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Trouble overnight - need help

Discussion in 'Parents of Children with Type 1' started by Lorraine, Sep 3, 2007.

  1. Lorraine

    Lorraine Approved members

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    Hi all.

    I have been struggling with Caleb's numbers overnight. There was a period where he would have nights of highs. I would adjust basals only to continue to see highs. Then lows would come out of nowhere. I would drop the basal and then the highs would start and the roller coaster would continue and has been continuing for what must be 2 months now.

    Endo mentioned that parents notice that a basal change takes 2 days to take affect. So I've started to wait longer before making any basal changes. However, for the past 5 days I have made no basal changes. Within this time he has had three nights of highs - needing continuous correction every 2 hours, only to be followed by a night of lows (well, in the range, but requiring treatment or insulin suspension to avoid lows). This is with NO change in basal and all occurs well after any food should be out of his system. The early morning hours are usually stabalized, but I am constantly checking him throughout the night and struggling with inconsistent numbers through about 1 or 2 am.

    During the day we see no significant problems. It all happens between about 8 and midnight. He typically eats dinner between 5 and 6 each night.

    Because his body is the most sensitive to insulin in the early morning hours (3 to 6 am) I continue to check him in this period as well to ensure he hasn't gone low from an earlier correction, or that's he isn't too high from an earlier suspension.

    Am I the only one (because I feel like I must be) who needs to check their child every two hours overnight on a consistent basis because BGs are so inconsistent? What an I doing wrong? I had thought this might be attributable to the honeymoon and coming out of it and the pancreas being completely inconsistent, but the endo did not seem to think so.

    Any thoughts would be appreciated. Particularly since the endo's advice was if I want to keep his numbers tight I need to keep doing what I'm doing. But getting sleep someday would be nice.

    Regards,
    Lorraine
     
  2. kel4han

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    Hi Lorraine,

    I am glad you posted this as we are experiencing the same exact thing. I am up every 2 hours for the last 6weeks chasing numbers. Correcting, only to see the corrections doing NOTHING and numbers actually being increased after 2hours of the correction. Changed the basals, this caused lows so I was forced to correct and watch every night. Growth spurt? Stress? I dont know. It was just the last 4 nights that I was successful that the basals (increased again) are perfect and all numbers staying within 30pts. So why didnt this work before? -SIGH- I dont know but I am overwhelmed too.
     
  3. wilf

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    Hey sorry to hear you've been having what must be a lot of nights of interrupted sleep. We do not pump, so will leave comments on that aspect of things to others.

    I am wondering if your child is eating things that have a kind of delayed reaction in terms of digestion and subsequent rises in blood glucose.

    Every child is different, but in our daughter we see delayed digestion and high nightly blood glucose any time she eats anything that is very fatty including:
    - potato chips
    - ice cream
    - most pizza
    - any deep fried foods but especially french fries.

    We have learned to deal with this by giving her longer-acting insulin (Regular, instead of NovoRapid) with her dinner-time injection.

    Good luck with what must surely be a challenge you don't need just now..
     
  4. Isabelle's Mom

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    We have been struggling with Isabelle's nighttime numbers as well, but have made some progress lately. We have learned the following things, maybe one will resonate with you:

    1. We have a higher basal from 6pm to midnight, .2 u/h instead of regular daytime .15 u/h. If we can get her numbers good by midnight, she's fairly predictable from midnight to morning.

    2. Isa's bg patterns are very different depending on the type of food she eats, i.e., high fat or high/low glycemic index. This is much more true in the evening than anytime all day long. Milk really screws her up, and I usually have to give her 1 1/2 times the insulin in a square wave to cover it.

    3. The bg patterns are also very dependent on the time that dinner is served. We now try to eat earlier.

    4. When she has a bath, we prime the pump immediately before reconnecting, as the cannula leaks (or draws back, can't tell which) some insulin while disconnected. We use a MM 522.

