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BG drifting downwards during sleep

Stever750

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My 16yr old son has recently changed his regime from novomix 30 twice daily to Lantus plus novorapid for each meal. I had him and his brother stay with me for a weeks holiday, the first evening he suffered a severe deep sleep hypo - I woke to find him having a seizure in his sleep. Although he was concious when I stirred him, he was completely "gone", and only just aware of our presence. It took me and his brother several minutes to administer glucose gel to his gums but he was fighting us all the time. It's not the first deep hypo he has had, but it's the first he has not woken up from, and I still do not like to think what could happen if I had not got up when I had to check on him.
I spent the rest of the week monitoring his BG many times daily to try to check what was happening, it seems his deep hypo was a result of injecting about 3 times the does he needed after his previous evening meal, but I've noticed that his fasting levels still drop quite noticeably during the night. He might start at around 7, 8mmol, but can drop to half that in 3-4 hours. We dropped his Lantus injection from 46u to 38u, and will do another 4u tonight after speaking to the local paediatric clinic nurses, but am I right in my understanding that when the Lantus level is correct, there should be little change in BG over 24 hours assuming the carbs/novorapid injections are balanced (or even fasted readings).
It's taken a week to reduce the range in his readings as we've had to work out his carb / insulin dose ratio more accurately, but I think we have made good progress now and have a good idea of how to calculate it (though calculating the carb content accurately is challenge in its own right - I use Carbs and Cals app which is at best only OK). It's been a tiring week, I have been getting up and testing him every 3 hours during sleep, and been on edge every time we have undertaken any activity, bearing in mind we were on holiday!

So, in summary, can I expect a relatively flat fasted BG when the Lantus levels are correct?
Is his teenage nocturnal habits affecting this - he injects his Lantus at around 10, and sometimes is up until 4 am?
The hypo seizures are pretty traumatic for a parent, what cold happen, asuming he hasnt drunk alcohol, is he likely to wake himself up after the body releases glucagon?

I appreciate any help, however small, as after 3 years I thought he had started to make good progress and control; but his hypo and the ensuing hospital drama frankly scares me for the future.
Thanks
 
Hi

Reading yr post reminds me of what I went through when I first started using Lantus and Humalog. I too had an extremely bad hypo the first night whilst soundly asleep and only came round with glucogel being massaged in my gums and cheek lining and then later being able to drink some lucozade.

If your son is going hypo 2hrs after eating food with a bolus, then its more like that he is using too much bolus and needs to adjust the amount. If he tests his bg levels every 2hrs, he should be able to work out what is called an insulin to carb ratio which means that he calculates the amount of carb to be eaten and then uses a ratio for the insulin. The ratios need to be adjusted so that his bg levels fall within healthy targets as set by NICE or your sons D consultant/dsn. Most people start off using the 1u to 10g carb ratio and then by testing bg levels every 2hrs to see what they are, adjust the ratio upwards or downwards. Lots of people find that they need to use different ratios at different times of the day. Some keep the 1u the same and adjust the carb amount up or down and some keep the carb amount the same and adjust the bolus up or down. Look at the BDEC website for more info and also DUK have now done a download booklet all about ratios for carbohydrate called Carbohydrate Counting. Be patient, it all takes time to get the insulin levels correct but you will get there in the end.......
 
Thanks for the reply. I'm confident we have git a reasonably accurate insulin to carb ratio of 1:6, it's his fasted readings that drop too fast. It appears his Lantus is too high, as my understanding is that when the dose is correct the bg level should not change significantly over time, currently hus drift down by 5 to 6 mmol over a 4-5 hour period
 
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