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High morning readings

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RealGoneKid

New Member
Relationship to Diabetes
Parent of person with diabetes
Hi, I'd be grateful for any thoughts on high morning readings please.

My 5 year old son was dx on Good Friday so we're in the very early days. He's having Levemir every morning (increased to 6 units yesterday) and novo rapid with meals (1 for every 25g carbs plus any correction with 1 for every 10mmol reduction). We're managing to keep fairly steady levels in the day which are a bit higher than usual but come down ok, but his morning reading is very high. Today was 16.4 and the last few days have been in 17s.

I'm a bit torn tbh - I'm terrified of him going hypo at night when I'm not there, but this is way too high. He was 8.6 at bedtime yesterday and had a snack with insulin.

It feels as if his Levemir isn't covering him til morning, but I'm very new at this so may be way off mark. I know it will take some time to regulate - after all, it's only 10 days since he was diagnosed and was 44! Maybe I just need to chill out....

Any ideas?

Thanks
RGK
 
Hi, if he is going from 8 to 16/17 overnight there would seem to be a lack of insulin during those hours, however you need to check that he is not going low part way through the night and then having a large release of glucose from his liver. Have you done a BG test at 2 or 3am? If his levels just go up and up through the night, then he needs more insulin - talk to your DSN about whether to give him an additional small levemir injection at bedtime. It may be that he doesn't need a bedtime snack either.

For info, when my son was on MDI (Lantus and novorapid), he had the Lantus injection at bedtime and his levels would crash overnight and rise dramatically towards tea time, because the basal insulin had run out by then. After years of struggling I was finally able to get an insulin pump for him, which is so much better because you can tailor the basal insulin hour by hour to his changing needs across the day and night. I would recommend you think about a pump for your son (don't feel they aren't for the newly diagnosed - many of the better hospitals put children straight onto pumps at diagnosis, but as you have found, some hospitals are more old-fashioned than others and don't even teach carb-counting. Sometimes the impetus has to come from the parents being proactive and asking 🙂).
 
Thanks Redkite. He does get higher during the night, it tends to be 14 or so around 12/1am. I've been checking him as I go to bed and if I wake in the night. I was going to set the alarm to keep checking him at night (and would if he was low) but I haven't needed to so far.

The bedtime snack is because he is hungry - and, boy, is he hungry! - rather than to regulate his blood sugar.

I'm seeing his DSN tomorrow. I'll have a chat with her then.
 
Levemir rarely lasts the full 24 hours in anyone, so if he is having his injection in the morning and then climbing through the night it sounds like this may be the reason. Many people split their levemir injections into two per day, and this has the added flexibility of being able to give a higher proportion when more is needed e.g. most people are more insulin-resistant in the mornings, so would give a higher proportion of their daily levemir in the morning to cover this. As people become active during the day their sensitivity tends to increase, reducing the need for insulin as the day progresses. As Redkite suggests, the ideal solution is a pump, where basal needs can be addressed on an hourly basis 🙂
 
My daughter's BG always jumps up quite drastically immediately after she goes to bed and then stays high until the small hours and will then sometimes drift down a bit. We are on a pump and I have to do an awful lot of fiddling about with basal over night to try to keep her stable. We had a blissful few weeks where numbers were great but we're now getting some 13s creeping in again. Not every night though it seems, I have just been doing full basal testing and when I did the overnight one it only went up to 9! So am thinking I'm going to tweak it up just a little bit and then see what DSN says.

On school days my daughter's basal goes as low as 0.15 u/hour for part of the day and at night it goes up to 0.72 from 8pm to midnight (soon to be increased again!), so it's quite a difference! But that's the joy of the pump, it can be hard work sometimes but if you stick at it you can get it fine tuned so that you get more basal insulin exactly when you need it and less when you don't.
 
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