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It's 2 A.M: What is your low BG cut-off to give carbs and high BG cut-off to give insulin?

Discussion in 'Parents of Children with Type 1' started by DavidN, Jan 21, 2013.

  1. DavidN

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    Assuming it's a normal day (if those exist) with no exercise, if you check your child at 2 am, what is your BG cut-off on the low side to give carbs and at what BG level would you give insulin?

    Also, if you give insulin, do you check on your child again before morning?

    We are 6 months in and still nervous. We give carbs at below 120 and insulin above 200.

    We check at 8pm, 10:30pm and 2am, on average. Sometimes more if stuff is going on.

    Thanks!
     
  2. Christopher

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    At 2am if she is 80 or below I would check again at 2:30 and then if she was at the same number or lower I would give carbs and check again around 3am.

    At 2am if she is above 175 I will give insulin. I would ABSOLUTELY check her again around 4am for the simple reason that I do not know if the correction I gave he is too much or too little.

    The last thing I want to do is give my child insulin and not make sure I gave her the right amount.
     
  3. Brenda

    Brenda Junior Member

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    You are going to get many different responses to your question. Every person with diabetes is different and what one does is not necessarily what another does. Stage of diabetes (your child is in the honeymoon) and age/weight can be factors.

    Our daughter does her own care so I cannot say what she does/what her cutoff is. I do know that about six years ago I once checked her at 4 a.m. and she was 141--I gave her 0.5 unit. Christopher might do the same, but should you? NO, not at this stage. For most people whose child is 8 and under, 141 at 4 a.m. might be perfect. For you, the cutoffs you are using sound reasonable. What does your diabetes team suggest?
     
  4. cdninct

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    I think Brenda is right--every body handles insulin differently, and every family has its own comfort level, but, FWIW...

    ...that is exactly what I would do!
     
  5. DavidN

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    I'm not taking Christopher's, or anyone else's, numbers and applying them to my child. Our care is between me, my wife and my D team. Was just curious what other parents do.
     
  6. selketine

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    My answer would depend on his IOB - I might be really worried about a 140 if he had a lot of IOB.

    I think if the child has a cgms it also factors into it - the trend of going up or down, arrows, etc.
     
  7. Anyelday

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    I just had to Google IOB...I'm a newbie. Our daughter is 5 and honeymooning and the the number they gave us before bed is 110...and we have been wondering the same thing about when to treat at night and if we always have to give the 15 or if we should give less. It all seems simple until it is 2am and you are sitting there with the BG monitor in your hand and trying to make a good decision. last night she was 81 at 2am so we did the 15 of juice and she went up to 155. This is something we definitely need to discuss with endo.

    I a just happy we check MORE often than we were told when leaving the hospital.
     
  8. DavidN

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    The other night I checked my son at 2am. I left his room, thought for a moment, then went back to prep for a bolus. Half way through the process I changed my mind again and headed to bed. Five minutes later I hopped out of bed and gave him a bolus. Then, like we always do after a bolus, checked on him two hours later. I long for the days of a strong honeymoon when I could send him to bed at anything between 170 - 250 and he'd wake up at 115, every single time. Thought this was supposed to get easier, not more difficult. Sigh.
     
  9. Christopher

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    I guess it depends on your definition of "easier". For me, the truth was that it did not get easier, I just gained more knowledge and experience as time went on and felt like I was better able to manage this illness. But I never have considered it easier. I think what you will find is that there are peaks and valleys. There will be times when things are going well and you feel pretty comfortable. There will be other times when nothing seems to work and each day is very tough. It is just the nature of this illness.
     
  10. danismom79

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    I still go through the same process after almost 5 years. Things get even weirder when you throw puberty into the mix. I can leave my daughter at 200 one night, and she'll stay in the 200s all night. The next night can start the same, and I'm treating a 60 out of nowhere. And I do mean nowhere - no IOB, no extra activity. Some nights are good, some are frustrating as hell, and you might second guess every decision you make, but you get used to it.
     
  11. zuzinka

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    night anything below 75 I treat and anything above 150 I give insulin. But we do have a sensor so its a bit easier, since I can see much more than guessing.
     
