bedtime levels- night time hypos?

[flojos mum]

hello,
Chloe was diagnosed last october, she is 11.
her levels during the day are generally good, bit high around certain times in month!! and having about 3-4 hypos a week.
recently ( last 2 weeks) her levels on going to bed are good between 5-11 ( at most) but on waking between 11-14. Nurse sugested testing over a few days at 3am with the results being between 11-16, one showing 21.3. She said these are high enough to suggest night hypos then rising as she would expect them to be in 20s. advice to make sure Chloe is getting 15g or less for bed time snack and will speak on friday. Other nurse says if level at bedtime is below 7 Chloe should have about 20g carbs if below 7 then 15g or less. my questions are:

What is the ideal level to go to bed on?

What are the best things and how much carbs to eat before bed?

A couple of times she has complained of getting sweaty at night but when she wakes like this and we test she is around the 11-14 range how can I tell if she is having a hypo when she is asleep- is there any obvious signs?
Thanks in advance

 

[suzi]

Hi flojos mum,
what insulin is Chloe on now? i can't see night hypos raising her bs and putting her in the 15-20's in the morning, unless you've over corrected it. You may find if high in morning then she doesn't need so many carbs, or its the type of carb shes having, or more insulin required. Cereal before bed would tend to make kids peak, Andrew goes to bed at night with bs of around 14, has 19units Levemir and is a perfect 5 in the morning, but if he goes to bed with bs of 9 he'll wake hypo. He has a glass of milk and a couple of gf biscuits or low sugar hot drinking chocolate before bed most nights.
When Andrew has a night hypo (which hasn't happened in ages) he tends to wake himself as if by a bad dream and my built in sensors always wakens me to go into him. I would honestly think if Chloe was having night hypos her bs' would still be pretty low in the morning as the liver can only dump so much glucagon into the blood stream, but you know every child is different and another reason her bs may be playing up is because she's coming to the end of her honeymoon period.
Hope this is a bit helpful, take care,
Suzi x

 

[flojos mum]

Thanks for the quick response, chloe is on 11 units of levemir which she has at 19:30 and tests, has snack and goes to bed about 9ish. she has milk and biscuits or rice cakes before bed usually. In general her b/s are about 6 before bed.
At the moment she is not always recognising hypos during the day probably about 2/3rds of them so not sure what is happening at night- is 14 a good level to go to bed at as consultant said I should be aiming for 7and its always worried me about her going low at night. She has gone back to doing sports again after being a bit scared of doing any excerise incase of hypos and I have noticed her b/s level is much better since this just cant work out what is going on during night, she is very restless and waking alot during night but never shown hypo levels when tested in the dark hours.
Thanks Charlie.

 

[suzi]

Hi Charlie,
for Andrew going to bed with bs of 14 after snack and before injection works for him and as his bs levels in the mornings are around 5 then the combination works for him. I know what a struggle it is to balance everything and us poor mums have growth spurts and puberty to deal with as well. When Andrew isn't hungry before bed (which is rarely @10yrs of age!) i reduce the Levemir by 1unit, this works for his morning bs reading, but i find his bs creeps up before lunch.

As for Chloe during the night i would imagine if her levels are highish when tested during the night her bs levels are probably making her toss and turn and sweat, making for an uncomfortable nights sleep. High bs' can cause restless legs during the night, well this it what i find with Andrew, though you would assume bs of 14 high, he does gradually drop during the night.

Not sure if i'm making much sense, it really is trial and error, unfortunately. There will be a time when you manage a full nights sleep, remembering Chloe was only diagnosed in October, and you've both coped remarkably well.
Take care,
Suzi x

 

[Jen&Khaleb]

Just to give you another example, I can tell you that Khaleb is on Levemir 2X daily(7.5 units 6.30amish and 4 units 5.30pmish) with his Novorapid (1 unit) and dinner. His bs at around 8.30pm will usually be around the 6 or 7 mark and he'll get supper of around 15 - 20gm carb (something like fruit, semolina and custard). By 10pm he would need to have a bs of around 18 before I would consider sleeping through the night. At 2am he has bs close to 8 and wakes in the morning at about 5. I find the Levemir really drops Khaleb when it first kicks in and I have to allow for that.

For the last week Khaleb was really sick and his bs was all over the place but we are back on track now. Nearly took him to the hospital when he went from 3.2 to 32 one afternoon. I've spent so much time taking care of Khaleb my fish died because I forgot to feed them. I feel terrible!

Khaleb is only 2 so that explains the small dose for you and the fact that he can go a bit higher at times. He stays between 4 and 10 all day and then up to get through the night. Mind you I've only had the oppportunity to have 1 night of sleep in the last couple of weeks but I'd been getting up so often I woke up anyway. Grrr.

I haven't met any kids that could go to bed with 'normal' blood sugar and make it through the night but I've seen on here that a lot of adults manage. If Khaleb's bsl's are a bit unpredictable I tend to just get up in the night and see that he is okay. I seem to also have mother radar and just seem to know something isn't right sometimes.

It really is such a trial and error and very little sleep. I certainly found it hardest to get the night dose/food right but since sorting it out Khaleb's hba1c went from 8.7 down to 7.0.

If you are going to make changes do it slowly over several days so you can see what is going on.

Hope Chloe is coping well as I imagine it would be very hard at her age. Hope you are okay too.

Jen.