Having a lie in?

[MeanMom]

Hello everyone

Just needing some advice today in lie ins during this festive season. K has clinic tomorrow and her numbers for the last few days are a bit high. This has pushed her averages up on her meter which she worries about when she is going to clinic.

Yesterday and today K has not got up until lunch time so as therefore skipped breakfast (and therefore one injection) completely. We have upped her Levimir by one unit to allow for this (she has Levi. Once a day at 9pm ish - tho' last night it was 10.30) Readings have not been in range at all.

Should I let her lie in? Clinic said this was OK last time we went (suggested the increase to Lev. to cover) but I'm concerned that control (normally OK considering) goes to pot during school holidays (which always seems to be when we have clinic )

Any ideas?

 

[Northerner]

If I have a lie-in then I do find that my 'waking' numbers are a little higher, but not hugely so. I suppose that the lack of activity might be the thing that affects things the most as this will reduce sensitivity to insulin taken later in the day. 🙂

 

[Ellie Jones]

In theory with MDI, if the background dose is correct then having a lie in and missing breakfast is no problems..

If you finding that with lie in's.. That her BG is high when she gets up, but on a school day it's fine earlier then this is probably due to Dawn P, a natural hormonal raise of BG, but this dose pose some problems though as if you adjust background insulin to compensate then it's likely that you create hypo's at another point if you using one background injection a day, so you may need to consider splitting the injection to get a better and more controllable coverage..

So check out what her fasting levels are like on a normal school day to see if this may be the case

 

[novorapidboi26]

Also with the Dawn P, actually eating something can trigger the process to stop......

So for me I have to get up and eat something in order for numbers to stay in range, however if I didn't have a 2 year old son who needs up, I would almost certainly lie in [10.30] at least one day at the weekend..........

 

[Monica]

When on MDI I used to wake Carol up at 9.30, so that she'd get up at 10 to have breakfast.
Now, she lies in all morning and will have brunch at around 11/12. Not having breakfast doesn't seem to affect her morning levels.

 

[MeanMom]

In theory with MDI, if the background dose is correct then having a lie in and missing breakfast is no problems..

If you finding that with lie in's.. That her BG is high when she gets up, but on a school day it's fine earlier then this is probably due to Dawn P, a natural hormonal raise of BG, but this dose pose some problems though as if you adjust background insulin to compensate then it's likely that you create hypo's at another point if you using one background injection a day, so you may need to consider splitting the injection to get a better and more controllable coverage..

So check out what her fasting levels are like on a normal school day to see if this may be the case

K's levels are fine (ish) on waking on a school day - when she gets up at 6.30- but because she has to get up so early on a school day and she is a natural 'owl' I think she needs to lie in weekends and holidays where practical.

I have thought about splitting the dose but dont really understand how and clinic say it's not necessary. When would she have the second dose and how much/how would you split? Currently she has 26 units of Levemir at bedtime/9pm (whichever is the earliest)

Today she didn't have anything to eat until 1.30 pm (got up about 11.30) and when she tested at 1 .15 she was about 15 I think her liver probably decided she needed something to feed off! Think we over compensated because she then had a reading of 2ish at 6.15pm. That's going to be fun to explain at clinic tomorrow!

 

[Ellie Jones]

Don't blame her for wanting a lie in after 5 days of getting up at 6.30am😱

Splitting is pretty easy to do, but K must be happy to do this, as yes it does mean not only another injection but another timed injection, this is why her team will try to avoid it if possible, and why I would never advise you to go ahead without seeking their approval first..

With today's reading it would be wise to see if you can rule out whether it's based on a liver dump or Dawn P.. Would it be possible for you to go in and do some BG's testing during the morning without disturbing her too much...

As getting this information would go a long way to seeing if A, her team have to consider splitting her background.. B, if needs be and a split isn't what K wants to do at the moment then you can come to some compromise perhaps that you'll will test a xxx time, and if needs be she's have to have a correction/breakfast then back to bed... C, it could show that an insulin pump might be a better solution or something for K to think about using..

And I wouldn't worry about trying to explain today's results, as well they are a very good indicator of what you'll facing, and a kid deserve's a lie in...

 

[trophywench]

Err - could her mum actually help her out here and take her a cup of whatever and a biscuit at 8 am, for which she would need to bolus - but then you'd let her snuggle straight back down and get up whenever?

Doing that and having my morning Lev at the same time as the biccy was the only way I could hack it.

I took my Lev when I got up - 07.00 ish - and about 9.30 - 10.00 pm at night! Started off 50/50 morning and bedtime - but finished up with 4 or 5u at nightin between dinner and bed and 14/15u in a morning ! Sounds potty and took a lot of testing to get there. But - it worked ....

