Daytime hypos night time hyper?

nayantara.colicchia said:

Hello, we are relatively new to T1. Our 6 year old daughter has been going high at night in the last few days (400) and we noticed when it happens often in the day she had various hypos. Could this be related? We do carb counting and had her usual evening carbs.
Thank you for your feedback.
Tara

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Hello @nayantara.colicchia,

Would you be so kind as to provide a bit more information?

What type of insulin(s) does your daughter take?

If she's on injections, can you advise on her basal dose injection time?

Did you perform a correction dose for the high 400mg/dl reading (22mmol/l)?

I'm not sure whether you are saying hypos in the day happen before hypers at night or hypers at night first followed by hypos in the day?

If she is going so low in the day that this causes a liver dump response then the hormones released due to the low are counter regulatory to insulin and that might cause hypers in the night. I hope she isn't having such severe hypos that she is getting a full hormone response sending her high because that would be fairly dangerous and unpleasant.

If it's hypos first have a think about how to reduce them, maybe I:c ratios need adjusting to a count for running around and playing, treat quickly with a small amount of fast acting glucose, think about treating pre-emptively before she drops low.

If she is having hypers first, it could be correction doses are stacking to cause hypos later in the day, it could be that the basal dose is not high enough at night, but too high for her in the day. You might need to look at splitting the basal dose, or looking at a pump.

Do you mean Humulin or Humalog at lunch time @nayantara.colicchia ?

How long after eating are the lows during the day happening?

A half unit pen for meal time boluses would be helpful. That way you could match her insulin more closely to her carbs. They help a lot, especially in children or people on low doses of insulin.

i would also consider whether splitting the basal insulin dose would give you more flexibility. It may be she needs more basal at night but less during the day. A split dose would allow you to achieve this. There are also other basal insulins to try if the Lantus isn't working as well as you'd like @nayantara.colicchia

Testing during the night would help you identify when any rise was happening and that would be useful to know.

Hi. You say you do carb-counting but imply you give fixed Humalog doses? This isn't carb-counting so I'm not sure which you're doing i.e. fixed Humalog for each meal or carb-counting (matching the dose to the carbs). Yes, a half-unit pen is useful if you haven't got one; I use half-units sometimes. You say you avoid fats with carbs? Was this specific advice given to you by the docs? There may be a good reason but fats do slow-down and smooth carb absorption. They can reduce hypo risk but you have to be more careful with correction doses.

You can still carb count on fixed doses @Daibell You have set amounts of carbs to eat for each meal dose eg lunch 5 units of insulin and eat 40g carbs (all figures made up just to give an example).

I was started on fixed doses and carb counting like that. It's just another way to match insulin to carbs. I then moved on to MDI and carb counting and adjusting my insulin.

I've noticed a number of newly diagnsoed people doing this and it's fine as long as they eat the right amount of carbs for the insulin dose.

Do also get 1/2 unit pens if you havent already.

Also, if going low.... how are you treating these lows?? Highs can occur if you are over greating the lows...you may be told to give 15h of carbs if lows start to occur, but daughter may not be needing that much...