- advertisement -

Overnight levels - Registering as "HI" on the meter

Discussion in 'Parents of Children with Type 1' started by SarahsMum, Apr 17, 2009.

  1. SarahsMum

    SarahsMum Approved members

    Joined:
    Dec 30, 2008
    Messages:
    47
    Well a few weeks ago we were having issues with Sarah having Hypo's overnight so changed her basal rate down an incriment, now we are having the opposite problem.

    So here are her levels from last night

    Here are her levels

    8pm -2.5/5.2 after 3mls sucrose
    1am- 13.2
    430 - 7.5
    730 - 25.1
    1000 - HI

    We did a line change last night so I dont think its line failure.

    Oh Basal rates are:

    12-8am - 0.025
    8am-6pm -0.050
    6pm-12pm - 0.075

    We only just changed the overnight rate as we previousily were running at 0.025 till 4am and then 0.050 to 8am, but she would always have a hypo between 4am-7am so we changed it down, but now she is running really high.

    Ive got a temp of +30% running at the moment and Ive primed there line incase there was some air that I couldnt see. Have checked her blood ketones and they are at 0.0 so she is obviousily still getting insulin just not enough it appears.

    Any ideas? Its Saturday here and Ive rung the Registrar at the hospital and she was hopeless!

    Oh FWIW - Sarah is a 4.5 months old ex-mircoprem, she currently only weighs 2610 grams and is only on Breastmilk/EBM of about 120mls 3-4 hourly, so we are not bolusing or doing corrections, we are only using the basal rates and she is pumping on a Animas 2020 Pump.

    Oh her weight gain is not going along so well, she was born at 735grams, spent 16 weeks in NICU at the childrens hospital, discharged 5 weeks ago at 2560grams, weight that was taken 2 days ago was 2610. We have really battled highs so wondering if that is contributing to her poor weight gain:confused:
     
  2. Abby-Dabby-Doo

    Abby-Dabby-Doo Approved members

    Joined:
    Feb 23, 2007
    Messages:
    4,804
    Karina~
    Boy I'm hesitant giving you advice on such a small baby. I would encourage you to get to a hold of Sarah's Endo.
    If it were me I'd be checking after 430am and see if your missing a low, it could be that Sarah's little body is rebounding thus causing the highs later on. That is a big drop she's doing between 1am and 4:30- I'd make sure she's not going down further earlier in the morning.
    The other thing that comes to mind is she could be going through a growth spurt- growth hormones cause the blood sugars to rise.

    I would do some further testing in between those times to be sure.
    I'm glad to hear she's put on some weight since she's been discharged. :)
     
  3. Kelly

    Kelly Approved members

    Joined:
    Jun 22, 2006
    Messages:
    438
    Wow, she is so precious in her lil picture!

    With a baby so little it is hard to say what to do. She is on very small doses, obviously, and growing very fast... she is 3 and a half times bigger then she was at birth. Still super small, but all that growing is going to cause her numbers to be all over the place. Growth spurts will send any childs numbers, tiny or not, everywhere.

    Anastacia was diagnosed at 10 months, so a fair bit older then your lil one. But all the same her numbers were everywhere and very unpredictable.

    Its great that her ketones are Zero, that always great to hear. :)

    To me it looks like she may be going low between her 4.30 and 7.30 readings, causing a rebound. Does she have any EBM between this time at all? Maybe she needs some sort of tiny bolus for the EBM during this time, or a slight increase in basal for 1 hour?

    I shouldn't even say this as I know you know, but, just make sure she is unplugged when you prime the line for air bubbles. Sorry I know that is obvious, just can be so damn hard when your tired and fighting highs and worry all the time.

    Where in Australia are you, we have from WA. Good luck hunny, you are doing awesome with your (very) lil one. :)
     
  4. Darryl

    Darryl Approved members

    Joined:
    May 8, 2008
    Messages:
    4,313
    I also have no experience with a child this young, but would recommend:

    - Never assume that "basals" are repeatable, consistent, or predictable from day to day. They are not. By the time your doctor advises you on what to change, the basal needs have probably changed again.

    - The key is frequent testing, often enough to know when basals need to be adjusted, or corrections (carbs or insulin) are needed before BG gets too far out of the target range.

    - Speak with your doctors about the possibility of a CGM. If she is already using a pump, the insertion is very similar. It would give you 24-hour monitoring of her BG, and ability to react immediately. It would also give you the ability to assess the outcomes of your decisions, which in turn will improve your ability to make the decisions.
     
