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Sharing ideas on reducing/avoiding night time lows

Discussion in 'Parents of Children with Type 1' started by Becky Stevens mom, Mar 30, 2010.

  1. Becky Stevens mom

    Becky Stevens mom Approved members

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    Ive always felt that knowledge is power therefore shared knowledge is even more powerful. We all have a fear of night time hypos so I wanted to start a thread about some ideas on reducing the risks of nighttime lows. These are things that people have tried that have worked or things that you may have read about that have been recommended.

    Some things that we've done over the years with Steven are:

    Steven is on lantus and gets one shot per day right now. We give that shot at night around 8:30. This way if hes had a very active day I will cut back on his basal shot, sometimes by as much as 2 units if hes been very active.

    With the good weather Steven is going to be out alot more and active more including after supper so I will cut back on his bolus insulin for supper if hes going out after. Activity really affects Stevens BGs and he will have delayed hypos from it often

    Speaking of delayed hypos, if Steven is real active during the day I will be very cautious about giving him much humolog for supper or his bedtime snack as it will cause him to go low early in the night. Hes gotten up several times at 10:00PM to tell me he felt low and sure enough was in the 60s or 70s even though he'd been over 100 at 7:30 snack

    We have always given Steven a bedtime snack since dxd. He was on NPH for 4 years and had to have something to catch that peak that happens with NPH. I still give him 1/2 cup of low fat ice cream. If hes been very active during the day I will increase the snack and add a couple peanut butter crackers or a handful of potato chips. Things like ice cream and chips digest slowly so they dont make BGs spike and hopefully will keep them from dropping.

    In Dr Ragnar Hanas's book he recommends mixing raw cornstarch with milk for young children. The cornstarch breaks down very slowly. I would imagine this mixed with some chocolate or strawberry milk would be really tasty.

    If Steven has severe lows we tend to run him higher for a few days including at night in order to allow his liver to recupe what it may have lost during the low
     
  2. Bam

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    This is a very good post. My son is the same way. It has been almost 3 years since diagnosis. Milk use to work great now it doesn't so I'm interested in finding something new.
     
  3. GaPeach

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    Pay close attention to the nighttime BG check. Give consideration to IOB, type of food last eaten (Is is slow to digest?), time of last food intake, amount of bolus, day's level of activity, etc... THINK it through - and make a decision as to whether or not the BG is acceptable. A target range is only good when you weigh in all factors.

    Set an alarm to check BG again.
     
  4. joy orz

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    We've done this. But we mix it with sunflower seed butter. (peanut butter would work too) I just weigh it out on the scale so it's not much more than 10 carbs and mix it up and give it to her on a spoon. Fat, protein and cornstarch do the trick. BUT we've gotten some stubborn 300's from this as well. Hard to find the right mix.

    Great post by the way!
     
  5. hold48398

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    Our only way to reduce nighttime lows is:

    -testing at midnight & 3am, every night with no exception (no cgm)
    -keeping the target range at 130 for the nighttime and 150 for a new site
    -correcting conservatively when in doubt
    -using a reduced basal rate when in doubt

    I know that the key to a good A1C is to get the nighttime basals set appropriately but I am more inclined/comfortable to be aggressive with Mia's targets during the day and keeping her at a slightly higher/safer range at night..at least until we have better, more reliable technology available.
     
  6. MyAngelEmma

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    Becky, when you talk about giving a nighttime snack such as icecream and peanut butter crackers do you bolus for these or are they uncovered?
     
  7. Becky Stevens mom

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    Im sorry, that is a good question. It all depends with Steven. If he is over 100 I will give him 1/2 unit. If over 150 I will give him 1 unit. There have been times when he is under 100 or even higher that I dont dare give him anything as the humolog will just slam him. Especially if hes been very active, the activity seems to drop him as quickly as insulin does . We usually test at 1AM or 2AM and his BGs still havent risen that much even if I dont bolus for the snack at 7:30
     
  8. RosemaryCinNJ

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    Amanda gets ice cream ...1/2 cup ..yes I do bolus for it ..but if I use Carb Smart by Breyers I dont..
     
  9. KarenRI

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    Becky,

    My son thinks you are the best!

    His BG's have been very stable all evening 85 - 120. At bedtime he was 88. A bit too low for bedtime....He's always gone for a juice box at bedtime if he's on the low side of his normal range. But lately, the juice box will bring him up, but then he drifts back down again.

