Highs after bedtime

[ageez]

Hello! My five year old son has had type 1 diabetes for a year now and we are currently going through a few night time problems - familiar to all you diabetes parents out there, I'm sure! He is on novorapid and levemir. The problem we have is that although we are putting him to bed on good numbers (usually around 6mmols), when we check him before we turn in, he is running at 10mmols +. We always correct this, and go to bed, but he continues to rise and we have to correct again in the early hours. Last night he had a relatively low carb dinner and was around 5mmols during the night and woke at about 7mmols, so that really worked. But I have had a phone call from his school TA telling me that he has been feeling odd all day and lacking energy with bloods at round about 4mmols. Seems like a low carb dinner works overnight and leaves him worn out all day. Any suggestions?

 

[fencesitter]

Hello ageez
Is this a long term problem, or just the last few nights? We've found that when William has a growth spurt his numbers can be a bit wild for a while, maybe five days or so, and then they calm down again. If it's more of a pattern then it might be useful to go back to basics to establish whether his basal is OK (maybe it needs splitting?) or whether it's the food he eats for his dinner. William finds that high fat/high carb meals (eg pizza, cake, ice cream) are tricky late in the evening. Usually he injects at least twice for a meal like that, splitting the dose to cover the lengthy spike, like a pump extended bolus. That's difficult if they're going to bed after dinner though. Must say we haven't noticed a low carb evening meal making him tired the next day, so perhaps something else is going on, unless he might have had a hypo in the night? William does feel wrecked after a big low.
Hope that helps a bit
Catherine

 

[Hanmillmum]

Hi,

Nights are frustrating as early evening there is still the bolus on board from tea, once that has worn off it might be that his basal insulin that is not enough, just a thought, esp if it has been a while since being changed and he is growing - need more insulin with body mass increasing. Especially as well if you are correcting sometimes twice a night. This is what I would look at if I was certain it wasn't a slow rise after a fatty pizza/pasta tea. What time does he take the levemir ?

 

[ageez]

Hi Catherine,
This has been going on for about a week now. I am going to try to avoid things like pizza for a while. I will see what affect that has. You are probably right about the growth spurt. He seems to be shooting upwards at the moment. Cripes, this diabetes thing is a slog, isn't it?!

 

[fencesitter]

The other thing to consider is that he might be coming to the end of his honeymoon period? Don't know whether he's had this, but William did (really strong last summer). Gradually he has needed more bolus, and in the last month his basal needs have really increased too. We think his own pancreas was putting out a bit of insulin until recently, contributing to his background insulin quite significantly. Not any more - and it's made a big difference to how he manages high carb/high fat food.
William's pattern was 15 lantus/1:10 novo on diagnosis, right down to 2 lantus/1:75 novo at the height of his honeymoon, then gradually returning to original amounts, with lantus lagging behind somewhat. He's still not back to original lantus levels, taking around 9 right now but with a 1:10 novo ratio again. Main effect of all this is that he has to be much more accurate with carb counting as his own pancreas isn't mopping up the errors any more, and he can no longer manage high carb/high fat combo easily unless he splits his novo.