  5. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    I want to say that you are dong a great job!!

    With the limited amounts of testing that you are doing it could be several issues.

    Rebounding from a low that was undetcted

    growth hormones causing a rise in BG

    inadiquate basal for that time period

    illness/injury

    being a baby!

    The great news is that she does not have ketones!

    Are you only testing the four times a day? I know that she is such a small one but better control of her numbers will result from more testing. Most parents on the pump test 8-12 times a day. We are trying out the Dexcom Seven CGM and the sensor does not hurt any more than the pump site even less from what my dd has expressed. The adhensive patch that it is on is fairly big and on such decicate skin You would need to insert threw a skin barrior if that can be done.

    Also please remember that basal changes that you make are not immediate, it takes 1.5 to 2.5 hours before those changes affect the BG. So if she is heading low do change the basal but probably should check again to make sure that the previous basal is not going to bring her down before the lower basal brings her up.

    GOOD LUCK
     
  6. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    I think the tests posted were just the overnight ones - from 8PM to 10AM.

    I would suspect a rebound, but that is if this was happening to me, and obviously I have never experienced diabetes in such a young baby. Could you try testing more over one night, to see if there is a missed low?

    You are doing great! It must be so difficult in somebody so young.. :(
     
  7. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    So sorry, your are right. Maybe you don't have to test more, but instead test at slightly different times. If there is a time that she is allways at a good number then push that test back an hour so that you can have the next tests an hour later and see where her bg is going.
     
  8. SarahsMum

    SarahsMum Approved members

    Joined:
    Dec 30, 2008
    Messages:
    47
    Thanks for the replys - Its great for someone else to maybe see something that I am not!!!

    We are testing pre-feed and she feeds approx 3 hourly so doing 8 tests per 24 hours, the rates above where just overnight from 10pm.

    Your right have a baby with Diabetes is almost impossible to get and keep her in Target range - her target range is 4-8 and we are no where near getting there on a consistent basis.

    I would love to do the CGM but I dont believe its available here yet, well not that its been discussed with us, I think it is available soon but just not yet.

    This morning she was 12 at 7am after being 5.5 at 4am, but 12 is better than 25!

    We shall just keep plugging away at it, hopefully avoiding the real lows and the real highs and hope to hit target range at some stage.

    Kelly - We are in Malbourne:)

    Oh and it appears the Diabetes does bother her in the slightest, I just got this pic this morning! Her first Smile

    [​IMG]
     
  9. Tricia22

    Tricia22 Approved members

    Joined:
    Jun 30, 2008
    Messages:
    683

    What a cute little peanut! She's adorable... and I'd say by that smile, you're keeping her happy and healthy... those numbers appear to me like a rebound as well... or crazy amount of growth hormone at a certain time causing the super highs...
    Good luck with everything!
     
  10. Kelly

    Kelly Approved members

    Joined:
    Jun 22, 2006
    Messages:
    438
    Kelly - We are in Malbourne:)


    Very cool, that is where my Hubby is originally from.

    Just wanted to let you know that CGM are available in Australia. VERY expensive, but being she has been born without a pancreas and is only a tiny, brand new baby... maybe you could get it through a trial or something? I want one so badly for my lil girl, but it is just far to expensive for us to be able to have and maintain. Hopefully soon it will be covered on health insurance like the pump is. :)

    Sarah is gorgeous... gotta love those first smiles. Judging by that happy lil face, you are doing an awesome job. :) Bubby will cope so much better then you will... lol... they just take it in there stride and really dont know any different at all.
     
  11. badshoe

    badshoe Approved members

    Joined:
    Jun 28, 2006
    Messages:
    2,153
    I would test more and talk to the doc. One thing you can ask about is cycling the rates to simulate lower basals increments.

    We had (a much larger) child with sensitivity over night. At one rate she went up but a click higher she cam down too much. We had some luck with hourly basals that increased or decreased every hour. This gave us an average basal at the increment between what our Animas 1250 would deliver.

    1:00 up a click
    2:00 back down
    3:00 Up
    4:00 down
    etc.

    Think drill Sargent with a recruit who giving him problems.

    First I would try to get more data over more nights. Oh and never assume a set works when assuming it didn't makes more sense of the data. Sometimes they just don't work.
     

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