day time n evening bg's driveing me bonkers!

[char nd jay]

hi guys!

courtneys 2 n half her sugars have been all over the place for a few weeks and its driveing me nuts!

her sugars are 20's - hi all day and evening dispite carb counting ( 1 unit of nova rapid to every 30g of carbs) and correction doses of nova rapid between meals to attempted to bring them down! only bring her down abit to no luck!
when we test her when we go to bed (around 11 midnight) they tend to be in the good range or on the edge of been hypo) yet by morning shes 15+ not due to see our dsn/clinic till feb!

over 2 weeks wev uped her levermir by 1 unit she now on 6 1/2 units am and nova rapid at meal times depending on the carbs!


help its driveing me nuts! she is also very moddy and very agreesive with high sugars !

any ideas?

 

[leggott]

Sorry to hear about this. It sounds like the carb ratio needs adjusting so worth speaking with DSN to see what they suggest. With the night issue it could be a result of a number of things one of which is that she is having a hypo sometime in the night and then bouncing up again by the morning. It might be worth doing some hourly testing throughout the night to establish what is happening. It would help to know when she has her levemir and what time she has her tea or last novorapid injection as it could also be that the amount and timings of these are causing the problem.

 

[leggott]

Re: day time n evening bg's driveing me bonkers!vhu4

Sorry, but I've just noticed that you said the levemir is given in the morning. Although levemir is supposed work for 24 hours it doesn't for a lot of people. It could be that it's effect has tailed off before the morning, hence the reason her blood is higher then. The solution could be to give it at night or split the dose giving some in the morning and the rest in the evening before bed. You will need to speak to your DSN about this if you think this could be the reason. I would not wait until Feb to discuss this, best to call tomorrow and explain the problem and insist they at least discuss it over the phone. It might be a good idea to do some checks tonight which may help you figure out what is causings the highs.

 

[Jen&Khaleb]

Do you think her honeymoon is coming to an end and you are going to have to readjust all her insulin? I see she was diagnosed in March. It also looks like you've been on quite low doses of insulin and have a high insulin:carb ratio. How many units of insulin in total is she having compared to her body weight. My son is on just over 1 unit per kilo but 0.8 - 1.2 unit per kilo would be the norm. 65% of my son's insulin is Levemir and the other 35% is Novorapid but this can vary child to child. Keep correcting to avoid DKA and get an appointment to help you make these big adjustments if you are not comfortable doing it yourself.

If she is sick you will see weird levels that will settle once well.

 

[char nd jay]

hi thanks for the replays shes 2 stone and 88cm tall she has levermir half an hr b4 she eats witch is about 8am then nova rapid depending on what she has for breacky n what her levels r normaly about 2 units it fr breacky n 1 unit to bring her dwn , has nova again just b4 i do her lunch at 12 midday then has nova again at tea time witch is about 6:30 ish (she finsih nursery at 6 ) we giv correctionl nova dureing the day if needed depending on her levels iv changed her morning and lunch ratio to 1 unit for every 25gs of nova and thats seemed to help abit for now untill i can get to clinic in hte nxt week hopefuly ! im thinking of askin to borrow a cgm meater from my clinic to see if we can pin point the spikes n the lows!

wev had problems with her insulin from day dot sometimes half a unit up cn make her hypo qwickly causeing her to have a hypo fit

roll on gettin her pump!

 

[char nd jay]

forgot to add we tryd split doseing levermir but the lap over in the morning left her hypo in the morning or during the night and low hypos witch tooks ages or glucogon to treat , and yes she hasnt honeymooned in a while *touch wood*

 

[Jen&Khaleb]

I would find 1/2 a unit Novorapid would also be enough to cause a hypo. I carb count quite carefully as 1/2 a unit would drop Khaleb by 4mmol or be enough for 7gm carbs. Khaleb has actually been hypo this afternoon (3.4mmol) as we went swimming this morning and I really should have given him an extra snack.

 

[leggott]

That's good to hear that you are getting some better results.

I know it is a pain, but testing periodically throughout the night is the only way of knowing what is going on. If you are lucky enough to get your hands on a CGM that helps. We don't have them in my area so I did and still do a lot of night time testing. Pumps do help but are not the magic answer and they have to be programmed with hourly basal rates which does mean lots of night testing especially with little ones. I was testing hourly throughout the night some days, but it was worth it in the end.

Once you know what is going on at night you can make changes which will help the problem. it could be (like in our situation), that a pump is the only real solution when it comes to control over night. If you can prove this your DSN this may help your daughter to get a pump sooner.

 

[char nd jay]

courtz meets all the criteria in r area for a pump shes on a waitin list theres a few in front of her she will be gettin hers in the summer time! we are going to use omnipod as theres no tubes n stuff for her to play with like other pumps luckly r hopsital funds them her controll has been terible from day dot and no one no's why! i test her every 2 hrs on a good night or every hr if shes hypod at bed time for me or oh she is tested every 1/2 hrs durin the day we go threw like 20 test strips a day! im at my wits end i changed her ratio to 1 unit for every 25g of carbs n workd better bt not by much, we r hopeing with the pump because u can gv small amounts then with the junior pens it might help i cant wait to be honst i no its hard work esp to start with till u get the bousl right bt i want to get her on the right track soooner rather then later and to set an expamle to her that good controll is a better life for her with minumal problems were as if her controll stays as it is she will probz end up with mega problems!

 

[leggott]

We use Omnipod and are pleased as punch. At least you know that you are getting a pump and I am sure it will help in dealing with the issues that you are having on MDI.