if on MDI your background is at the correct level and you eat a bedtime snack of around 30g carb after the last novarapid has worn off would you expect you BG (which were 6 before the snack and have rised to around 15 1hour after the snack) to remain high all night or would the background insulin chip away at the carb and bring you back down to nearer 6 by the morning ?
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late night snack
- Thread starter Matt1212
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totsy
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i wouldnt eat 30g ever without injecting for it, even a 10g snack often puts me up a couple of mmol 
I guess everyone is different so what works for my daughter may not be the same as for you. If my daughter were to have a late evening snack after her rapid has worn off then she most certainly will wake with a high reading the next morning. T
he background insulin in her case keeps her blood sugars steady all night (provided she's had no or a carb free snack), if a carb snack is introduced the Levemir will not cope with this and Rapid would need to be given to cover the snack.
She has her Levemir split into two doses, one in the morning and one at night. I guess if you're having a larger single dose at night then perhaps it will chip away at your levels through the night. But I don't think this is good in any case because surely you'd then be spending quite a few hours with a high reading before the background insulin brings your levels into an acceptable range?
he background insulin in her case keeps her blood sugars steady all night (provided she's had no or a carb free snack), if a carb snack is introduced the Levemir will not cope with this and Rapid would need to be given to cover the snack.
She has her Levemir split into two doses, one in the morning and one at night. I guess if you're having a larger single dose at night then perhaps it will chip away at your levels through the night. But I don't think this is good in any case because surely you'd then be spending quite a few hours with a high reading before the background insulin brings your levels into an acceptable range?
thanks Sophia - my questions relates to my 5 yr old daughter , we have deliberately been keeping her levemir higher than would keep her steady at a fasting level to allow for mid morning / afternoon and evening snacks - this has worked for a couple of months but now we seem to be getting hypos regularily before evening meals and then subsequent highs late at night
We are now lowering the background to try and stop the lows (we use insuman rather than novarapid at night to try and cover the bedtime snack)
good point on the levermir as we do not split and give at 6pm , however i would have thought it would have run out by later afternoon when we get the lows so I am still confused (maybe lunch novarapid ratio needs increasing ?)
We are now lowering the background to try and stop the lows (we use insuman rather than novarapid at night to try and cover the bedtime snack)
good point on the levermir as we do not split and give at 6pm , however i would have thought it would have run out by later afternoon when we get the lows so I am still confused (maybe lunch novarapid ratio needs increasing ?)
I think the trouble with giving a higher basal to cover snacks is that you run the risk of hypos if you miss that snack or when your child is active doing sports. If Jess does sport in the afternoon she can have the snack without a bolus to cover it, is she doesn't do sport then she'd need a bolus for that snack. Have you tried keeping your snacks to carb free/low carb foods? That has worked very well for us if Jess doesn't want that extra injection and isn't doing sport to compensate for the snack.
If you're giving basal at 6pm and you think it would have worn off by later afternoon the next day which is when she's experiencing hypos then I'd think that it's her lunchtime novorapid that needs correcting.
We found the best way to work it all out was to do some fasting tests. Once we had the Levemir worked out to keep fasting levels stable throught day and night then it was easy to work out the novorapid ratios which vary depending on the time of the day. We also learned from this that it was necessary to split the Levemir into two injections, one at 8am and one at 8.30pm.
Also just wanted to add that a 30g carb snack is quite high. Jess' carb snacks are seldomly over 10g carbs, a meal is usually around 40-50g carbs
If you're giving basal at 6pm and you think it would have worn off by later afternoon the next day which is when she's experiencing hypos then I'd think that it's her lunchtime novorapid that needs correcting.
We found the best way to work it all out was to do some fasting tests. Once we had the Levemir worked out to keep fasting levels stable throught day and night then it was easy to work out the novorapid ratios which vary depending on the time of the day. We also learned from this that it was necessary to split the Levemir into two injections, one at 8am and one at 8.30pm.