 

[Adrienne]

I think she is a teenager (I think) and wants to lie in.

This is much much easier on a pump, my 11 year old didn't get up till 10.30 am and only because I made her and didn't eat until about noon.

On injections its a bit trickier but so long as she is safe then don't worry. She needs to be ok with having diabetes and if she is made to get up then she may well rebel and being a young girl/teen that could well be on the cards if you don't let her have her lie in.

It is better that she is allowed this bit rather than laying down the law of 'you must get up, your levels are high, you must inject' etc etc

When Jessica was about 3 or 4 years old we went on to Lantus when it first came out. Lantus was given in the evening. This is partly due to teens and older people using it. As it was (and I think still is but not sure anymore) licensed for over 18 year olds first then it was thought that too many of them would miss their morning dose as they would be lying in bed ! Obviously for a 3 or 4 year old that was out of the question and we changed to morning injections very quickly which worked much better as Lantus isn't really 24 hour, it only works between about 16 and 20 odd hours if you are lucky.

Levemir is less and only works between 14 and 18 (if you are lucky) hours. This is why generally people split the levemir dose (some split Lantus but not as many as on levemir).

I personally feel you need to make sure she is safe and leave her to lie in. Can you chat to her about it maybe? Can you say you want her to have a lie in but you may need a couple of mornings practice ie testing hourly or something (you'll work it out) and then you will know she is ok and she knows she is ok and she'll know that she has your blessing. It might make any rebelling less perhaps.

Hard one as you want her levels to be good but you also need her to be ok with her diabetes whilst a teen.

Good luck.

🙂

 

[Adrienne]

Ah ha just seen your daughter is 12 years old, so nearly a teen and pretty much the same as my daughter who is 12 in April.

So at the moment you still have a fair amount of control over diabetes and your daughter, same as me but I feel they need to know they can be normal like their friends and if they want a lie in, that is fine and we, as their mums, have to find a way around it for them.

 

[trophywench]

Puzzled what you say about Lantus Adrienne!

I was an adult and on 1 jab a day of porcine 80u/ml Ultralente insulin. It was always injected at bedtime. It was the nearest thing to Lantus really, but with added faster-acting.

It has nothing to do with teenagers whatsoever IMHO. They 'always' knew most of us need a lot of insulin after we go to bed at night because that's when the body is extremely active repairing itself so needs to be able to utilise glucose to get on with it, and I have always supposed the 'soluble' elements of the mix propped up the lack of onset of action of the isophane part.

 

[Pumper_Sue]

When Jessica was about 3 or 4 years old we went on to Lantus when it first came out. Lantus was given in the evening. This is partly due to teens and older people using it. As it was (and I think still is but not sure anymore) licensed for over 18 year olds first then it was thought that too many of them would miss their morning dose as they would be lying in bed ! Obviously for a 3 or 4 year old that was out of the question and we changed to morning injections very quickly which worked much better as Lantus isn't really 24 hour, it only works between about 16 and 20 odd hours if you are lucky.

Levemir is less and only works between 14 and 18 (if you are lucky) hours. This is why generally people split the levemir dose (some split Lantus but not as many as on levemir).

Hi Adrienne,
Lantus and all other analogues were not licensed for the use in children under the age of 6 years of age.
I'm not sure if this applies now or not. It was all due to them not having been tested on this age group. Nothing to do with teenagers sleeping habits 🙂

 

[MeanMom]

Thanks for replies everyone🙂

I would still like some advice on how I start with splitting the Levimir please? Clinic have put K up to 28 units Levimir during school holidays all of it at 'bedtime'. K is not keen as she worries about night time hypo's (she does wake up but it can take An hour or more out of her sleep - she likes her kip😉)

Clinic still dont think splitting necessary and insist Levemir lasts (nearly) 24 hours. I didn't press this as there were other issues to discuss.

If we did split should I start 50/50 - it would not be possible to inject 12 hours apart on a school day unless we changed to say 6.30pm and am.
I just cant get my head round this, for some reason

 

[Northerner]

Thanks for replies everyone🙂

I would still like some advice on how I start with splitting the Levimir please? Clinic have put K up to 28 units Levimir during school holidays all of it at 'bedtime'. K is not keen as she worries about night time hypo's (she does wake up but it can take An hour or more out of her sleep - she likes her kip😉)

Clinic still dont think splitting necessary and insist Levemir lasts (nearly) 24 hours. I didn't press this as there were other issues to discuss.

If we did split should I start 50/50 - it would not be possible to inject 12 hours apart on a school day unless we changed to say 6.30pm and am.
I just cant get my head round this, for some reason

You might be interested in reading through this thread from the 'other' forum 🙂

http://www.diabetes-support.org.uk/forum/Blah.pl?m-1249317866/

 

[Adrienne]

Puzzled what you say about Lantus Adrienne!

