Bed time highs.

[ivm18]

We don't do basal splitting even in Levemir.
Doctor doesn't advised it. I really don't know what's wrong, why my son still getting high now.

 

[Saikoudaze]

Unusual. In the DAFNE course they recommend splitting Levemir as the best course of action using basal insulin to control sugars. As far as I see you can increase the fast acting ratio at bedtime to reduce the highs, and reduce the basal to stop bms dropping overnight.

Another possibility is that you're checking the blood glucose too soon after eating. Apidra acts for 4 hours. If you're testing at 2 hours, the apidra still has 2 hours to act which may explain why your son is high before bed but lower in the morning.

 

[ivm18]

We did, his previous ratio was
breakfast-1:14
lunch-1:14
supper/dinner 1:12
Now his dinner ratio is 1:10 and he checked before taking lantus @9 pm and he was 9.2.

 

[ivm18]

We haven't told to split basal maybe because when my son was on levemir his bedtime readings were in ideal range which is in low 7. It is only now that he switched to Lantus two weeks ago and his bedtime numbers were high.
I pray his endo will answer my email ASAP.

 

[slip]

No need to panic I'm sure they'll reply soon.

 

[ivm18]

Thank you @slip
May i ask are you type 1 yourself? How old are you?

 

[teacher123]

I hope you get a response soon and that normal range can be achieved post-meal

 

[ivm18]

I hope too! its getting late here and I'm exhausted and tired trying to figure out what's wrong with my son's level. This medical condition is very mysterious, one day okay, and one day out of nowhere weird things happens.

 

[Saikoudaze]

There's always a reason, sometimes it's just difficult to find. Patience is important with diabetes but it's hard when yours or a loved ones health is at stake.

 

[Saikoudaze]

Apparently there are some online learning resources here: http://www.bdec-e-learning.com/

 

[ann34+]

I hope too! its getting late here and I'm exhausted and tired trying to figure out what's wrong with my son's level. This medical condition is very mysterious, one day okay, and one day out of nowhere weird things happens.

In my own experience - nearly 36 years of being very insulin sensitive - thats how it is ! constant change, within a framework. a few high readings only at one time in the day will still give a good average even if insulin changes do not always work. i have been fortunate to see consultants at teaching hospitals, and I recall one of them saying that there were so many complex factors involved, and that there are a mix of numerous hormones etc in the blood at any one time all influencing the action of insulin, that things cannot always be totally exact. Also.In your son's case, he is still young and developing and things will be likely to be more erratic in the next years . Hopefully more responsive pumps are on the horizon. best wishes

 

[Spiker]

It's worth mentioning that lantus is licensed for once daily use, you shouldn't really split that one.

This is not true, you can split Lantus with no problems.

 

[Spiker]

When something goes wrong or acts unexpectedly, always look for what changed. In this case he changed from Levemir to Lantus. Unusually he was on 1/day Levemir. That was not a good idea as Levemir only lasts about 12 hours. Changing to an equal 1/day dose of Lantus is going to have very different results. His I:C ratios will have been compensating for the fact that for half of the day he had very little active basal insulin. Now with Lantus he has much greater basal coverage than he is used to. As others have said, you need to tune his I:C ratios and basal all over again. Swapping Lantus for Levemir is not like-for-like.

 

[ivm18]

Hello @Spiker
My son bedtime readings when he was still on levemir were quiet stable, although we don't practice basal splitting he usually get 7-7.5 which is our target for him to go to bed.Until recently like 2 weeks ago when we switched to lantus his bedtime readings went crazy! and I don't have any idea why this craziness happened/happening.
Maybe growth hormones, food he eat when at school or when out with friends? Or maybe its the lantus? Definitely will have a talk with his endo once she gets back from medical convention.
So far now, all I can do is to ask some help/advice here. It really is trial and error for us now.

 

[Spiker]

If the crazy bedtime readings started after he switched to Lantus then that switch is the most likely cause and the one to investigate first. Not any hypothetical hormones or unknown eating.

Changing from 2/day Levemir to 1/day Lantus is difficult enough and very hard to achieve without seeing big fluctuations. Changing from 1/day Levemir to 1/day Lantus is pretty much guaranteed to cause big changes in BG patterns throughout the (24 hr) day. Any changes like that will require a period of testing and adjustment before BG will be stable over the 24hr day again.

Probably your son should not have been on 1/day Levemir. This is normally only used for people who are newly diagnosed and honeymooning, still producing their own insulin, and so don't need 24hr basal cover. 1/day Levemir cannot provide 24hr basal cover.

 

[Spiker]

So for now, all I can do is to ask for some help/advice here. It really is trial and error for us now.

OK to help us help you please provide information from a typical day before on Levemir, and a typical day now on Lantus:

BG readings (with times)
Meal times (with description of meal)
Bolus insulin times and quantities
Basal insulin times and quantities
Bed time / waking time.

It might also be good if you describe in detail the sliding scale method he is using for his Apidra doses.

With this information we can give better advice with less guesswork.

 

[ivm18]

My son was just diagnosed 6 months ago.
His daily/night readings prior switching to Lantus.

6:00 am woke up, BG 5-6.5
breakfast- toast/ grilled cheese sandwich,fruits(apple or banana). take his shot usually in the middle of his meal.

11:00 am lunch at school. 5-7.7
eat lunch- fish, brown rice and yogurt/fruits
bolus.
2:30 pm- snack usually biscuit and cheese/nuts anything below 15 grams of carbs.

6:00 pm/6:30 dinner, 5.5- to high 7
fish, chicken or lean pork, brown rice (always just a cup), grilled veggies.
And just tonight its 9:25 pm here. he tested and got a reading of 9.3!
took lantus 18 units.
He has this I:C app on his mobile phone, you enter your BG reading and grams of carbs in your meal and it will automatically calculate how much insulin you need.
His I:C
breakfast-1:14
lunch-1'14
dinner-1:12 but we made adjustment in his dinner ratio 1:10.

 

[Spiker]

And before Lantus how much Levemir did he take and when?

But a key fact is that he is newly diagnosed. Newly diagnosed T1 diabetes during the honeymoon phase is unpredictable and hard to control. He will have to make frequent changes to his regime until it settles down.

 

[ivm18]

Same as Lantus it's 18 units @9:00 pm every night.
He was on a pump couple of months after diagnosis but chose to get back on MDI.
He said he is more comfortable in shots. I on the other hand would really want him to be on pump but it's his choice and it is his condition, I must respect it.
It is really hard, when you feel like you're getting the grip and suddenly diabetes decided to change direction!

 

[ivm18]

Re tested just now @11:10 evening.
BG-4.5
Drank half a cup of milk and 2 pcs. Ritz biscuit.
Weird!