Also just wanted to add that a 30g carb snack is quite high. Jess' carb snacks are seldomly over 10g carbs, a meal is usually around 40-50g carbs
In theory the levemir is only there as background coverage and should not be used to cover snacks, however, if the dose is too high then a larger snack will be needed prior to bed and probably snacks between meals as well. You have to remember though, the blood will go up relatively quickly, but take several hours to come back down to the desired level in the morning, resulting in higher blood levels through out the night, not an ideal situation. You then may as well be on the mixed insulins, we are not seen to be as effective since they don't bring the blood down as quickly as basal/ bolus regime.
If your daughter is like my kids, they sleep about 11 - 12 hours, so her blood sugar levels would be higher than you would like for a long period.
We have also had this problem of snacks at night with our kids, as they are quite young, they like something before bed, but we don't like giving novorapid before bed encase they hypo. We now only give them a small snack ie 5g of carb if their blood sugars prior to bed time are lower than 7mmol. We try and compensate with things like popcorn, crackers and cheese, sugar free jellies or sugar free ice-pops. This issue has always posed a problem for us too, we also have the added problem when one can have a small carb snack but the other one can't!
If your daughter is like my kids, they sleep about 11 - 12 hours, so her blood sugar levels would be higher than you would like for a long period.
We have also had this problem of snacks at night with our kids, as they are quite young, they like something before bed, but we don't like giving novorapid before bed encase they hypo. We now only give them a small snack ie 5g of carb if their blood sugars prior to bed time are lower than 7mmol. We try and compensate with things like popcorn, crackers and cheese, sugar free jellies or sugar free ice-pops. This issue has always posed a problem for us too, we also have the added problem when one can have a small carb snack but the other one can't!
Since being diagnosed we were told to give Ewan a supper of about 20 carbs, he,s still in honeymoon so might be different from everyone else. Usually he goes to bed around 8 and gets up maybe 7 or less. If he is does have a high bs at supper time then I will reduce supper and occasionally not have one, very hard though with 2 kids as leggot says. I dont like giving novo at night either in case he hypos have had to do it a couple of times for corrections and its been awful. He is still on 1 levimer injection which I expect will change as most people seem to be on two. Tonight we have lowered his levimer as he has been having hypos this week.
suzi
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Hi Matt,
the only thing i can suggest is that you try giving your daughter a snack before bed and experiment, its all trial and error with diabetese i'm afraid and what works for one child, might not work for another. Andrew is 11 and on 23units of Levemir at bedtime, now he usually has a snack before bed, about 20g carbs, and it doesn't affect his bs readings in the morning. Sometimes if he doesn't bother having a snack and readings are ok before bed he'll wake with bs of 3.8 slightly lower than i would like, but easy to correct with fruit juice with breakfast.
We have also began spitting the Levemir (because it definately runs out at 4pm) and top him up with 4units of Levemir at breakfast, tried an equal split, didn't work, and his Dr reckons his just one of those unusual kids who needs more at night. You can but try, you will eventually find what works best for your daughter, of course if shes newly diagnosed, then it'll be a bit more of a juggling act as she'll still be in the honeymoon phase.
Good luck and let us know how you get on, take care,
Suzi x
the only thing i can suggest is that you try giving your daughter a snack before bed and experiment, its all trial and error with diabetese i'm afraid and what works for one child, might not work for another. Andrew is 11 and on 23units of Levemir at bedtime, now he usually has a snack before bed, about 20g carbs, and it doesn't affect his bs readings in the morning. Sometimes if he doesn't bother having a snack and readings are ok before bed he'll wake with bs of 3.8 slightly lower than i would like, but easy to correct with fruit juice with breakfast.
We have also began spitting the Levemir (because it definately runs out at 4pm) and top him up with 4units of Levemir at breakfast, tried an equal split, didn't work, and his Dr reckons his just one of those unusual kids who needs more at night. You can but try, you will eventually find what works best for your daughter, of course if shes newly diagnosed, then it'll be a bit more of a juggling act as she'll still be in the honeymoon phase.
Good luck and let us know how you get on, take care,
Suzi x
Jen&Khaleb
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Khaleb would be one of those kids that is on a higher level of Levemir. A lot of this is due to a low body weight and the fact that half a unit of Novorapid is going to drop Khaleb's blood sugar 10-15mmol. This makes it impossible to try and correct or even inject for snacks as I would have to give him a snack of 20-30gr carb. He would then not eat his meal, would be over-weight and having too many doses overlap. Yes, Khaleb's blood sugar does continue to drop overnight and he can be prone to hypo if snacks are late. Khaleb's food is also limited as it needs to be puree or mashed. I actually don't see how I could only use the Levemir as a basal dose at this stage of life but can certainly see that as he is getting older and the ratios change it gets a little easier. 
