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Night time correction

Discussion in 'Parents of Children with Type 1' started by tiger7lady, Feb 11, 2011.

  1. tiger7lady

    tiger7lady Approved members

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    We have recently fallen out of honeymoon and are struggling with higher numbers. His correction factor is 1:100 (which I think should actually be adjusted to 1:90 or 1:85) but if he's high at bedtime or overnight that correction does diddly. After several nights of doing corrections every 3 hours it appears his correction should be somewhere between 1:40 to 1:50 overnight. That seems like a huge difference. I know that with hormones and what not they can be insulin resistent overnight but by that much? Do you think I should just jump right into a 1:50 correction overnight or should I try 1:75 first and gradually work my way down each night?
     
  2. hawkeyegirl

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    I actually think it's more likely that your basal needs to be adjusted. Since you're on MDI, it's a little bit harder to adjust basal to address growth hormones, but it may be an instance where splitting the basal into two doses (one given in the morning and one at night) might help.

    I'm no Lantus expert, however, so hopefully someone else will chime in here.
     
  3. saxmaniac

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    Going from 100 to 95 or 90 will probably make no difference whatsoever.

    Going from 100 to 50 isn't as big a change as it looks. It's doubling the insulin -- so something that used to be .2u correction might now be .4.

    However, going from 10 to 5 looks smaller is also still doubling the insulin. Exactly the same. So something that used to be .2u correction might now be .4.

    I'd suggest changing to 75 first, then 50 if you're stuck high (25%). More conservative would by 10% -- 100, 90, 80, etc.
     
  4. tiger7lady

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    I thought about that but there were 2 times this week where he went to bed at a decent number and woke up almost exactly the same. For example the other night his bedtime reading at 9PM was 110. I checked him again at 3AM and he was again 110 then at 7AM he was 105. You can't get more constant than that so I figured his Lantus was spot on. Though I'm only a year into this and I'm just now starting to get more in depth with adjustments.
     
  5. tiger7lady

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    I never thought about it in those terms but I see your point.
     
  6. hawkeyegirl

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    Did he have high fat meals on the nights where corrections weren't working? Pizza, burgers, fries? Pasta? Fat absorption issues will also cause corrections to not work right.
     
  7. tiger7lady

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    No, not really. Standard at home cooked meals. I'm really trying to lose weight so they haven't been that fat intense except for last night he had a big piece of cake after dinner. I was throwing that calculation out becauseI figured the cake was messing it up. 3 hours after he was at 240, I gave hime 1 1/2 unit correction, and 3 hours after the correction he was 222. Gave him 1 unit correction and he woke up at 174.
     
  8. mom2two

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    My exact thought as well. If you are having to give corrections every night and you know it doesn't have to do with fat from a meal lantus needs to be adjusted. Does the correction work during the day?
     
  9. quiltinmom

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    When we came out of honeymoon, his lantus nearly doubled over the course of a few weeks. How often are you correcting/having highs during the day? If it's only at night, your lantus might be just fine. If you are correcting highs at every other meal or so, I would try increasing basal. Another thing you could try is move the time of the lantus to around dinner time so it is working its hardest around bedtime.

    Another thing you could try is increasing his dinner insulin.

    Does he have a bedtime snack? That sometimes will throw my DS's numbers off. We don't do bedtime snacks as a habit, although we do allow it sometimes.

    Could you have take a walk with him after dinner? Some sort of mild exercise might also help your problem.

    My DS seems to have the highest averages in the afternoon/evening hours. His dr. says that's pretty normal.

    Good luck!
     
  10. wilf

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    Are you testing in between those corrections? Or just testing every 3 hours and correcting then if needed?
     
  11. tiger7lady

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    I'm just testing every 3 hours and correcting again if needed.
     
  12. tiger7lady

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    Oh, and no bedtime snacks usually. I know his dinner I:C ratio is off so I've been adjusting that. I know if I can get him in range before bed then he is fine all night and wakes up with a good number. His lunch and dinner have been spot on, it's just that bedtime reading and the morning reading if he's high at bedtime.
     
  13. wilf

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    I would test 1.5 hours after the correction so you can see what is happening..
     
  14. Trev

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    Quick response

    I am about to go test my kid before heading to the pillow myself. Always take the conservative approach, is safer to correct a hight then to glucagon for a low, especially over night.
    I did not scan the other comments, forgive me if i am repeating somebody's response.
    Cheers!
     
  15. KRenee

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    My daughter started experiencing dawn phenomenon after 2 years of D. Her usual correction is 1:40, but for that morning rise her correction is 1:10. Four times as much insulin! So, yes, the hormone insulin resistance is HUGE.

    BTW, cake always gives my dd a huge, resistant spike 4 hours later. It's worse than any other food. We have banished cake from this house!
     
  16. dejahthoris

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    My son just went from honeymoon to real world. It is challenging. I got alot of advice from the endo on this. His carb ratio went way down from 1:70 to 1:15 in the last several months. During the honeymoon he could eat like a pig, take no bolus and still have gorgeous frame-able numbers!! Then his carb ratio gradually started going down. But one thing they said was we would rather see him at 200 than 50. Also only 1/2 correction over 200 at bedtime. We always give bedtime snack but if he is high it is free, like cheese sticks and boars head turkey, jerky, popcorn, a few nuts, stuff like that. Its become a ritual, bedtime bg check and snack for him. Being low at night is a scary thought, and I want to avoid that.
     
  17. akablonde

    akablonde New Member

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    High Numbers

    I'm not an expert, but my 10yr old son recently had high #'s in the 250-300's for like 2 weeks. I called his Endo Dr. and he said to increase his Lantas from 9 to 13, and give it to him at 6:00 p.m. every night. Also he changed his correction from 75 to 60. Let me just say that after 2 days of giving him his lantas early and at a higher amount, his #'s were ranging from 110 to 150.. It has made a big difference for him.. If I have to give him a correction at bedtime I cut the amount in half so he doesn't fall to low.
    I'm not sure what time you give him Lantas, but maybe just giving it to him early and see if that makes a difference.. Good Luck.. *:)
     
  18. JacksonsMom

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    Here is what comes to mind. Lantus is wearing off or it's a basal issue where he needs more at night. Second thought is that it could be a rebound. How does he run prior to that? Maybe do some checks earlier in the night to see if he is dropping low then rebounding high? Thirdly I do suspect Growth Hormone for those night time highs.

    We were on Lantus and would experience 3 am highs regularly. It just became routine that he had to have a correction every night. That is one reason why pumping is better because you can change those basals to match his needs at different times in the day!
     

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