  12. cdninct

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    As you say, you should certainly check with your endo, but I know from experience and measurement that 15g of carbs would bring my 4 year old up 150 points, which is always too much. 1 or 2 glucose tabs (4-8g) is enough for him.

    FWIW, it took me months to figure out that 15g was ludicrous for treating his lows! I wish I had thought about giving smaller quantities sooner. I actually started bolusing to cover the "extra" carbs before I realized that I could give fewer to begin with because I was so fixated on following the 15-15(-15) rule!
     
  13. mom24grlz

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    We give carbs if Ashleigh is below 90 at night. I'll recheck her 15 minutes later to make sure the carbs brought her up. And then again 1-3 hours later, depending on how much the fast acting brought her up.

    We give insulin if Ashleigh's blood sugar is above 140. I'll check her again 3 hours later.
     
  14. hawkeyegirl

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    Mmmmmm...it depends on the day we had, and how comfortable I am with our basal settings at any given point. But on an "average" day, where I am comfortable with our basals, at 2am I would give carbs for anything below 85 or so (or higher if there is a down arrow on the CGM), and correct anything above 130 or so (again, depending on CGM arrows). Our alarms are set at 80/140.

    But having a CGM makes a huge difference. I would be much more conservative without it.
     
  15. Anyelday

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    We will definitely discuss with endo...I think they do the 15 15 to make it simple...

    When you are bringing up a low what number are you trying to get to...during the day? at night?
     
  16. steph

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    This, exactly. The disease didn't get easier, but my increased knowledge and skills make it easier to manage and cope with most of the time. And it is extremely rare for me to actually be scared or freak out about something. I get frustrated and discouraged at times, but not that panic I would get in the first few months after Dx.

    It's important to remember that different age ranges also have different target BG ranges. For my 2yo it's 80-180. Also the 15-15-15 is a basic guide developed for adults and may or may not work for your child. I use 4 carbs for my DD and wait 20 min bc through months of trial and error, I found that is what works. Now that she's a lil bigger we sometimes use up to 10 carbs. I will usually treat if she is under 90, check to make sure she came up and go to bed. I will bolus if she's over 200, and check 2 hrs later. With that being said, for my child, we now do this process at 12 rather than 2, but we started out with the 2am check. Just a personal preference.
     
  17. Christopher

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    As Stephanie correctly pointed out above, whatever number is "in-range" for your particular child.

    For Danielle during the day I would try and bring a low up to around 100.
    At night I would go a little higher, maybe 130.

    The thing to remember is that there are so many variables it is hard to make blanket statements. For example, if she was low during the day and I was bringing her up, but I knew she was going to do some type of activity, I would shoot for a higher number than if she was just going to be sitting around reading a book.

    You are in the very early days....and they are tough. Your instinct is to try and get control of this thing, but it will not be controlled. As time goes on you will focus more on managing this and the more experience you have, the better you are able to do it.
     
  18. Anyelday

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    Thanks! I was thinking that about activity levels...rainy/relaxing day vs jumping on the trampoline or playing at the park for a few hours. I am glad I have a few months before I have to factor in the crazy Charleston heat
     
  19. Christopher

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    Activity really does affect most children's bg. But, like everything with T1 diabetes, it is different for each. But I would say for most kids, activity lowers their bg, sometimes drastically. But there are kids here whose bg can go up from activity so....you will have to see how it goes with yours.
     
  20. Turtle1605

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    I always dread those iffy numbers at 2:00 a.m. I usually don't give him any carbs unless he is below 80 because he tends to increase after 2:00 a.m. However, if he is in the 80's, I check again in an hour or so...because I worry so much I can't sleep well anyway.

    I just hate getting on that roller coaster of giving carbs, numbers shooting up, correcting, etc. So, if he is in the 70's, I let him take a couple drinks of a juice box and check in 15 minutes to make sure he is rising.

    If he is below 70, he gets the whole 15 carbs and I check in 15 minutes. I actually check in 10 minutes because in the past I have given him the juice and he has continued to fall pretty fast. Of course, after 2 juice boxes, we end up on the roller coaster...but better safe than sorry.
     

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