I was an adult and on 1 jab a day of porcine 80u/ml Ultralente insulin. It was always injected at bedtime. It was the nearest thing to Lantus really, but with added faster-acting.

It has nothing to do with teenagers whatsoever IMHO. They 'always' knew most of us need a lot of insulin after we go to bed at night because that's when the body is extremely active repairing itself so needs to be able to utilise glucose to get on with it, and I have always supposed the 'soluble' elements of the mix propped up the lack of onset of action of the isophane part.

Ooops goodness me, this is what I was told when we were under one of the worst teams in the UK and they could give me no other reason except that it was because teens wanted to lie in. They wouldn't let Jessica go on it and wanted to keep her on mixes. We had to go into Gt Ormond St for a few days whilst they put her on it. They had never put anyone on it either but the local team were so awful and would let her have a pump etc that GOSH had no choice.

They started it at night purely because that is what they were told as well, having no experience. It took 3 days before we moved it to the morning. Obviously for a 3 or 4 year old hormones didn't play a big part so I had nothing to compare it to or no-one to compare it to as we knew no-one else on it, they were all still on mixes.

Apologies for getting that wrong. I still think that hospital thought they were right though, terrible really. I do still think that is part of it though. It is hard to get any teen out of bed but to get them up to do a shot would be nigh impossible.

 

[Adrienne]

Hi Adrienne,
Lantus and all other analogues were not licensed for the use in children under the age of 6 years of age.
I'm not sure if this applies now or not. It was all due to them not having been tested on this age group. Nothing to do with teenagers sleeping habits 🙂

I believe that Levemir is now being or has been licensed for under 6's (or 5's).

I don't think Lantus is. I've just read a long old paper on Lantus (I'm supposed to be wrapping presents) and it says it can be given at any time of the day just so long as it is at the same time. Interesting. I guess that rotten old hospital didn't know the real answer (if there is one) so said about sleeping in teens and as it was a paediatric team that would make sense. 🙂

 

[trophywench]

I'd definitely start 50/50 pre brekkie and dinner time (or after dinner, dunno what times you eat) and take it from there. Exactly 12 hours isn't a prob.

Except obviously, the very first dose is at bedtime and don't expect any sensible or reliable results for at least the first 36 hours!

 

[Adrienne]

Thanks for replies everyone🙂

I would still like some advice on how I start with splitting the Levimir please? Clinic have put K up to 28 units Levimir during school holidays all of it at 'bedtime'. K is not keen as she worries about night time hypo's (she does wake up but it can take An hour or more out of her sleep - she likes her kip😉)

Clinic still dont think splitting necessary and insist Levemir lasts (nearly) 24 hours. I didn't press this as there were other issues to discuss.

If we did split should I start 50/50 - it would not be possible to inject 12 hours apart on a school day unless we changed to say 6.30pm and am.
I just cant get my head round this, for some reason

Hiya

If you ask on the cwd email group there is a wealth of knowledge there with spliting it. Lots of them split it and many without the help of their teams.

 

[PattiEvans]

Incidentally, the Levemir graph referred to in the "other" forum is now at this URL http://www.diabetes-support.org.uk/info/?page_id=428 Once you get your head around it, it is very useful. Down the left hand side look at the nearest dose per kg weight to what you are on and you will see where to expect the peak of Levemir and how long to expect it to last. To get the dose per kg weight divide your total dose by your weight in kilos.

FWIW I take Levemir whenever I go to bed and whenever I wake up, even with a long lie in. It seems to work because it does work longer than 12 hours for me - possibly between 16 & 18 hours.

I hope splitting the dose helps K.

 

[MeanMom]

Thanks for advice everyone 🙂

Adrienne I am a member of CWD but, I am embarrassed to admit, I struggle with the format, especially as I mostly used my IPod these days.

Anyway I had a look at that graph (thx Patti) - I think I have seen it before but didn't get it, but think I do now, so thanks. K is on 0.5 units per kg so do I read it right that her Levimir should be lasting about 21 hours? In which case clinic is right to say it is lasting almost 24 hours, I suppose. It looks like the peak is about 11 hours? In her case (on a school day ) that would mean a peak at 8am? I don't get this bit because wouldn't that mean she doesn't need so much Novo with her breakfast to give her a good number at lunch, whereas actually it's her highest ratio of the day. Also if she is going to go low on a school day it is usually around 3pm - the graph would indicate she is all but
out of Levemir by then? It Would be veryhard to test at 8am or 3pm she would be on the school bus or in the middle of her last lesson

In some ways less puzzled, in some ways more😱