    5. I check her bg twice in the evening. Once at her bedtime, around 8pm, then again at around 10pm. I choose my correction based not only on her bg, but at the rate she is rising or falling. If she is rising quickly (>50 points per hour), I might DOUBLE the correction. (Now I sometimes only check once, and get the rise or fall rate from the CGMS).

    I hope you can find something useful here.
     
  5. wilf

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    I forgot to mention, if she has a significant amount (25 carbs or more) of any of the fatty foods mentioned in my previous post, then we give the slower acting Regular insulin AND we also increase the amount by 50%..
     
  6. muddymessalonskee

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    We are having the same thing with my 13-year old daughter. The endo fusses at us because her basal dose is set so low...then we raise it, she crashes all night, and if we don't catch it, she wakes with a rebound high. :confused: We pore over the records, looking for trends. There are too many variables. Even days that look exactly alike don't have the same outcomes. Very frustrating. We are getting CGMS as soon as I can find someone here to prescribe it! At least her daytime numbers are good.

    More D "fun" too: yesterday she came down with the Norwalk flu: normal numbers all day, but couldn't eat at all and had large ketones by afternoon. We live 40 or so miles from the nearest hospital now and don't have a doctor of any sort yet, so had to have the resident EMT give her an injection of Phenergran last night so that we could hydrate her and wash out the ketones. The sodas and the illness combined to give her highs all night: 400+, 300+, 300+. I was waking her up for fluids every 15 minutes or so. We were stacking insulin doses and still couldn't get the numbers down. I finally got to go to bed at 3:15, but got up at 3:45, 4:45, 6 a.m: finally got four hours of sleep then because by then she had only trace ketones. She stills feel horrible today (fever, muscle aches, the pain of the Phenergran injection site), but at least she's able to eat. Now we'll be chasing highs for days: raising night-time basals and getting up several times at night to correct. Grr.

    Deborah
     
  7. Mary Lou

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    Okay, well, I tried to "quote" and insert my thoughts, but it didn't work. I will change the color of text to make it easier to read...


    Everyone here has had some great tips. Not much left to cover, but I have a couple of comments/suggestions/questions. I hope some of it is of use to you, as diabetes seems to catch each kid differently...


    I have been struggling with Caleb's numbers overnight. There was a period where he would have nights of highs. I would adjust basals only to continue to see highs. Then lows would come out of nowhere. I would drop the basal and then the highs would start and the roller coaster would continue and has been continuing for what must be 2 months now.


    How much are you adjusting the basal rates by? We find that if we notice a 8 - midnight pm high, we would increase the 6 pm - 10 pm basal rates by 0.05 U/H. Also, if you are eating at 6 pm, is he high by 8? That might indicate a meal ratio change. Often when there isn't a pattern that's easy to see, it's a meal thing. Or at least it is for us.

    Endo mentioned that parents notice that a basal change takes 2 days to take affect. So I've started to wait longer before making any basal changes. However, for the past 5 days I have made no basal changes. Within this time he has had three nights of highs - needing continuous correction every 2 hours, only to be followed by a night of lows (well, in the range, but requiring treatment or insulin suspension to avoid lows). This is with NO change in basal and all occurs well after any food should be out of his system. The early morning hours are usually stabalized, but I am constantly checking him throughout the night and struggling with inconsistent numbers through about 1 or 2 am.

    This is really frustrating. Sometimes nothing makes sense at all. Do you regularly check the tubing for bubbles? I always check before dinner, and often suspect bubbles are the culprit for unexplained highs. Then again, I really want things to make sense :D

    Because his body is the most sensitive to insulin in the early morning hours (3 to 6 am) I continue to check him in this period as well to ensure he hasn't gone low from an earlier correction, or that's he isn't too high from an earlier suspension.

    How often do you correct during the night? I found that when I switched from hourly checks to checks every 90 minutes, the insulin was less likely to "stack" and then cause him to crash later on. Same with suspending the insulin. Maybe a lesser reduction would work, or a suspension for a lesser amount of time? Depending on the rate of the drop (as opposed to just the number), I might set a temporary basal rate of anywhere from 20 - 50% to help nudge the numbers up a bit.