    So, before he could get to a juice box, I handed him a 1/2 cup of low fat ice cream. He looked at me in disbelief. LOL! I burst out laughing at the look on his face!

    What? Ice cream?? Now?

    Yep. Sugar, with a bit of fat and some protein. Let's see if it keeps you from dropping.

    Mom, you're the best!

    (No, not me. Steven's mom). :D

    Thanks for starting this thread. It's a helpful one!
     
  10. Becky Stevens mom

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    Oh no:eek: just dont tell the endo:) I hope it helps to keep him from dropping
     
  11. Rukio

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    peanut butter and jelly sandwich

    ppppppppppppppppppppeaaaaaaaaaaaaaaannnnnnnnnnnnuuuuuuuuuutttttttt
    bbbbbbbbbbbbbbbuuuuuuuuuuuuuuuttttttttttttttttttteeeeeeeeeeeerrrrrrrrrrrr
    sssssssssssssssaaaaaaaaaaaaaaannnnnnnnnnnnnnnndddddddddddddwwwwwwwwiiiiiiiiiiiiicccccccccccchhhhhhhhhhhhh
     
  12. Becky Stevens mom

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    thats a good choice yes, the peanut butter has protein and the jelly is a good fast acting carb
     
  13. KHM

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    I honestly don't know how we'd get through any day or night without wheat thins and peanut butter, except it can be a bit slow getting started up...I hadn't thought of putting a bit of jelly on them to speed things up. Nice.
     
  14. wilf

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    Best way in my books to avoid night lows (for you folks on MDI) is to not give the basal insulin (Lantus or Levemir) in the evening. Both of these insulins can have a peak in children, and will tend to cause BG levels to go low at the time of the peak. Either giving them in the morning or in a split dose is how I'd do it.

    NPH (if it's your only basal insulin) is trickier as you need to have some working overnight, and it has a peak that's much stronger than Lantus or Levemir. Back when DD was on NPH we'd make sure her bedtime BG was in the 150 to 200 range, because we knew the NPH peak would bring her down 50 to 100 points overnight.

    Night testing is essential in avoiding night lows, esp. if you're going for tight control. The only time you can get away with not doing it is during the honeymoon, if things are really going well for a time. More frequent testing overnight is indicated after heavy or unusual exercise.
     
  15. Barbzzz

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    We split Alex's Lantus dose; 11U am, 3U pm. Before bedtime we check, if she's below a 7.0 (or around 120 mg) I'll give her a juice box, as it helps with the smallish Lantus peak. If she's below a 5.0 (a 90 or so) I'll give her the juice box and maybe a handful of something like Cheese Doodles -- because it's corn based, it releases slowly through the night. All uncovered, btw. And, of course, I always check at some point in the night, usually 2 am but earlier if I awake for some reason. I'll wake her up and give her a juice box only if she's below 80. She generally wakes up in range, then.
     
  16. czardoust

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    Make sure Kat eats lots of protein at dinner.
    Check at midnight, recheck at 3 am if she is in the 100 range at midnight. I prefer her to be 200-240 at her normal bedtime, so she will wake up in the 100's.
    If she has consistent lows at night (or anytime) I drop the lantus back by a unit and change the I:C to 1:15. She is fairly unactive in the cooler months so she has been 1:10 or 1:8 all winter, now that its warming up she is getting 1:12.
     
  17. Becky Stevens mom

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    We actually prefer to give lantus in the evening. That way we can gauge Steven's activity level during the day and cut back on his basal at night if needed. I would suggest splitting it if there is a peak during the night
     
  18. danalynn

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    for sure. add a delayed hypo to NPH and you can get some pretty scary drops! if he DOES go low in the night I have to treat it very aggressively, at least double the carbs I would give for a correction during the day, and even then sometimes he's still dropping by the second test.
     
  19. Becky Stevens mom

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    When Steven was just on NPH for a basal insulin I would give him full fat ice cream and potatoe chips so he would have enough long lasting carbs to be there for the NPH peak
     
  20. danalynn

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    that could be part of our problem, I usually give him chocolate milk for a bedtime snack, sometimes with a spoon of peanut butter on the side- but I just recently realized just how long it takes high fat foods to absorb (I just got to that part in 'Think Like a Pancreas' :rolleyes:), it freaked me out but I didn't make the connection that it would be a GOOD thing for night time, thank you!! :)
     

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