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HELP!High Readings in the mornings.

J

jonny12

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14
We have just changed my son's insulin routine. He was on Novomix 30 and his last HBA1c was high.On Wednesday we decided to start on 3 injections of Novorapid and one evening injection of Lantus.
Control in the day is fine.He has gone to bed the last two nights at 5.1 and 7.2.
The next morning his reading were in the high teens.
Do I increase the lantus?
I have tried yesterday and today to phone the hospital but just get an answering machine.
Please can anyone help me.Thankyou.
 
Hi jonny,

It's difficult for anyone here to say with certainty where the problem lies, without a lot more background information. It could be related to diet, Lantus doses, timings, underlying illness, or even a combination of some of these.
Can you tell us more? For example, what does he eat and when, how much basal and bolus insulin is he using, when does he inject the Lantus. What are his typical blood sugar levels at various points throughout the day.
Chances are that at least some of us will have experienced similar problems at some point and will be delighted to help if we can.

All the best,

fergus
 
hello jonny12,

The not enough insulin explanation
The most obvious reason for your son waking up with high sugar in the morning
will be not enough basal insulin(lantus) during the night. This is solved with extra
lantus the evening before.

The too much insulin explanation(SOMOGYI EFFECT)
If your son's sugar has dropped too low at any point during the night, then his
body's reaction to this low sugar level will be to overcorrect and send his sugars high.
It's more common to wake during nightime hypos, due to the hormones involved in
the body's reaction to low blood sugar, but, in this instance, we're assuming that the
hypo has been slept through.
This is solved with less basal insulin the evening before or a snack (slow-acting
carbohydrate if possible) before bedtime.

Information overload
Just to make things even more confusing, there's "dawn phenomenon", which can
also have an effect on morning blood sugars. The link below will expain it and tell
you how to deal with it's effects.
:arrow: THE THEORY OF DAWN PHENOMENON

All the best,
timo.
 
Thankyou for your advice. I am giving Jonny 4 units of Novorapid before each meal plus 20 lantus just before bed.He always wakes up in the night if he is feeling low so I don't think he is having a hypo during the night.
I have changed his diet in the last few days:
Breakfast - no more cereal, instead one egg, two slices lean bacon and two small slices of oatmeal bread.
Lunch (at school) one BLT sandwich.
Dinner- chicken breast,half a baked potato & lots of veg.
I am now weighing all carbs.

Where am I going wrong?!!!!!
 
Thankyou Fergus for your thread on carbs. I have only recently discovered this forum and we are now following your advice on a low carb diet.
 
Thanks Timo your comments are much appreciated. I will try Jonny with some cheese before bed tonight and up his lantus by 2 units.
 
That'll be spot on, jonny12. No more than +2 units lantus at a time, and see how he gets on.

Good luck,
timo.
 
Thanks Sarah. Could the lantus run out when he is injecting it at 9:30pm (his bedtime)? Testing all through the night is not practical for us as Jonny is twelve and going to school with no sleep isn't going to do him any good.However only four weeks of school left so we could do this during the summer holidays.
 
Thanks.He has only been on lantus for two days! Should his BS be around 5 before we inject the lantus? Does Lantus maintain whatever your blood sugar reading is or can it lower it.We have only changed from Novomix30 to Novorapid and Lantus to give us more control but I don't feel we are achieving this.
I guess I am an impatient person and want instant results!!
Seriously though I just want to keep my son in the best possible health.
 
jonny12 said:
Thanks Sarah.The information on this forum is fantastic.
Click to expand...

More than fantastic, it is awesome. I knew NOTHING before I came on here, and with the help of some of these guys I have a handle (if not actual control!) on what my body is doing.

I'm loved up, you will be too.

Hope you stick around and good luck.
 
Hi Jonny's Mum

If you are giving Jonny 20 units of Lantus before bed and his bg level is normally about 5 then you should I think give him some carbohydrate of about 10 grams before he goes to sleep. This should then see him through the night without causing a hypo about 2am. Do take note though of what Timo has said. I myself have found that Lantus does have a peaking action to it approx 4 hours after it has been injected and will be active in the background for about 12-15 hours.

