ADJUSTMENT OF BASAL LANTUS

You would increase it stoney but I would do it one unit at a time and give it at least 3 days to work before adjusting again, if in doubt speak with your lads DSN.

Nigel

I would also look at 3 bg's

His bedtime
A 3am reading
His morning reading

This would help to rule out an rebound high from going too low overnight...

It his bedtime and 3am are pretty slimilar, then he's unlikely to be suffering rebound highs in the morning, if how ever the drop from bedtime to 3am is more than you expect he might be having a hypo, so you need to then check, every hour (can do this on different nights) to pick up a pattern to see when he's going low.. This also helps to find the point where is hormone levels natural increase for the wake up call, this can sometimes be subtle or very pronounced, the latter is called Dawn Phenomon..

As nigel says if high in the morning, then it's probaly needs increasing but doing the above checks will help to make things slightly clearer.. And can identify if he may need to split the lantus into two jabs...

If his levels are running high all the time, this can make him hungery, it's to do with the insulin isn't able to transfer the energy/fuel into the cellls for use, so the body thinks it's being deprived off fuel (carbs) so it's calling for more carbs to fuel the cells, mix this with a teenagers ability to eat one out of house and home not good..

Perhaps try him with carb free items, or a protein source that either doesn't impact or has very mnimal impact on his blood sugar levels.

We ideally like to do a blood test 3 hours after tea before my kids go to bed. We like their bg to be about 7/8 mmol for daughter who is on MDi and about 6mmol for my son who has a pump.

My daughters bloods will vary between 4 - 9mmol throughout the night, with the occasional reading outside this range, My sons bg doesn't fluctuate as much but he is on a pump which allows us to gain tighter control.

If my children have a snack before bed then I would give them a bolus with this. We don't do this that often as it means us checking their bg in the night to make sure we got the carbs / dose right.
My daughters ratio is 1:7' so she would need about 10 units of novo rapid if she had a supper like your son.

it is hard getting it right with kids - especially the teenage years. My son is now pumping as we had overnight problems. We tried everything to get his bg stable and now we are pumping life is much easier.

Hopefully some other parents will be along later with their thoughts.

Do you really mean by the ratios you quote that you use 8 units of insulin to 1 carbohydrate portion??? Or am I reading that quite wrong and you mean something else altogether? If it is real it seems an extraordinary amount.

I am astounded that your nurse (?) has said to not use insulin for his bedtime snack. When on a regime where you inject for meals, you have to inject for every meal, including any snacks of more than about 1CP. If you don't, I think the results you quote above speak for themselves. A snack of 70 grams of carbohydrate is a major meal and needs insulin, and I don't care what your nurse says, she's wrong.

That is the first time I have ever directly contradicted the advice of a health professional in any forum and I hope I don't ever have to do it again. We are not supposed to give any kind of medical advice like that, so make sure you talk to a professional before doing anything drastic. I suspect that maybe said professional doesn't know how much carbs that snack consists of. At least, I hope that's the case, otherwise I think you need to get a second opinion.

Ducks back behind her parapet...

It sounds like he needs some novorapid with the snack. His blood did come down in the morning but this was due to the basal which therefore perhaps needs reducing. I think you need to give him a carb free supper and then test every hour. I'd imagine if you did this he would go hypo which would confirm that the background needs reducing.

I too am shocked you've been advised not to give a bolus with that snack! Perhaps you should speak with your DSM tomorrow to discuss your sons readings.

I know of at least 1 other child that has a snack before bed withOUT a bolus...so I do not count that as abnormal....however,,,,,,again it is a case of finding out what suits the individual...on this scenario it does look as if there should be a bolus to have with the evening snack........but it will be a suck it and see scenario...and the bolus ratio might be a completely different one again to the day time scenarios.......

I can only talk from my personal experience, and I could never eat a snack even of 10g without a small bolus....even before bedtime...and to go up 11mmol is quite a significant rise...judging by this... me personally I would have to give an injection or for go the snack and see how that works....however, if a child is used to having a snack before bed, I don't see why they should change...just giving a bolus would in this one off snapshot seem to be an idea to consider....

Stoney,

A starting bg of 11.7 with 70g of carbs with no insulin was sure to elevate his bg even further, I think you need to go back and discuss this matter with his diabetes consultant asap.

Nigel

70g of carbs before bed is not a snack, it's a meal, and I've never heard that much carbohydrate called otherwise. A snack before bed to avoid going low eg an apple or a piece of toast is one thing, but 70g is quite another. There's nothing stopping him eating it if he wants it, but I think you need to go back to your DSN about it - to my mind he should be injecting for it. Things change over time and the advice she gave you at one point may no longer be valid, and whilst I've never dealt with puberty + diabetes it seems blatantly obvious to me that some insulin needs to go in for that meal.

Hi,

Firstly, I am not a growing teenager, so things will be different, and I do see that as a 14 year old, tyhour sons needs will be different from mine, but, like others have said, I think you/he needs to show these results to the DSN, as, I think, in his case, he may need to have some insulin, even if it is before bed.

Having said this, I am conscious that his BG then dropped about 4 units over noght, so clearly, his ratio for "supper" may be very differnt to the rest of the day. Go back to the DSN as soon as you can, and take with you an accurate as possible, carb, insulin and BG record.

Khaleb has a supper without a bolus before bed (pre supper bsl tonight was 4.9) but it is about 20gm carbs. If it was any bigger I would certainly bolus. Ideally I like to see Khaleb's bsl around 10mmol at 10pm when I go to bed and I am quite confident I can sleep through the night without fear of a hypo (unless we have done something really energetic that day). Khaleb usually wakes up in single figures but sometimes he is a little higher. I've done a lot of testing and Khaleb drops down a lot at around 3am.

I think it looks like the Lantus is doing a lot of work that short acting insulin would take care of a lot better. You'd also end up with much shorter periods of time being high rather than the whole night and much of the next day. Did you do a correction for the higher bsl in the morning with breakfast.

Bit of an example is that Khaleb gets 1 unit: 10 gm carbs for Breakfast. If his breakfast was 20gm carb and his bsl was 10mmol I would give him 2 units for the breakfast and 0.5 unit to correct the 10mmol back to 6mmol. He would then be back in range by morning tea time. If he was 21mmol at 10.30pm I would correct by 1.5 units as I know this would bring him back to 9mmol but I'd then get up and check in the night. I'd try very hard to not wake him with the needle and am mostly successful.

Maybe your dsn thinks the supper is some small muffin or something like that and not a growing boys snack. I see what my teenager eats and am very thankful he has a fully functional pancreas. You've certainly got hormones to contend with aswell. A friend of mine who has a teenager on a pump once told me she had the thing running at 150% to deal with hormones and the increased appetite of a growing lad.

Wishing you well.