Help please, with high eve BMs

[shellyk]

Hi all forgive me asking yet another question this is all still so new to us. my 14 year was diagnosed in march and is doing really well, through the day mostly she has acheived resoanable control, but the evenings remain a problem. she will eat her main meal around 5-530pm usually taking 6 units of novarapid, what is happening in that he 2 hour post meal BM is ok but at bed time has gone high

for example last night had chilli with tortilla bread and a very small slice of daddy's birthday cake
pre meal bm was 4.1, post meal 5.6 and 12.6 at bed time ( she did not eat anything else) , this is a very common pattern for her in the evening, clearly she needs more insulinn to cover the larger eve meal, but when we have tried increasing to 7 unit of nova rapid she has a hypo ! Any suggestions ?

 

[louiseb]

Im type 2 and no experience of insulin so sorry I cant offer any advice other than have you tried speaking to DSN they would be best to advise.

 

[shellyk]

Yes have spoken to her nurse, but she currently to more focused on preventing hypos rather that worring about highs ! Very frustrating

 

[Spearmint]

Hi all forgive me asking yet another question this is all still so new to us. my 14 year was diagnosed in march and is doing really well, through the day mostly she has acheived resoanable control, but the evenings remain a problem. she will eat her main meal around 5-530pm usually taking 6 units of novarapid, what is happening in that he 2 hour post meal BM is ok but at bed time has gone high

for example last night had chilli with tortilla bread and a very small slice of daddy's birthday cake
pre meal bm was 4.1, post meal 5.6 and 12.6 at bed time ( she did not eat anything else) , this is a very common pattern for her in the evening, clearly she needs more insulinn to cover the larger eve meal, but when we have tried increasing to 7 unit of nova rapid she has a hypo ! Any suggestions ?

Hi

My daughter was changed from premix to basal/bolus 2 weeks ago and this week i am having the same problem as you!!
She goes to bed 2 hours after dinner testing 5-6 at 7:30pm, i test her about 10pm and she has gone up to 12-15 :?
I don't really have any advice as i am not sure what to change myself.
Spoke to her nurse yesterday, and last night she had her levemir at dinnertime instead of bedtime and reduced the insulin to carb ratio for her dinner but it had no effect other than to make her higher this morning :?
I am going to do the same again today and see what happens tonight and in the morning, if it is the same then i am thinking of upping the levemir dose at dinnertime but i have no idea if this is the right thing to do or not

 

[wsmum]

This is an interesting thread ... my son had exactly the same problem for about 2 weeks recently (Spearmint, can see from this thread that you're v. experienced so my post on the other thread was probably a case of 'teaching grandmother to suck eggs' ... )
We were away on holiday at the time. Son had 2 novorapid pens, one in his bag for the daytime and another at our holiday cottage, which he happened to use for the evening meal. His numbers went up to 15 before bed. I called his diabetic team for advice, and they said to give a correction dose. Didn't work (stayed at 15)! So I assumed the pen had gone wrong for some reason and did a correction dose from the other one. Numbers went down. The next evening, exactly the same thing happened with the 'non faulty' pen! So it was something else going on. We adjusted his carb:insulin ratio for the evening meal and that helped but he was still going a bit high (11 or 12) at bedtime. Things are better again now, after about 2 weeks of this. He didn't seem ill (although he did have hayfever but everyone assures me that shouldn't be a big problem), so I'm wondering if he was having a growth spurt? Don't think it was the different stuff we were doing on holiday as it carried on when we got home ...
I hope that your kids find it's a short-lived thing too. Would be interested to know how your experiments go!
Catherine

 

[Spearmint]

This is an interesting thread ... my son had exactly the same problem for about 2 weeks recently (Spearmint, can see from this thread that you're v. experienced so my post on the other thread was probably a case of 'teaching grandmother to suck eggs' ... )

I hope that your kids find it's a short-lived thing too. Would be interested to know how your experiments go!
Catherine

Nooooo i am not experience really!!
My daughter was on a premix injected twice a day with specific carb amounts for each meal and snack time.
I had to drastically reduce her doses to the bare minimum 6mths ago but still had problems with hypos, after much deliberating by the hospital she was moved to the basal/bolus routine 2 weeks ago and i feel like i have gone right back to the day she was diagnosed but without the daily support and advice i got back then!

 

[wsmum]

I know ... lack of daily support is v.hard. We have a nice DSN but she's so busy that she often calls back the next day, by which time you've had to make a decision.
When my son was diagnosed he was in hospital about something else, and a nurse treating him (who just happened to be a diabetic) said don't be afraid to experiment a bit when you can't get a response. So that's what we did, pretty much right from the start ... of course, if something really serious was going on I might not take the 'suck it and see' approach!
If it's a question of tweaking doses, we only change one insulin at a time so we can be sure which one is responsible, and wait for a bit to see the effect. Changes to Lantus (not sure if this applies to Levemir) can take a few days to get established, while Novorapid is faster. I suppose in the end, we all become the experts on our (or our child's) conditions since we're the ones who have to cope 24 hours. But it would be nice if we could have someone on the end of the phone when things go pear shaped ... we are lucky because we're allowed to phone the hospital's paediatric ward if the call is urgent and the DSN is not there.
This other nurse also told us she got her DAFNE invite a year after being put on MDI! We haven't been taught carb counting officially either and they don't offer DAFNE where we live, but I can't really see how you can do MDI successfully without carb counting :x
I've been reading a couple of books (Ragnar Hanas and Gary Scheiner) and lurking on this and other forums to get as much help as poss. William is still in a strong honeymoon period (ratios are in the 1:60 range, and has 4 units of Lantus) so I daresay everything is going to change when that comes to an end ... quite nervous about it in fact ... No 'anxious face' smiley available but if there was I'd use it now!
Catherine

 

[Spearmint]

Same here Catherine, there is only 1 nurse who has 3 times as many children in her care as she is supposed to have
I felt confident changing the premix doses as i knew where i was with them and food, if that makes sense but i am still feeling a bit lost with this changeover.
When she was on the premix i used novorapid as a booster, to either bring down unexpected highs or to cover a bigger meal when eating out and her ration then was same as yours - 1:60 for food and 1 unit would lower her levels by 1-12.
Her initial starting doses were 2units levemir daily, 0.5units breakfast, 1 unit lunch, 1.5units dinner.
She then came down with food poisoning the day after we started the basal/bolus routine which threw us out for a week!
She is currently having 10units levemir twice daily, novorapid is 3units breakfast, 3units lunch, 5units dinner on average so a massive difference :shock:

They do DAFNE here but only for over 18's, there is nothing for children or parents, i got given a small book which lists carb amounts for different foods per 100g
I found out through this forum about an online course though which i have done this week, i passed the end of section tests apart from the one where you have to visualise how many carbs but i can't seem to be able to put into practice what i learnt!!

http://www.bdec-e-learning.com/

 

[shellyk]

Hi everyone , it is so nice to hear people experiecing the same kind of frustrations as me, thouight it was me doing something wrong. Our DSN has been fab but at the end of the dsy are not on the phone 23/7, so we have also started `playing` with her doses, My daughter had started her period shortly before the diabetes arrives but stopped when she lost the weight, but returned this month to add another set of stress. I think i may of been a little naive but i thought things would settle down and life would more of less return to normal, I am just longing for a day when my firdt last and every thought inbetween seems to be about diabetes. Sorry to rant i have good days and bad, and this is def a bad. we have just been tught basics of carb counting and hope in the cvomming weesk this migyht provide a bit of stabilty.

Hopefully things will setlle again thanks to all you fellow mums out there for the ever practical advice and somebody to rant to

 

[wsmum]

@ Spearmint: interesting about the huge difference in doses before and after food poisoning! I wonder why that is? I also wonder about the balance between bolus and basal. I was under the impression that somewhere around 50:50 was the usual balance (give or take), so for instance you might have 15 units of basal in total, and 5 units of bolus with each meal. In our case, my son has 4 units basal and 1-2 bolus with each meal, depending on how many carbs he eats. 20 units of Levemir against 11 novorapid sounds a bit odd so I would ask about that - they may have their reasons but it would be good to know what they are!
@shellyk: I've read on this forum that many women find their cycles really play havoc with blood sugar ... I'm 40 something and going through perimenopause, and not diabetic so hardly a comparison :-D but I do feel quite shaky at certain times of the month, and my GP said it was low blood sugar! So maybe there will be different rules for different days ... groan ....

 

[wsmum]

Me again ... just wondering Spearmint what happened to your daughter's levels when she had food poisoning? Poor girl - did she end up in hospital? If she went very high that would explain the higher doses to get things back under control. Maybe the next few weeks are going to be a bit hit and miss as she returns to normal ... after diagnosis William's doses came down very slowly and his numbers were all over the place. Perhaps this sort of thing is to be expected after illness too?

 

[Spearmint]

Me again ... just wondering Spearmint what happened to your daughter's levels when she had food poisoning? Poor girl - did she end up in hospital? If she went very high that would explain the higher doses to get things back under control. Maybe the next few weeks are going to be a bit hit and miss as she returns to normal ... after diagnosis William's doses came down very slowly and his numbers were all over the place. Perhaps this sort of thing is to be expected after illness too?

Yes i know her ratio is about 65:35 for basal/bolus which does seem really different to everyone else!!

Me and my eldest had food poisoning too, all at the same time
The first day she woke up at 18, an hour later 20, 2 hours later 28 and +4 ketones :shock:
I panicked
I rang her nurse thinking they would want to admit her but she said i can just do 2 hourly tests and injections of novorapid at home, she gave me a scale of how much to give her according to what her levels were, she did ring 3 times a day to see how things were but i was so worried
She was having 40 units of novorapid most days and the 2 hourly tests and injections carried on for 2 days after she was better which was 7 days in total i think.
The 5 days after she was better levemir was 14 units twice daily, then dropped to 12 units twice daily for a few days and then i dropped it to 10 units twice daily because she want from being 11 before breakfast to being 2.9 3 hours later.
She was a bit more stable for a few days, levels 9-11 so too high but at least there was some stability and then this week it has gone all over the place :?

 

[ebony321]

Hi all forgive me asking yet another question this is all still so new to us. my 14 year was diagnosed in march and is doing really well, through the day mostly she has acheived resoanable control, but the evenings remain a problem. she will eat her main meal around 5-530pm usually taking 6 units of novarapid, what is happening in that he 2 hour post meal BM is ok but at bed time has gone high

for example last night had chilli with tortilla bread and a very small slice of daddy's birthday cake
pre meal bm was 4.1, post meal 5.6 and 12.6 at bed time ( she did not eat anything else) , this is a very common pattern for her in the evening, clearly she needs more insulinn to cover the larger eve meal, but when we have tried increasing to 7 unit of nova rapid she has a hypo ! Any suggestions ?

Hi,

I've only read this post as i'm hurried for time, so not sure if it's been discussed..

What sort of background insulin is she on? does she take this only once? and at what time?

my reasoning for this is that some insulins are commonly know not to last a full 24 hours. Which could explain the usually pattern of an increase even though her BG's appear to be good beforehand.

Most people tackle this by splitting the background insulin dose, one in the morning and one at night 12 hours apart acheving better coverage.

Was the post meal reading 2 hours after the meal? unless the meal was high in carbs or fat that would take a long time to digest i wouldn't blame it on the evening meal without looking into the background insulin aswell.


the only way to find out if it is the background insulin running out and not the evening meal dose is to fast i'm afraid. not eating over tea time to bed time testing every hour to see if there's a rise in BG without food being the cause.

Your specialist should be able to advise you how to do this safely, and if it does appear to be the background insulin then your specialist can also advise you on how to go about splitting your doses too.

 

[shellyk]

Thanks ebony321, F curretly has 12 units of levilmir around 2130, i hadn't consdiered that this might be `running ou` will ask DSN if things dont settle in next couple of days, not sure my daughter would be trilled to add another injection into a regime, of course i assume another injection, it might be being a bit dim but is there a way to give novarapid and levimir together ?

 

[ebony321]

Thanks ebony321, F curretly has 12 units of levilmir around 2130, i hadn't consdiered that this might be `running ou` will ask DSN if things dont settle in next couple of days, not sure my daughter would be trilled to add another injection into a regime, of course i assume another injection, it might be being a bit dim but is there a way to give novarapid and levimir together ?

Sounds like it may be the case, levemir is quite reknown for not lasting 24 hours, so it looks like it's running out and allowing her BG's to rise.

I know it's an extra injection and a pain (one is too many for a child!) but it may be the only way to prevent this high, it's important she has stable BG's overnight as it's a large portion of the day.

Some people draw both of the insulins up into a syringe but this is only when on two injections a day, Also some insulins are unable to be mixed due to acid/alkaline levels being different.

Suggest it to your nurse and see if you can come up with a reasonable solution if you do come to the conclusion her background insulin isn't quite making it a full 24 hours.

When i was injecting i too split my Lantus (glargine) to one in morning and one at night, and i hated the fact it was one more, so i understand that will be a big issue. But it might enable to to crack this high your having so it does come with a pro

good luck

Remember consult your DN before making changes

 

[Spearmint]

How are things going shelly?

I seem to have got rid of the 10pm highs but ended up with morning highs which least all day instead!!