I have been using Lantus since 2002 . I'm afraid that contrary to what Sarah has said, it doesnt necessarily keep bg stable all night without the intake of carb. I for one have tried many times to go to bed without eating any carb at all having a bg of 5 and just injecting a slightly lower than usual dose of Lantus but found that I had really high bg levels in the morning. I then increased my dose but found myself going hypo. In the end I gave up fighting with the Lantus and just kept to my usual dose and fed it some carb before going to bed. All of us are different though so you just have to find out what it is going to work for Jonny.

It does take time to get the correct dose of Lantus sorted so you will have to use the 'trial and error' method to find out how much Lantus to inject according to what Jonny's bg level is and how much carb you need to give him to eat. If Jonny can wake up in the morning with a bg of about 4 or 5 you'll know that you've cracked it.

Good Luck :)
 
Thanks tinkerbelly. I was advised to give Jonny cheese tonight before bed. Would a 10g carb snack be better? We eat bread with oats and seeds in one slice = 16g carbs. So 3/4 of a slice of bread would be O.K?
 
My daughter is 9. She is on novarapid after every meal, and Lantus in the evening.

We carb count every meal. Her BG can be fine for weeks then go all over the place for no reason. So I wait a few days to see if there is pattern before changing dose.


We have been advised to only increase/decrease Lantus by one unit at a time and only alter amount once a week. If she goes without supper her bloods are all over the place for the following day.

I do check her blood occasionally in the night and she doesn't even wake up.

Good Luck.
 
Hi

Yes, try that and see how things go. Everyone learns as they go along. Jonny may need to eat 10gms, 15grms or just 5 or 8grms. You'll eventually find the correct amount by what his bg level is in the morning before breakfast.

Just ask if you need anymore help lol
 
This advice is so helpful I can't thank you enough.Hospital said he did not need snacks with Novorapid.He is definately having supper tonight.
Just been on Amazon to buy "think like a pancreas".
I have just started the carb counting.
Previous guidance from doctor/dietician was lots of carbs with every meal!
I am slowly going to reduce the carbs once I get his BG's under control.
 
I think they tell all parents to make sure they eat carbs with everything and not to cut anything out of their diet.

We were told three meals a day, mid morning snack, and supper. But she now has an afternoon snack at 2:15 or she is hypo by 4 o,clock. If we reduce insulin at lunch she is to high at tea.

Daughter never misses supper or any other snack or meal time as she is constantly hungry.

Carb counting soon becomes second nature. Sad but true.

One thing we have found with carb counting is with porridge and pancakes she always need extra insulin.
Its very much trial and error. Plus to keep you on your toes, what works one week might not work another.

Good Luck hope he enjoys his supper
 
Hi Again

I have always used snacks as part of my regime. I have 3 main meals plus a snack mid morning, mid afternoon and before bedtime.

I do not eat a high carb diet though, just smaller amounts in varying quantity according to what my bg levels are, and what I want them to be 2.5 - 3hrs later. I test myself approx 5 - 6 times a day. I have always been led to believe over the past 40 years that this is the best way to control blood sugar levels.
 
Well, jonny12, see what happens when you ask a simple question?!
I hope the avalanche of advice isn't too much - there's a severe danger of information overload when you admit to being a newbie and all the old lags want to take you under their wing :)
I must say, you seem like a completely fantastic parent, making such an effort to help your child. It's life affirming. My folks simply left me to it.
I think the only thing to say here is that you can already see how advice differs from person to person. I didn't want to offer specific advice until I knew much more about your specific circumstances. I think the message would be that trial and error will lead you to a solution, but that you have made a terrific start. I was particularly impressed with the diet you had devised after such a short period of time.
Keep in touch, keep asking questions, and you'll have no shortage of advice!

All the best,

fergus
 
All your advice is really appreciated. We could of gone for months not knowing where we were going wrong. I am up early this morning waiting for Jonny to wake up so I can measure him!
I will be back on line later to let you know what his reading was.
I am delighted to have found this forum, it has given me a much more posotive outlook.
(And some people think the internet is a bad thing!).
 
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