get an accurate ISF.

    ISFs are often different at night, but it is a very individual thing as all of diabetes seems to be. My daughter has the same ISF around the clock, and her ISF is 1:70 whereas all the books say she should be around 1:50. I've read that some kids (during puberty?) have an ISF that is lower (more insulin) at night rather than less insulin.
     
  3. dpr

    dpr Approved members

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    My first guess would also be a growth spurt. With growth spurts temp basal is your friend and you might need larger than normal corrections (for my daughter A LOT larger than normal corrections). If things go back to normal in a few days that's probably what it was. Do more checks tonight to see if you can catch it just as it starts and then be fairly aggressive. They're not too bad once you get used to them. Just for fun measure her height now and then again in a month or so. We've seen so big increases in height after growth spurts, but it seems to take 3-5 weeks.
     
  4. shannong

    shannong Approved members

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    My son can have some wicked spikes when he sleeps, especially during growth spurts. It almost seems like insulin has turned to water during these times. I generally set a very high temp basal as soon as he falls asleep and might even bolus right away. I find that after the growth spurt, things usually settle down, but he still has his highest basal rates going during when he falls asleep. Same thing happens when he naps.

    If you are not noticing any unusual numbers during the day, then I don't think it would be site issues. I have had problems with bubbles in the tubing but usually it gets noticed because he ate a meal and has high numbers afterwards, like he didn't get any insulin with the meal - and then sure enough I find a ton of bubbles in the tubing.
     
  5. susanlindstrom16

    susanlindstrom16 Approved members

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    I'm definitely going to measure her height tonight!
     
  6. susanlindstrom16

    susanlindstrom16 Approved members

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    what annoys me so much about the air bubbles is that when we change the insulin I bust out the flashlight and inspect for air bubbles. and then a few days later when we change again, I will find air bubbles! where the heck to they come from?!?
     
  7. missmakaliasmomma

    missmakaliasmomma Approved members

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    Could it be a fat spike from dinner, depending on what time dinner is. I just figured out that pasta for my dd takes 4.5 hours to actually start digesting normally. Mine is 5 too but she is tiny, about 42" and 37lbs. She needs more basal from bedtime to midnight and then it goes down from there. I will say that her Isf is never less than 1:140. But it really is so individual. She's always been sensitive to insulin, except in school of course!

    Air bubbles were a humongous problem for us when we pumped the first time, which definitely resulted in high highs for us. We use room temp insulin now and I fill it and wait so all the bubbles come to the top. Don't take the needle off and then try to tap the bubbles out, tap it with the needle on.

    Also, we've had absolutely no issue with contact detach this time. We used insets the first time and got kinking. Just something I wanted to throw out there.

    I saw a big increase in basal about a month ago, about 150%. She went from 2. something units a day to over 4.5 u and almost 6 u on school days.
     
  8. susanlindstrom16

    susanlindstrom16 Approved members

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    Our basal pattern right now is the highest all day from 8-12, followed by the lowest it is all day from 12-6, since she usually drops overnight. Maybe i will try an increased temp basal during the first part of the night and see how that works.

    Good to know about contact detach. MomofSweetone also said they work well for her daughter. I think i am going to order a box or 2 for our next shipment and see how they work out
     
  9. missmakaliasmomma

    missmakaliasmomma Approved members

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    They were suggested to me when we had all these issues pumping the first time. At this point, I don't know if I'd ever have her go back to the flexible cannula. They're annoying though because it has two points of contact but you gotta do what you gotta do.

    My daughters lowest basal is middle of the night too.

    When she was on lantus, she always had the rise at 8pm. The dr said just to give her a snack with insulin to try to offset it. Sometimes it worked, sometimes not
     

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