Discussion in 'Parents of Children with Type 1' started by mamattorney, Apr 28, 2014.
On average, how many times a week does your child require treatment for an overnight low?
I voted 2-3. But that is mainly because I have been a lot more agressive lately in an attempt to bring down her A1c. And it has worked, it came down 4 points at her last Endo appointment.
For me, the issue with polls like this is since all our kids are different ages and are being managed differently, it is hard to really determine anything from the results, unless you calculate in all the different variables (age, delivery system, CGM use or not, management type, diet, how often they are checked at night, amount of exercise that day, etc.). But it is still interesting. Thanks.
Looks like 0-1, 2-3 and 4-5 are all running neck and neck! :smile:
I voted 2-3. It could be lower but because we CGM we can be more aggressive with keeping night-time numbers lower, We aim for 80-100 overnight. I'd say that we temp basal most of the time and usually have once a week that we have to actually feed a kid...and that's with two kids. And the 2-3 is an average. My son is probably 1-2 and my daughter is 3-4.
Also, not sure if by times you meant nights or events...there are nights that we get up more than once to set new temp basals. My long answer is that we average 2-3 nights per kid but probably average 4-5 events because a low early in the night will usually need a later temp, too.
I picked 4 -5, so I am basically trying to see if there are other people like me/my kid out there. Post dexcom, I've seen the beauty in being able to let a 100 at bedtime run its course. A long time ago I read a post on this forum that said something like - "night time is my diabetes management secret weapon. I work hard at trying to have good nights, and it helps evens out the ups and downs of the days" and I've taken on that perspective as well.
I could give her a little something before she falls asleep to bring her up so that when she drifts down (which even at a year in, she still does most nights), she doesn't go low, but lately I've just been seeing whether we can let the low number ride all night until her natural rise starts around sunrise. I would say about 4 times a week, the dexcom beeps low (below 80) between 2 and 4am and I give her a juice, but because she's spending many hours in the double digits at night, her average BG is lower than it was before and she says she feels really good in the mornings - well rested, energetic, etc. I should add that I think the drifting is "her" more than her basal rates, because she can go to bed at anywhere from 100-150 and I see the same results. I would think if the basal was too aggressive, she would dip lower earlier if she started at 100 than if she started at 150.
I was reflecting over my coffee this morning about whether it's too much though - so I thought I'd set up a poll to see if I had any compatriots.
I'm also 4-5. Sometimes it's 2 in a night, sometimes it's 1 in 2 nights. It varies. We keep tweaking basals to see what sticks. It seems all his insulin kicks in at 3:00 am with his growth hormones. But sometimes there is neither rhyme nor reason it seems. You'd think after a year and a half, we'd have a better grasp on it. :/
Yes, there are! I would say 4-5, although that's events, not nights. When things are really wonky, we'll have double lows and have to treat the same low a couple of times. We also make generous use of TBRs.
The Dexcom has allowed us to skirt closer to the low-to-mid 100s than we'd otherwise be comfortable with in a preschooler. But that also means we're more often in her room tinkering. Looking at nights per week, I'd say we manage lows 2-3 nights, highs 2-3 nights, and enjoy smooth sailing the other 1 or 2 nights. Every once in a blue moon, the basal settings are just right, and we get 3 or 4 perfect nights in a row; if this was one of those weeks, my sense of what's our "average" might be rosier!
I'm not sure if you're looking for advice about this piece of your post. It looks like you want to avoid a bedtime snack, but have you experimented with a small tweak to the midnight-ish to 2-ish basal to see if you can hit a slightly higher number from 2 to 4 and eliminate the low treatment? (I offer this with a touch of humility -- like I said in my previous post, our nights feels like we're constantly steering between highs and lows, and we do sometimes find that basal tweaks to address one lead to the other, but it might at least be worth a try for a night or two!)
