- advertisement -

Insulin Resistance and slow GI absorption, a repeating pattern

Discussion in 'Parents of Children with Type 1' started by forHisglory, Dec 4, 2015.

  1. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    So, the last time this happened we ended up in the endos office. It's now our third episode and it usually lasts 3-5 days. My son will have an unexplained spikey sticky high around midnight that takes multiple corrections. I'm calling this the "insulin resistant period." He comes down to 100 or less by 7 am. Then, it is followed by 12-18 hours of what I'm now calling "slow GI absorption/diabetes free time."

    Dinner last night was 3/4 cup cooked pasta al dente with 1/2 cup lean 93% ground beef on side with a light Greek yogurt smoothie of blueberries, avocado, milk, splash of juice. No spikes for 4 hours post meal (dinner at 6 pm). Then giant midnight spike into the 300s that takes 2-3 corrections (one every hour) to budge below 200. Breakfast with 15 min prebolus and 80 carbs of quick oatmeal with brown sugar/cinnamon and he doesn't come above 97. Usually he spikes to 150. Just for a test, I let him have a choc covered Quaker granola bar (23 carbs) and he only goes to 115 from 97.

    This same pattern occurs every 2 months. I find it quite interesting but I cannot find any answers. Absolutely no signs of illness or abnormalities. Tests during last episode reveal no thyroid, celiac, or other issues.

    ????????????

    Edit: the giant midnight spike will happen even if he has a salad and grilled chic dinner. In other words we have ruled out a delayed fat spike.
     
    Last edited: Dec 4, 2015
  2. Snowflake

    Snowflake Approved members

    Joined:
    Dec 1, 2013
    Messages:
    482
    Before diabetes, when my daughter was a baby, every time she went through a fussy or difficult period, we would chalk it up to "teething." Sometimes there was a tooth coming in, sometimes there wasn't.

    Now, I think of "growth spurts" as the "teething" of diabetes management in a young child. Whenever we have these period of inexplicable overnight highs that don't seem to be related to food, travel, or other illness, I always fall back on growth spurts as a convenient explanation, without any way of verifying that it's true.

    Last spring and summer, we had multiple periods like what you're describing, where she would spend night after night high and we'd spend night after night bolusing, but we wouldn't see the same insulin resistance during daylight. Then, right when we changed the pump settings, her nighttime insulin needs would return to baseline, and we'd start seeing lows. Things have calmed down a lot recently, and I suspect part of the reason is that her growth has plateaued recently. I have no idea if this is what's going on with your little guy (or even with my daughter!), just a thought...
     
  3. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802
    Did the endo happen to offer any plausible explanation?
     
  4. rgcainmd

    rgcainmd Approved members

    Joined:
    Feb 6, 2014
    Messages:
    1,371
    Sounds like somatotropin (growth hormone) release to me. Sometime around midnight is when this happens with my daughter. As there's no way to accurately (and consistently) predict when this will happen, all you can do is ride the wave and correct, correct, correct (being careful not to stack insulin, of course.) The only thing we've done that has been useful (at least a handful of times) was to set a much higher basal rate starting 1.5 hours before the predicted spike and continue it for 2.5 to 3 hours (during the nights after the first spike in that particular "series" of spikes.) This strategy entails taking the chance that the spikes will continue after the first night and subsequently risking going low in the event the spike doesn't occur. My daughter usually experiences somatotropin spikes for several nights in a row, but we've had a few "one-night stands", too, which is when Dexcom comes in especially handy. I honestly don't know how you would effectively handle this (other than chasing after your tail with multiple corrections) without the adjustable basal rates provided by a pump. Sure, you could try to time a higher dose of long-acting insulin to match the timing of the spike, but you can't exactly "turn it off" once you've injected it like you can with a pump's temporary basal.
     
  5. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    He had no idea. That's why he ran a bunch of tests. He ultimately said, "This is life with diabetes." I think Snowflake and rgcainmd are right about the midnight spike being a growth hormone issue but what I don't get is the "diabetes free" daytime period. He hangs in the 80's and eat things almost completely uncovered. In fact, covering him will drop him low. But it only lasts 3-5 days and he's back to his "normal" diabetes. It's so weird!

    Endo also said, "a virus" could cause the signs we see but there is absolutely no illness in our family, no sniffles, and never are for these episodes. Maybe some sort of silent virus?
     
  6. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    Those are good thoughts. I'm not too worried about the spikes because they disappear and don't cause ketones. But we were stacking somewhat (overriding IOB) and it didn't matter. Our normal correction factor was only dropping him 30-40 points at a time (given once an hour) when normally it drops him 100+
     
  7. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802
    I pmed you on this. GH and cortisol, catecholamines get used up when they surge, and they are important in counter balancing basal/other insulin during the day, so you may be GH and cortisol depleted for many hours following a surge. You may have heard that lows follow lows because lows tend to produce surges of counter-regulatories, also if it is adrenaline related, you can become resistant to adrenaline in the period following an adrenaline surge as a protective mechanism-adrenaline doesn't "work" nearly as well the second time in a short span because receptors downregulate. See additional pm.
     
    Last edited: Dec 4, 2015
  8. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    Joe, if I have permission I want to post an explanation you sent via PM.

    I completely forgot he complained of a tummy ache each time after dinner. No signs of colitis and celiac is negative but I'm also wondering about sub clinical or atypical presentation of appendicitis? Endo did mash on his abdomen with no pain elicited. I think inflammation related stress hormone release followed by depletion and insulin sensitivity sounds like an awesome plausible explanation.
     
  9. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    We posted at the exact same time. Ha! Yes, I got the PMs and they are the best explanations yet!
     