    Am I the only one (because I feel like I must be) who needs to check their child every two hours overnight on a consistent basis because BGs are so inconsistent? What an I doing wrong? I had thought this might be attributable to the honeymoon and coming out of it and the pancreas being completely inconsistent, but the endo did not seem to think so.

    We go through phases like this all the time, and are actually just *hopefully* coming out of one now. Can you download or get your daily log information to your nurse for review? Sometimes having an expert check things over is quite a relief. Whenever we go through a change (of seasons, of school starting, of new sports) numbers tend to fluctuate. We have one boy honeymooning, too, and you never really know what they are going to do, IMO!

    Any thoughts would be appreciated. Particularly since the endo's advice was if I want to keep his numbers tight I need to keep doing what I'm doing. But getting sleep someday would be nice.

    I believe that everyone goes through periods of inconsistency, and that you are likely doing everything correctly. I try to find a quiet space during the time of day when I'm at my best and review the logs for any sign of a pattern, or to make notes regarding anything out of the ordinary that might cause BG to spike.

    The advice our endo gave us seems to help us out a lot -- wait 3 days for a pattern to emerge. Change no more than 10% of basal or meal ratio. Wait a week to see if it works. I'm not patient enough to wait a week, but I do give it a few days. :rolleyes:

    Good luck and hang in there. It will get better!!
     
  8. Lizzy731

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    I am so sorry that you aren't getting any sleep :(. I am even more sorry that you are not seeing any patterns, that must be so frustrating!! I know it would for me.

    We just got finished testing Bethany's o/n basals as she started to go higher after waking up good for a while. We got it right last night so I am getting some good sleep tonight.:)

    One thing that I do when I am testing her basals o/n is that I am pretty consistent with her dinner meal and snack meal (I always give her a bt snack as this prevents her from going too low around 4:30A as she was w/o bt snack). I then test every hour from 10p to 12a as her basal needs changes from hour to hour at that time. Then I tested at 3A and 5A...I did get lucky as my guess for that time happened to be right.

    What I was wondering with your son is that maybe his patterns (or lack thereof) are associated with his meals for dinner? Are you keeping a log of his dinner meals each night? Maybe you will see a pattern there? It's worth a shot. As I said before, I am pretty consistent as far as Bethany's meals go. In that respect, having a picky eater who only likes about 5 foods is a blessing when she is a diabetic. :rolleyes:

    Good luck. I hope you can work with something I suggested.
     
  9. Lorraine

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    Caleb's basal program varies significantly throughout the day. Wee hours of the morning he is .05/hr, most of the day he is either .25 or .20 and then in the evening he peaks a bit with one hour being .45. When I make a change it is typically only an hour or maybe two, each at .05 at a time. I'm pretty sure it is not the IC factor bc there is no correlation to the amount of carbs he eats and I try to have all fast stuff so that this period is as free of food interference as possible.

    I track his meals, basal, CF, IC ratios, corrections, treatments in a spreadsheet that I analyze daily. I keep his dinner early and try to stay away from problem foods, but since this has been going on for two months it's become deprivation rather than just tolerating a test period. So pizza nights I analyze separately. Pasta seems to be another trouble food, so again I keep that separate. He uses the Omnipod, so bubbles are not supposed to be a problem - in any case it's not something I can check with the miniscule tubing. I try to keep in mind what day it is - like perhaps on the third day absorption might be poor, but again that correlation doesn't seem to exist.

    On particularly troubling nights - when I correct and an hour later he's higher, I have corrected hourly - discounting of course for the IOB. However I have recently tried to not look until two hours has passed - a huge point stressed over and over by the endo and therefore not correct more frequently than every two hours. And I will say that since waiting 2 or 3 days to make a change and waiting 2 hours bt corrections, the nights are less stressful, but the inconsistencies are still there - just not as severe. So althought the swings are a little less swingy, I'm still managing it constantly.