Khaleb's supper varies a little bit depending on what his bsl is about 8pm. 20gr carb is about normal and if it is low GI he will not go very high. He still gets a bottle of watered down milk in the evening also. I'm pretty happy if he doesn't go above 15mmol and wakes in single figures (above 4 of course).
After saying this I can also say that Khaleb is getting very low doses of insulin, but because of the thyroid medication being introduced, he has had a couple of hypos. His medical team have told me not to correct anything below 16mmol. He went from 12mmol at 2.45am to 2.7mml at 6am even with nearly a 30% reduction in insulin. This should settle in the next week or so. I tried to borrow a CGM but because he isn't on a pump I couldn't get one. :evil:
As Suzi said, it is just trial and error over and over again.
Khaleb's supper varies a little bit depending on what his bsl is about 8pm. 20gr carb is about normal and if it is low GI he will not go very high. He still gets a bottle of watered down milk in the evening also. I'm pretty happy if he doesn't go above 15mmol and wakes in single figures (above 4 of course).
After saying this I can also say that Khaleb is getting very low doses of insulin, but because of the thyroid medication being introduced, he has had a couple of hypos. His medical team have told me not to correct anything below 16mmol. He went from 12mmol at 2.45am to 2.7mml at 6am even with nearly a 30% reduction in insulin. This should settle in the next week or so. I tried to borrow a CGM but because he isn't on a pump I couldn't get one. :evil:
As Suzi said, it is just trial and error over and over again.
suzi
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Hi Jen,
I would push for a CGM, Andrew was offered one at a time when his bs was all over the place and they wanted to see if a pattern was emerging and how his insulin was working. But he refused as he is totally against the idea of something attached to him 24/7, don't think he'll be pumping for a while!!!
So as it would be of benefit for both you ,Khalab and the medical team, then to refuse him a CGM, is totally ****, in this country there for all diabetics, not just pumpers (no offence to pumpers) so if you want one, go and argue for it, i'd come and help, but Australias too far away, sorry Jen.
Suzi x
I would push for a CGM, Andrew was offered one at a time when his bs was all over the place and they wanted to see if a pattern was emerging and how his insulin was working. But he refused as he is totally against the idea of something attached to him 24/7, don't think he'll be pumping for a while!!!
So as it would be of benefit for both you ,Khalab and the medical team, then to refuse him a CGM, is totally ****, in this country there for all diabetics, not just pumpers (no offence to pumpers) so if you want one, go and argue for it, i'd come and help, but Australias too far away, sorry Jen.
Suzi x
Jen&Khaleb
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No CGM available. I gather if he was on a pump the company may supply a CGM and that is how an extra one could have become available. The hospital clinic wrote me a script for 2 hypo kits. I am treating Khaleb like sick day management and waiting for his bsl to rise before giving insulin or only half dosing his meal. Long acting is quite reduced also.
I don't know how Khaleb would cope with something attached to him - I've only just got him to keep a hat on his head. I know they use the CGM's as a bit of a trial for kids wanting to pump. I think I'd like to get Khaleb pumping in the future if I can wrestle the red tape. I've been told that once his thyroid levels are more normal he should have better bsl's. I'm surprised he was started on such a high dose of Thyroxine as the packets says adults are started on much lower doses. It must just be because his levels are so high.
Anyway, it shouldn't be too much longer and I can bring his levels back to normal.
I don't know how Khaleb would cope with something attached to him - I've only just got him to keep a hat on his head. I know they use the CGM's as a bit of a trial for kids wanting to pump. I think I'd like to get Khaleb pumping in the future if I can wrestle the red tape. I've been told that once his thyroid levels are more normal he should have better bsl's. I'm surprised he was started on such a high dose of Thyroxine as the packets says adults are started on much lower doses. It must just be because his levels are so high.
Anyway, it shouldn't be too much longer and I can bring his levels back to normal.
