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Night time highs for 12 year old - what am I missing?

Discussion in 'Parents of Children with Type 1' started by dk10, Sep 23, 2011.

  1. dk10

    dk10 Approved members

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    We've always had problems figuring out the night time basal/bolus from before we started pumping. While the daytime readings are goodish, at night the sugars start out normal after the meal, and would often suddenly shoot up about 3-4 hours after the meal (200+). So we just got used to testing frequently at night, correcting and changing basals every few months. Works sometimes, but I can't remember when I wasn't testing at night.

    Things have got really bad recently. I kept getting 300+ readings around 1:30 am and thought at first it might be a low rebound, specially because the correction (of 2+ units) would not seem to have much impact. I even thought it may be a quickset problem (we've had problems of bent canulas in the past) and changed the quickset on at least 3-4 occasions. Finger tests showed the same normal readings one hour after the meal, spiking late at night.

    She's not usually on a sensor but when we did the CGMS, it didn't show up a low. It did show that sugars dropped to 110-120 about an hour after the meal at night and then crept up slowly about 3 hours after the meal (still normal). She has about 60 odd carbs, vegetables and protein and there's not much fat at all in the meal; she takes a dual wave since much of the carbs are also relatively slow acting.

    It's got worse in the last week. She usually has 60-70% in-range sugars (the range is pretty broad - 70-180) but the last week has just about been 50%. No lows. Doesn't happen usually unless she's ill or had been cheating on her food (not true right now). Now the finger tests 1 hour after the meal, show the glucose at about 120-140. 1 hour later, it's usually going up - 160-180. Even after a correction, this doesn't come down and by 2:30 is 300+.

    Her daytime readings are pretty normal except for when she's very sedentary. Basals at night are already 50% more than the average day-time basal, so I'm reluctant to increase it very sharply from here.

    She turns 12 next month and just had her first period, so I was wondering if puberty had something to do with it, or if I'm just missing a low somewhere?
     
  2. Lisa P.

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    Not anywhere near puberty, but I'll tell you Selah's nighttime basal is way, way higher than her daytime -- like, twice. And some weeks (the last two, in fact) she still runs high at night. I think growth and healing happen in your sleep and you use a lot of basal glucose during those times. So I'd guess the huge changes in growth and etc. during puberty really make an impact!

    I also know when we have a few weeks with a pattern of highs at times, she develops an overall higher need for insulin because of (I think) increased insulin resistance.

    Never any fun, is it!
    :p
     
  3. Catiesmom

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    Definitely puberty. Increase those basals several hours before the highs and see if it helps. We just had a major increase in basals like 30% across the board with no decrease in sight, all these crazy growth hormones. Catie grew 4 inches and gained 15 pounds in this past year and went up 2 show sizes.
     
  4. obtainedmist

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    Have you tried an extended bolus for evening meals? I know that doesn't solve the night time problem, but if one hour after eating you are 120-140 and it goes up from there, maybe you need to split the dose over a few hours.
     
  5. mom24grlz

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    If this was the case with Ashleigh I'd look into increasing her I:C ratio at supper time.

    Me either, but i don't plan on stopping. The other night i caught a low (61) that Ashleigh was sleeping through.

    Every once in a while we got those stubborn highs too. where it will take 2 corrections to get her down.

    Ashleigh's basal amounts are highest in the middle of the night and first thing in the morning also.
    [FONT=&quot][/FONT]
     
  6. Lee

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    Yes - puberty can def. do that. IF she is high everytime after that meal, then I might consider upping the supper basal, or changing the time of the meal and see if she spikes without food at that time.

    I also want to add, and it sounds like you are doing it, but it is important to test at off times in these unexplained highs at night. We went through three months + where she was high at 3am. No matter how much I increased her midnight basal - she was high at 3am. I woke up at 2am one night and decided to test her - she was in the low 40's and rebounding back up. Seriously, I must have upped that basal 10 times and am lucky I didn't kill my kid. So now, anytime I have unexplained highs, I mix up my testing times.
     
  7. Heather(CA)

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    The only way to figure this out is to do basal testing...Nothing to eat after 6pm, then test at 9, 12am, 3am and 6am. Post those numbers if you want.

    For Seth if he was good at the 1 hour mark, he was headed for a serious drop. But we don't pre bolus so it might be different for you.

    If she likes Ceasar salad, have her eat that for dinner. That shold meake the testing very accurate.:cwds:
     
  8. Darryl

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    Based on our experience, for the next couple of years you may have some nights that require very high basal, other nights will not, some nights may require very little or no basal. The pattern may not be predictable (not monthly, just on and off). You may want to pick a basal rate to start with, say 0.5u/hr, then adjust nightly from there.

    At this age if you want to maintain good overnight BG control, you will probably need to test every night, every hour or two, and adjust as needed - or use a CGMS. In other words, every night needs it's own basal testing and corrective action. I would say from our experience that once you get to 3 AM, things settle out a bit. from bedtime until 3, every night may be different.
     
  9. MomofSweetOne

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    Do you test that frequently even with using the CGM? How much do you trust the CGM to alert for lows?
     
  10. Michelle'sMom

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    This is all very true for us & has been for the past year. There are several nights each month when her basal is as low as when we first started pumping, while still honeymooning.

    For us, things settle down around 8am. Even with the CGMS, we still test regularly throughout the night. At this point, there's simply no other choice.
     
  11. dk10

    dk10 Approved members

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    Are these insulin numbers normal?

    I was looking for that silver bullet and unfortunately there seem to be no easy answers :(

    Thanks for all the tips. Just to keep you posted, we give her a dual wave for the night meal and and we've changed the insulin-carb ratio as well. Interestingly, the same ratio doesn't seem to work at all times of the day. I test her 2-4 times at night, mixing it up so that (I hope) I'm not missing a low. Will keep testing and adjusting as suggested and perhaps try out the basal testing as well - thx Darryl and Heather.

    It's hard to keep adjusting because of all the history- till not long back we couldn't give her a straight bolus of 4 units - she'd always end up with sugar levels dropping sharply, only for them to rise later. So I'm still reluctant to give her a straight 4+ bolus.

    She's barely 88 pounds and on 43-44 units a day now (approx 300 carbs, not much fat). There's been a big jump in the last 10 days. I'm wondering if she's cheating on her food after school and that's adding to the issues. (I found out that she's been binging, but I don't know the extent and if it has anything to do with the nighttime highs. Am trying to solve that separately, not very successfully yet). Is it likely that she jumps from needing about 33 odd units by a straight 10 units in a week's time just because of growth/puberty?
     
  12. Lisa P.

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    I do think that hormones + fall light cycles = carb seeking in many of us. If she's "binging" it may be driven by a real bio need, maybe growth. Maybe there's a way to satisfy that need in a way more spaced out over the day, and with fiber and protein added in, and then the nights might look different. Good luck!
     
  13. sugarmonkey

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    Hi
    I checked out this thread because I was having the same issues with my 14 year old. He was running over 360 most nights, and wasn't coming down with corrections. Yesterday we accidentally may have found a solution so I thought I'd let you know.
    I persuaded Phillip to try putting his site in his thigh instead of his tummy. He has done this before but not for a while as he isn't keen on it there. Have you tried moving your CWDs site to a completely new piece of real estate? Last night Phillip's highest number was 108! We did have a couple of lows, but they're easier to deal with than stubborn highs.
     

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