    The trouble started after a period where his daily basal requirements doubled (from low 2s to mid to high 4s). It seems like we're constantly started all over to establish his basal.

    It's funny to think that when he was first diagnosed the thought of having to get up in the middle of the night to check him once was something I couldn't imagine. And now here we are...

    Thanks for the suggestions...keep them coming, please. Although I'm sorry for those who are having similar difficulties, it's helpful to know that I am not alone.

    Lorraine
     
  10. kel4han

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    Lorraine,

    After reading thru all these replies again since I am going thru the same exact things you describe....I realized there is no answer. Just like you said, we log, track, etc etc etc and there is not a reason except what I believe to be a growth spurt. Maddison has now been consistant the last 5 nights! WOW! After 6weeks of correcting all night I am finally only up at midnight and 3am to check, not correct! If I were to correct her now at this point for a 200 (I learned the other night) she will crash to around the 90's on a
    .1!!!!!! So, why does a .1 drop her now and a .8 didn't touch her for 6weeks? I hope your little one makes it out of this growth spurt (IMO) without giving you too many gray hairs :eek:
     
  11. Lizzy731

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    Funny, you just described Bethany's basal program. She peaks at .45 at 9P. I would be interested to see if Caleb peaks at that time too.
     
  12. Lorraine

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    He is .45 bt 8pm and 9pm, drops to .30 from 9pm to 10 although currently I sometimes lower that further depending on the 10PM BG. Then he's .05 till 6am.
     
  13. Isabelle's Mom

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    I used to have similar fluctuating basal rates, but have switched to always giving Isa a dual wave bolus for dinner. That is, I reduced her basal to a steady .20 for the evening, increased her dinnertime carb ratio, and always give it as a dual wave (timing depends of GI of food eaten). This has prevented some after dinner lows that she always used to get 1-1/2 hours after dinner, and has also helped keep her numbers steady throughout the evening hours.

    Good luck and I hope you get some sleep soon!
     
  14. MelStan

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    Trouble overnight- need help

    Hi Lorraine

    We seem to be in the same boat as you. And it's driving me crazy. We'll battle highs for several nights in a row, and just when we're about to adjust basals, low for no apparent reason. We're exhausted and I'm gutted at the thought that this is our lot forever! Life's not good when you don't ever get decent sleep.
    You sound like you're excellent at logging and so on!. I'm feeling so bad lately because I'm just so heartily sick of logging, analysing, etc, after 7 years of doing it, and just can't seem to get back into a good habit! It's not helping I know. But having said that, we take into account GI of food, exercise, and all the other factors we can think of, but still, usually there just seems to be no rhyme or reason.

    You probably already know this, but we were recently told that if bgs haven't come down within 2 hours after a correction, increase the basal by about 30% over the next 2 hours, as insulin resistance has started.

    I wish i knew the answer. It stinks:(

    Mel - Mum of Eilish, 10, dx'd at 3 (NZ) Pumping (and no sleep!) since Sept 06.
     
  15. Ivan's Mum

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    We're on MDI and this has started being a problem for us. I asked the same question the other day to lantus users. It's NOT every day (eg, 4 days it happens, 2 it doesn't - random as hell) and it's not food related, the I:Cs are fine post dinner and I'm tearing my hair out. It's so hard to plan for something that may or may not happen.

    I decided it's growth related. I did start to give him a longer acting insulin (6hr) with dinner to cover the highs as well as his short acting (and it can sometimes take 3 units to bring him down over the night period high period) and then if he didn't go up, give him some food to cover it when he started to go low.

    I feel you ,hear you, suffer with you. I can only figure it's growth as he's fast asleep and relaxing and I guess that's when it kicks in.

    Doesn't make for restful sleep thou does it?
     
  16. Big Hair Momma

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    Hey Lo! Sorry to hear about Caleb and you're lack of sleep. I don't really have anything to add, but I wanted to commiserate with you! :) Of course, these are great suggestions. I hope you get some sleep soon, if we were closer Caleb M could come hang with Caleb. Hang in there, it won't last forever!
     

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