  10. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    Well hello midnight spike (actually more like 11 pm tonight) here you are again! Ruining our sleep. That's okay though, my son will love his diabetes free morning tomorrow! Geez, D is so weird sometimes! image.jpg
     
  11. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    PS- it makes me so angry to see that spike. It's so freakin' annoying! We do all the right "stuff" and it appears out of nowhere. I know, growth hormones, but it makes me mad. It's going to take 2-3 hours to pull it down. I'm increasing correction factor and also resisting the temptation to stack and knock that 350 off.
     
  12. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    Here again we are 30 minutes after a 30% increase in correction factor and 50% increase in basal. Stupid disease. This spike is way out of control and he hasn't had food in 5 hours. image.jpg
     
  13. sszyszkiewicz

    sszyszkiewicz Approved members

    Joined:
    Dec 24, 2013
    Messages:
    842
    How often do you change the set?

    At what point in the rise do you get aggressive with the insulin?
     
  14. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    We change the site every 3 days. We changed on Thurs evening around 5 pm and so today (Sat) will be 48 hours. I got pretty aggressive about 45 minutes into the spike. I was waiting on it but wanted to make sure we were going to see a repeat before I increased basal. Basal was at 0.200 at 8 pm and I increased to 0.275 for the remainder of the night until 6 am. Then, correction for 350 was 1 unit for every 150 over 200. I added on some extra to that number (have to look-total was 1.3 units I think). After 45 minute he was still skyrocketing and I then gave 0.70 units again. He ended up in the 80's about the 2 hour mark via finger stick. Was a diagonal down arrow so I fed him 15 g of juice. Was a bit concerned I may have overdosed him. He's had breakfast with a bolus AFTER he ate this AM and we still didn't go above 200 so we are in that increased insulin sensitivity period again. Here's the Dex graph and it's ugly. I've noticed he'll have a mini spike around 3 am and that's why I increased basal tooc image.jpg
     
    Last edited: Dec 5, 2015
  15. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    Additional info: at 6:30 am he was 63, so my husband gave him 15 g of chocolate milk, (I was asleep) so that rise before breakfast is from that. No correction insulin was given after 12:30 am. So, basal needs to come back down but I know this thing is going to be gone soon so I'm trying to ride it out. I need to not get so angry at the spike too. I'm sure that's not good for decision making. :/
     
  16. sszyszkiewicz

    sszyszkiewicz Approved members

    Joined:
    Dec 24, 2013
    Messages:
    842
    You will flatten it. So thankful for the Dex.

    If it were me I would double the basal to 0.4 at around 900 and leave it that way until midnight and see if it flattens and how long it stays flat after that.

    You have the Dex. Make sure it has his number pretty good before bed.

    i would change the set tonight before this adventure to 100 percent rule out any set issues that sometimes creep in after 48 hours.
     
  17. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    Thank you. I was thinking of changing sites too. We have done that before 24 hours into it but still the spike. Still, good to rule it out. Basal to 0.4 from 9-mid sounds like a plan and one similar to what our endo suggested last episode (2 hours before spike). I'm gonna squash that sucker! Dex is a lifesaver!
     
  18. DiabetesMama

    DiabetesMama Approved members

    Joined:
    Sep 4, 2015
    Messages:
    258
    We had a night like that last night. He was 104 at bedtime then around midnight started creeping up towards the 200's. Dropped about 2 in the morning a bit, then almost 200's again about 3 in the morning! AAGGHH!!! I hate this. He came down on his own this morning but was higher than I want to see before breakfast. 132 after all that up and down craziness. Then the day before that, he had his normal breakfast of Poptarts, (ok, I know this is no the breakfast of champions, but we can't really get him to eat anything else) and it spiked like crazy! Normally, we have a controlled spike around 185 and then it starts going down within an hour on it's own. Yesterday was a completely different story! We had to treat twice, then he finally did a temp basal of -40% for 1.5 hours and he got it under control. This was amazing because HE figured the temp out, not me. He was out with his dad having some "guy time" and he did it on his own! I was so proud of him for doing it himself. But anyway, just wanted to say you are not the only one lately with crazy spikes. I know how you feel about wanting to squash those spikes, but what do we do with those nasty hormones? My son also has this weird cycle of spikes at night, then back to "normal" diabetes. It's every few weeks he has a rough spell, then it stables out and life goes on, but it is so hard to deal with the craziness when it happens. I'm so sorry that you are having to deal with this and be up with a newborn. You are a hero for all your juggling! Hope you and baby are doing good. Hugs for you! Hang in there, Mama.
     
  19. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    Thank you! This spike would reach 400+ without intervention. It's insane. I didn't realize 7 year old boys had such strong growth spurts. I thought that was teenage land? Newborn gives us much better sleep than the D beast. At least our babies start sleeping through the night around 2 months. The D is the real sleep killer, which is why it ticks me off! Adult type 1s don't deal with these spikes aside from monthly cycles right? At least as a male he will get a break from hormone surges once he's grown.
     
  20. rgcainmd

    rgcainmd Approved members

    Joined:
    Feb 6, 2014
    Messages:
    1,371
    I am NOT recommending that you take a similar approach, but I often end up doing the following when my daughter has what I believe are growth spurt spikes. I often double the correction dose recommended by the pump wiz and increase the temp basal by 90%. I gradually moved up to these rather extreme temporary dosage increases after seeing that my daughter didn't experience any lows after these adjustments. Maybe it's because she's a girl (a common theme is that hormone-associated BG increases are more intense and complex when there is no Y chromosome in the picture) but we have never fought persistent lows after one of these nights from D-hell.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice