Lantus and Hypo's

[Mini-Mimi]

hi all, just wondering if any of you can shed some light on this until i can get hold of the DSN.
Mimi was changed from 2 injections a day to 4 last week, Novorapid with meals and Lantus at bedtime, we was told to give her 2 units of Lantus, did that and during the night she had a hypo. DSN then tells us to lower it to just 1 unit, did that and still she either has a hypo or goes very low, i am getting up in the night every 2-3 hours to check her bsl's and give her something to eat, this has happened every night since we changed over, she is tired, i am tired and surely this isnt normal or is it? does it take a while for it to kick in? My DSN isnt available til Wednesday now.
thanks in advance x

 

[leggott]

Can you let us know what time the hypo's are happening, as they may be down to the novorapid given at tea time. You may need to send your dAughter to bed with a small snack so she doesn't drop too low in the night - sometimes a small amount of slow acting carb given just before bed can help. Another option might be to reduce lantos to half a unit?

 

[Mini-Mimi]

the pen that i use doesnt work in half units, i already asked the nurse that when we dropped from 2 to 1.
she usually has tea at about 4.30, a snack before bed at about 7.30, then i check on her at 10ish and more often than not she's in the 5's, i'll check again at midnight and she'll be low, 3am, low again...........i just dont know whats going on with her and not being able to get hold of the DSN just makes me worry even more.

 

[leggott]

it sounds like the dose does need to be reduced to half a unit. In the meantime, you probably need to increase the snack by about 5 g and see if this makes a difference.

 

[Mini-Mimi]

the thing i'm finding hard is that the past few days she eats tea at 4.30, lantus at 6 an at 6.30 she's wanting to go to bed, i give her biscuits and milk before bed but like last night, i'm having to wake her during the night to give her more to eat so she doesnt go lower, which is a struggle cos she's obviously tired and doesnt want to eat.

 

[leggott]

We like to leave it 3 hours after tea before bed so we can make sure novo rapid has almost done it's job, but I appreciate this can be hard with one so small. may be try for a few days giving tea at 4pm and then bed at 7. What are her readings before bed and during the night? You may find that the reason she is dropping soon after bed is because the novo rapid is still working. if it is happening later on in the night, then lantus will need to be reduced and it might we worth your while buying a half unit pen yourself if you still can't get hold of DSN or calling your local hospital for advice.

 

[leggott]

Forgot to say that if bg too low during the night and you need to treat, then we find that a drop of juice is easier. For my son it only takes about 50ml of apple juice to bring his bg up in the night. We give it to him through a straw which is better for teeth and he can even lay down and suck up the juice rather than mAking him sit up and have to chew a glucose tab. I know how hard it is trying to feed a small kid during the night when they are so sleepy and non compliant.

 

[Jen&Khaleb]

I'd think it might be worth asking to change over to giving the Lantas in the Morning rather than at night but to be honest I really like having Khaleb split morning and night with Levemir. I suppose you have to remember that being fairly newly diagnosed and after a couple of months of pancreatic recovery your daughter could be producing a reasonable amount of insulin. When Khaleb was very little I quite often didn't give him any Novorapid with dinner and he would start the night (10pm) with a blood sugar around 15mmol to last the night. He would still occassionally hypo if he'd had a big exercise day. I discovered that he dropped very quickly when the Levemir 'kicked in' so he was never high for very long but I couldn't avoid a few evening peaks.

As for the lack of sleep I can say I've lost countless nights since Khaleb's dx. He's been sick most of this year so I've missed more sleep than usual. I've only in the last week started getting a full night of sleep again because he's finally got stable and predictable levels. My record for nights of sleep 'in a row' is 9 since dx.

You really need to insist on a half unit pen. I couldn't live without them. Half a unit drops Khaleb 4 mmol these days and will take care of about 5gm carb eaten. In the very early days it would have dropped him about 7 mmol! Khaleb is also currently on 6.5 units Levemir twice a day which is keeping him in the 6's all day with the rest of his routine .

When you have to treat a hypo in the night do you find your daughter high in the morning or good?

Anyway, hang in there and hope you had a good Christmas.

 

[Mini-Mimi]

her novorapid pen dishes out half units but the lantus pen only works in full units, but the lantus cartridge wont fit in the novorapid pen.............. :shock:
i am usually treating her for hypos at around 2-3am, she gets up at about 8.30 an is mostly high 4's or low 5's.
before the change over she was really stable and i didnt have to check her in the night, i'd check before i went to bed and that would be it and she would wake up with good levels.
she went up last night to bed at 6.30 with a bsl of 15,(i gave her biscuits and milk hoping they'd see her through) which then dropped to 12 at 10pm, then shot down to 3.6 at 3am, i treated the hypo and she woke up with a reading of 4...........
roll on tomorrow when i can speak to the dsn and hopefull try to sort it x

 

[leggott]

It sounds like she may well only need 1/2 a unit of lantus or may be none at all if her levels are falling by that much! Basal insulin should be there to keep the bg stable, although there will be a degree of fluctuation but not that much. Hopefully your DSN can give you some guidance, and I suspect that will be to reduce basal. it might also be worth giving it in the morning at breakfast, but only ever make one change at a time and leave things for a few days before making another chAnge, otherwise it can be difficult to work out what change worked.

 

[ams162]

Hiya so sorry ur so tired its not easy living with diabetes in those first few months we have found with our son he has to have a blood sugar reading of over 10 to make it through the night anywhere under we have serious hypos, it does take a while to get it all sorted in fact we are not sorted now 4 years on lol but dylan is a puzzle to everyone, im surprised u cant get hold of anyone though we have 3 nurses and one is always on duty between 8 and 8 and after that we can talk to a consultant on the ward if we need to (not that they are as helpful as the nurses ). i hope u get this sorted for ur sanity if nothing else being tired all the time is the worst. good luck

 

[Mini-Mimi]

thanks for all the replies, i dont worry half as much through knowing that i can come on here and get great advice
i dont like to ring the hospital up as i usually have to explain everything twice/thrice over and tbh, i'd rather deal with the DSN than some doctor on a ward, i mean, the DSN knows Mimi, knows what she's on and she knows what i'm doing, the doctor is just a voice on the end of the line, if you know what i mean.
roll on 9am in the morning

 

[ams162]

yes i know exactly what u mean hun, we have 3 nurses but i nearly always talk to the same one as its easier dealing with one person who knows exactly what we have been trying and what is and isnt working only time i phone the hosp is if hes really ill and need some urgent advice

 

[Jen&Khaleb]

The only time I ring the nurse is if Khaleb is really ill. I think I only do this to warn them in the event I need to bring him in .

You have to get cartridges prescribed to be able to put the vials into half unit pens otherwise you just get the disposable ones.

Hope you can fix the night time hypos or they might fix themselves when she is unable to produce any insulin herself. I don't really mind just popping out of bed at night and doing a quick test. If I have to then treat a hypo and re-test I find it really hard to go back to sleep. We've been going to the pool most days and Khaleb's blood sugar has been heading down from the activity at stupid times.

Take care,

 

[Mini-Mimi]

well i got hold of the nurse and she told me the lantus pens dont come in half unit measures so we have to stick with the 1 unit, but instead of using 1 unit of novorapid per 25g of carbs, to change it to 1:30, (but only at tea time) and see how that goes.

 

[Deb Arkle]

Mini-Mimi, if it's any help we changed to Levemir instead of Lantus a couple of months ago, you use the same pen as for NovoRapid so you can give half unit doses. However, we found that Mini Deb's levels were all over the shop with Levemir, she was generally much higher and the levels didn't seem to correlate with her dosage, so we changed back to Lantus. It might be worth trying Levemir for your little girl though, I doubt everyone has the same OTT reaction as Mini Deb did. I hope you get it sorted!

 

[Mini-Mimi]

after another nightime hypo we've decided that this routine just doesnt suit her at all and have gone back to 2 injections of Novomix 30 a day, yes it is restrictive but i got very good control with it and thats what i'm missing now, her levels are sky high one reading, and very low the next. the novomix is only restrictive to me so i'm going to work around that and hopefully get her bsl steady again.

 

[ams162]

Thats great if it suits u, u might find as she grows it isnt enough for her, we have never had good control on anything best we have managed is with levemir twice daily and multiple rapid injections on top of that, we are now looking at an insulin pump to help dylan and have just been awarded funding so hopefully wont be too much longer. everyone has an option that suits them its great u found urs good luck for the future
anna marie x

 

[leggott]

Would recommend testing again a few times during the night over the next few nights, just to make sure her bloods are ok after switching back.

 

[Mini-Mimi]

yeah, i wont settle anyway til they're steady again