Night time spike

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ky333

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Wonder if anyone can shed any light on a recent occurance we have been experiencing after tea. My daughter eats her tea and for 4 hours after her BG are nice and level. As soon as her insulin wears off 4 hours later her BGs spike up to 13 /14 and refuse to come back down despite a number of units of insulin (11 units given last night! )

What can we do differently? Is her basal after tea too low or her bolus too low? Cant work it out!

( shes on a pump btw)

Thanks in advance
 
Mmmmm - 6 of one and half a dozen of the other - both need adjusting, they do NOT work independently of each other. My thoughts are - First consider basal, whether the change to the dose is up or down altering the rate from a time, will not have very much effect on the BG until approx 2 hours later.

If you thus reduce the BG from meal time and you do not wish to hypo in the next couple of hours then you will need less bolus that you are having now.

I ONLY know this is what I would try doing with mine in the same circumstances. I am not by any means saying either it will work like that for any other T1 adult OR that it would work for a child - my growth hormones and female hormones ceased a long time ago now! - neither does my body have the effects of any recent exercise to contend with most of the time.
 
What is your daughter eating for tea?
I find some foods, especially higher carb and higher fat meals like pizza and curry, affect my blood sugars for long so need a split bolus so avoid a later high.
 
@ky333 A similar thing happens to me occasionally, and for me it’s a sign of a ‘worn out’ cannula site or a ‘bad’ site.

Before upping her basal, I’d look into her site areas - what body area are you using? How often are you changing them? Anything changed at all?

If you’re sure her sites are ok and lasting, I’d then look at her basal insulin.
 
I also wondered about fat content of the meals. I gave up on Pizza and brought in curry for this reason, as it would send my levels very high quite a few hours later, sometimes with a hypo thrown in within the four hours after the meal.

Another thought that I had as this has recently started, could it be the insulin. Sometimes things are more evident at night as there are fewer other factors in the mix to confuse things.

How recently have you been able to do a Basal Rate test? I know my insulin sensitivity varies with the weather. I do not know how much this will impact a child. With a sensor this is a lot easier as it does not require extra finger pricks.

As you no bout know there is never just a simple solution to these puzzles, just lots of trial and improvement and head Scratching.

Well worth contacting your diabetes team, as they will have more experience with addressing these issues with children. I will also tag some of our parents. @Thebearcametoo , @Sally71 , @Bronco Billy who will no doubt have more ideas too.
 
How long after tea does she go to bed? My daughter’s BGs shoot through the roof as soon as she goes to bed and she has to have a massive basal increase then for a few hours.

What does she eat for tea, and is it always similar food? Things like pizza can be a pain, they take a long time to hit the bloodstream and then seem to keep hitting it for many hours afterwards which can be a nightmare to deal with.

Does this happen every night regardless of what she eats? Maybe do a basal test first to rule that out. If it’s the “pizza effect” then you could try experimenting with extended boluses and temp basals. We also find that if blood sugars are high for no obvious reason and you’ve done corrections and changed your infusion set and so on and it still won’t come down, just whack up your basal by about 40% for a few hours and that usually sorts it out!! You have to keep a close eye on blood sugars if you do that though, so that you can cancel the temp basal before they drop too low 😳 And if you have to do that regularly, it would suggest that the main basal pattern needs increasing.
 
It could be a basal issue mixed with a correction factor issue. We’ve had periods where my daughter goes high and it seems to take loads of insulin to get her to come down but an increase in basal with an increase in correction factor has helped. We still get some nights the day before a pump change where it’s a struggle as the cannula site seems to absorb less well but I just add more insulin in. Your team should be able to help if you send them your data.
 
Hi @ky333. If the BG levels are good 3-4 hours after eating, that suggests to me that the food ratio is right, although it’s hard to be absolutely sure without knowing what is being eaten. Foods that are higher in fat can cause a spike due to the delayed impact of the carbs. My initial thoughts are that the basal rate needs to be adjusted, but please consult with your team. Do you have the facility to download the information from the pump? If so, patterns will be easier to spot and you and the team will have more information on which to base any changes.
 
Hi, if these spikes are happening at pretty much the same time every night & you’ve ruled out spikes from high fat foods then my thoughts would be start by using her basal for that time period.

Im sure it’s an option on most pumps, but you should be able to increase the basal amount for a set period of time.
 
This is quite a useful method if you‘d like to check whether the basal profile active at that time might need adjusting

forum.diabetes.org.uk

Basal Testing Made Easy

Here's a link for basal testing, which will hopefully clear up the myths for anyone starting on their pump journey http://diatribe.org/issues/13/learning-curve Plus this might help as well. http://diatribe.org/issues/26/thinking-like-a-pancreas
forum.diabetes.org.uk forum.diabetes.org.uk
 
ky333 said:
Wonder if anyone can shed any light on a recent occurance we have been experiencing after tea. My daughter eats her tea and for 4 hours after her BG are nice and level. As soon as her insulin wears off 4 hours later her BGs spike up to 13 /14 and refuse to come back down despite a number of units of insulin (11 units given last night! )

What can we do differently? Is her basal after tea too low or her bolus too low? Cant work it out!

( shes on a pump btw)

Thanks in advance
Click to expand...
Sounds to me like an excessive bolus is hiding an insufficient basal, thus if you reduced the bolus 10% and increase the evening basal 10% that'd probably fix it.
However do a 4am blood test to check if the o/n basal needs lowering 5-10%.
Or before doing the above adjustments, you might test at 6pm, have a carb free evening e.g. swapping spud for aubergine/ cauliflower (baked 40 mins gm4 s+p a little oil and harissa) test at 10 or 11pm. If the glycaemia has significantly risen, thats good evidence for a need to increase the basal.
 
Hi @ky333

I would agree that it would seem like a basal rate issue as the issue arises after the Bolus has finished. However it could also be a carb ratio issue and the insulin has dealt with some of the carbs and then the leftovers kick in to increase levels later. I would suggest a fasting basal rate test so that you can check the basal rates before trying to sort out other variables.

I know that I have found that a change in temperature can play havoc with levels. On a pump you can ‘interview’ and % change using a TBR for basal rates, or for boluses before making alterations to rates by the hour or carb ratios. I found that these changes always caught me out and took me a while to notice I needed to do.

How are things now?
 
ky333 said:
Wonder if anyone can shed any light on a recent occurance we have been experiencing after tea. My daughter eats her tea and for 4 hours after her BG are nice and level. As soon as her insulin wears off 4 hours later her BGs spike up to 13 /14 and refuse to come back down despite a number of units of insulin (11 units given last night! )

What can we do differently? Is her basal after tea too low or her bolus too low? Cant work it out!

( shes on a pump btw)

Thanks in advance
Click to expand...
Simple solution would be to have tea an hour earlier and see what happens from then on.
I would suspect a basal problem like everyone else.
 
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