Perfect at bedtime, mornings ahhhhh!

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terrim1

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Type 1
Good Morning!

I am mum to a 13 year old who has been diagnosed T1 for two years.

So far so good other than the last week. He is testing just before bedtime, doing his lantus and having a drink and a snack and injecting his rapid accordingly. This has been routine since carb counting began 8 months ago.

Bedtime bloods of 6.0 and waking up with BS of 14.0!
Last night I got up at 1am and tested his blood, 3.6 so hypo treatment needed.

Why would this suddenly start to happen? Its not a one off mistake ( to much insulin ) as its been several nights now.

I will contact his nurse who is very supportive but thought I'd run it by this forum to.

Thanks

Terri
 
Hi Terri and welcome to the forum.

Sometimes a high in the morning can be caused by a hypo in the night - which your body then responds too. It may also be that when you have been treating the hypo you have encountered it is being over treated. My treatment of hypos will vary depending on whether I have any fast acting insulin in the system. Depending on when your son ate he may have had no fast acting insulin in the system so any carbs will induce a large increase in blood sugar than if it was active.

Is it possible that he has been more active the last few days as that may be affecting how much insulin he needs?

If you aren't already a member you can find additional support at

http://www.childrenwithdiabetesuk.org/
 
Hi there

Welcome to the forums 🙂

Diabetes is a fickle beast, especially where teenagers are concerned. As hormones ebb and flow, growth spurts begin and end the body will be using or releasing more or less of its stored glucose (from the liver and muscles). It was years before I realised how often my basal requirement changes (which can be every few months). I find it helpful to watch for patterns of unexpected BG behaviour, and more often than not a slight tweak to basal dose (Lantus) will see things settle.

Looks like your son's Lantus is a bit too high overnight. If he's dropping into a hypo the body can sometimes 'help out' by releasing glucose form the liver so you wake up high.

Ask your team for advice, or if you are confident adjusting doses, you could try dropping a unit off the dose to see if that helps. You may also find that a different timing helps (since Lantus does not have quite as flat a profile as people are sometimes told). I found taking it in the morning suited me better. Other people find it better to split Lantus into two doses approx 12 hours apart. And then, of course, there's always Levermir if you can't get Lantus to play nicely!
 
Welcome to the forum 🙂 x
 
Terri hi and a warm welcome to the forum
 
Hi Terri. Welcome 🙂

As said, your son's lantus is probably causing him to drop unless his teatime novorapid/humalog is very late and is still hanging in there through the small hours.

But more likely his lantus.🙂

Rob
 
Is his bedtime snack big enough to warrant some rapid acting insulin just before bed? I didn't think you were meant to use rapid acting at bedtime. Maybe I've got that wrong though?
 
Bedtime snack?

Why would you have one, on MDI or otherwise, with diabetes or without?
 
Hi Terri,
I would also hazzard a guess the basal's too strong causing lows. I haven't seen many of them, but your son may be in what I call a "transition" where the reason(s) could be (as others have said); A) increased activity (with possible increase in muscle tone), B) Teenage hormones, C) weather and D) ???

I've experienced (3) transitions of the weather and exercise variety. Spring-to-summer resulted decreased insulin usage thru smaller bolus and summer-to-fall went back to regular bolus and never reset basal in either case....not to say I would do it this way again - 2011 was first summer since diagnosis.

As for recent transition with exercise, I've had to reduce basal as my levels since x-mas have been running low. Over x-mas break, I started working out - basic at home exercises, but enough to see new muscle. This had knock-on effect of running low (one night esp noticable) and low'ish in following days. Boluses were also very quick to react or almost unnecessary at times - thereby raising flag my basal needs changed. As a result, I've reduced my basal by 25%, incrementally from 20 to 25, and numbers have returned to normal with more predictable bolus once again.
 
trophywench said:
Bedtime snack?

Why would you have one, on MDI or otherwise, with diabetes or without?
Click to expand...

We have been advised that if our sons reading is below 10 at night that he should have a snack before bed. His readings are tentatively low in the mornings as well (4's and 5's) so we are considering lowering his slow acting at night to compensate. I supose that way he wouldn't need a snack as much. You can also look to lower the dinner fast acting dose which would raise the night time reading.

It really is a juggling act and one which takes an age to master. Just as you think you have, their bodies change and you have to work it all out again! But keep at it and get lots of advice from your support nurses.
 
Welcome Terri

Given that your son is 13 years old, I think a possible explanation for the unexpected readings could be puberty and / or growth spurt. Not very helpful, I know - and coping with the changes is more important. Sounds like you and your / his diabetes specialist nurse have things on the way to being sorted out - until the next time... Sorry, but adolescence is a tought period for all teenagers and parents, and even tougher with diabetes, too. But, many people on these boards will reassure you that they survived / thrived 🙂
 
Martin-Parent said:
We have been advised that if our sons reading is below 10 at night that he should have a snack before bed. His readings are tentatively low in the mornings as well (4's and 5's) so we are considering lowering his slow acting at night to compensate. I supose that way he wouldn't need a snack as much. You can also look to lower the dinner fast acting dose which would raise the night time reading.

It really is a juggling act and one which takes an age to master. Just as you think you have, their bodies change and you have to work it all out again! But keep at it and get lots of advice from your support nurses.
Click to expand...

I was told to have a late night snack too, and did so for many years (particularly when on protaphane/insulatard and other formulations that predate modern analogue basal insulins). These days though I would see it as a slightly out-dated notion. Essentially you are taking too much basal insulin which causes your BG to fall overnight and the suggestion is to eat more to make yourself artificially high beforehand. The tail is wagging the dog.

The flat(ish) profile of Lantus/Levemir *should* make it possible to stay within 1-3mmol/L of your bedtime reading on rising. A movement as you suggest of more than 6mmol/L looks like rather too big a change.

Of course it's not always that easy. Growth spurts/hormones etc will wreak havoc... Dawn Phenomenon might push BG up in the early hours. You may need less basal insulin active at night and more in the morning (which one injection of Lantus will not be able to give you so you might need to split Lantus or switch to Levemir).

Fasting basal tests during the night, and also during the day can help you to observe (and adjust) the activity of your basal insulin to make it the least 'Hobson's Choice' possible. Once you have things as tight as you can get them then it would be possible I suppose to revise the 'when to snack' limit. While I was on Lantus it was a bedtime reading less than 5.

hth
Mike
 
ON Lantus, unless I was at least 7 at bedtime I'd have an early morning hypo. Guaranteed. Tried moving the timing and splitting the dose. Just moved the hypo times about. So I changed to twice daily Levemir and could go to bed at 5 and get up at 5. Then of course I went high till mid morning until the immediate jab of daytime Levemir kicked in but TBH nothing too bad esp when you consider I had to drive to work soon after getting up. But enough to keep my A1c too high.

I love my pump!!!!! :D
 
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