Yes, I totally understand. And I agree with you and the others who use nightime to better manage bg's. Aside from catching highs/lows, one of the positive things for me (which you mentioned above) is having her be in range (or close) in the mornings. It just seems to make the rest of the day go so much better. I know when she wakes up high, it seems to take longer to bring her down and just kind of screws up the rest of the day.
I also think Snowflake's suggestion above is worth trying.
I too try to keep my son in a tight range all night long. It is my "secret weapon" as well. I am up many times in the night to try and keep such a tight range. It may involve giving carbs if I don't think that a change in basal will work quick enough. It's so rare that basal levels are ever right on - I'm constantly tweaking them. I believe a huge component to this is having an 8 year old boy that is both growing and doing various levels of activity throughout the day. My endo recently asked me if I could see a pattern, like an active day means a reduced temp basal by x amount. The answer was a definite no. There is no pattern at all. However, I do notice that if for some reason there are a couple of days in a row where he has been less active, then my basal rates seem to work.
I have tried this a couple of different times and in a couple of different ways, but I can't get it to work right. Generally when I try the slight tweak, I see a rise which would be OK if it evened out the fall, but then the fall still comes. It's weird. That's why I think it's "her" and not the basals and why I went back to the old rate which has her number start lower, but stay relatively flat, followed by the fall. And the fall is basically a straight arrow fall over time - not a sudden drop. Maybe that's why I can't get the tweaks right.
I voted 4-5 as well. Between baseball practices/games/tournaments (and no indication of how much of those games/tournaments DS is going to actively play in, rather than sitting on the bench), our overnights can be a mess. We tried reducing his basal between 2-4, to catch the 4am-6am drop we usually see, but then he was running high when he woke up and I didn't like starting his day out like that. So we put it back and just deal with it when/if it happens. Not that it's good, but it is nice to know that there are others up just like me.
It's actually been very good recently... Well in regards to lows at night. She's getting sick I think so I've had to correct instead of treat recently. Sometimes after her site change though, it could require to treat 2-3 times a night sometimes.
Since we got our Dexcom things have been really good. 1-3 times a week and we catch them before she's really low. Except for tonight, I'm up at almost 1am dealing with a tough low that just doesn't want to come up. I know in a hour she's going to spike up but I'm just seeing low 70s now after 40 grams of apple juice over the last hour. Do any others see very slow absorption at night? It seems to have been getting worse for us over the last few months.
We tend to see a bit more in the way of overnight lows, because we run DD's Lantus higher than just needed to keep her blood sugars steady. We find that having her Lantus gently pulling her down throughout her waking hours helps us get better numbers overall. But it means we have to typically give some carbs around 4 am to keep her from going low. However these lows are very predictable, as she is gently dropping at a steady rate through the overnight hours - so it's just a straight-line extrapolation to figure out when we need to wake and give carbs.. :cwds:
Juice tends to be very slow for my son - it can take so long to come up that I would have to give so much that in an hour he would end of really high. I tend to use Dex liquid now. It treats a low very quickly. You can buy dextrose sugar in bulk food stores (also called corn sugar) and just dissolve it in water.
That's great to know, I'll give it a try, thank you!
Nights are a nightmare for me.
Wow, how did I not know this after all of these years? My daughter wears a mouth guard and juice boxes are a pain. Before she started using the guard at night, she used glucose tabs exclusively. Now to figure out where to find a bulk food store in the area! I'm sure it would be much less expensive as well. Maybe you could post this in it's own thread, or I will once I find some. Thank you!
7 nights a week. But we use the tightest alarms that the Dex G4 will allow, 80/120, so there are several lows and several highs just about every night.
I'm going to try to find that bulk dextrose. Drinking juice or anything other than glucose overnight just prolongs the agony of waiting for BG to come back up at 3 AM. I've tried using juice to save some money but it just doesn't work like glucose.
Health food store. A bag was about $4 here, much cheaper than the glucose sticks at Wal-mart.
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