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Post-bedtime highs

S

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Type of diabetes
Parent
Treatment type
Insulin
Hey all,

Sad dad of a three-year-old with T1 here.

We've ironed out stacks of problems with meals, doses, timings, snacks and more in the 18 months since his diagnosis, but the current situation has me beaten.

Child has been put to bed many times with a BG in single figures, only for it to rocket up to the 16s and above two hours after he's asleep, and continue to dawdle upwards until the middle of the night when the Levemir starts chipping away at it. It doesn't always happen, but has happened the last three nights in a row.

It's crushing to see my hard-won series of half-decent daytime results ruined like this every night. I may even have headbutted the microwave when the result came up just now :(

Tonight, for example, he went to bed on 8.6 and is now already up to 16.5 two hours later, so that's another ****** night unless I risk giving him a shot while he sleeps. We're told to give him a 10g snack at bedtime, but in view of this problem tonight he only had a 2g cheesy biscuit and a drip of milk. 4g of low GI carbs, max.

I guess it's a dinner GI issue, but tonight I also gave him his injections (novorapid and levemir) after dinner (at about 5.30pm), in an attempt to stop these horrible highs. Went to bed at 8.30pm on 8.6. Thought all might be well, but of course not.

Anyone have any ideas? I can't shrug it off. It's my boy :(

Dinner was pasta. I thought I was friends with pasta.

:(
 
It's so tough to get it right and I wouldn't even try to advise you with such a young child. I do find pasta does slowly keep raising my BG as the evening goes on. What did you give with the pasta?


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Hi Sad!

I haven't really got anything useful to tell you except that the same happens to me quite a lot - and I'm a lot older than 3 LOL. Last night, went to bed on 6.2, woke up on 11.8. Grrr! If I think it's going to be like that, I do take a unit of rapid acting before I go to sleep and that usually works. I know it's more difficult with a little one like your son. I really do feel for you. I certainly wouldn't ever take the amount of carb they recommend before bed - my BG would go sky high. I think it must be the effect of your lad's tea, but it's just so difficult to know.

I hope you sort something out - go back to his diabetes team and see if they have any useful suggestions.

Take care

Smidge
 
With an 8.6 before bed reading would try to skip the pre bed snack. How will you ever know if bssal is correct overnight if having a snack after evening meal. For me a small glass of milk would see a sharp rise sure to the lactose very quick sugar release. There was sufficient time from evening meal to do an overnight basal check with a good reading to go to bed on. Obviously I would advise to do some checks through the night and discuss with your dsn. There should be a level to go to bed.on not needing a snack such as anything above 7~8, if 5~6, have a very small snack (not milk) test through night and see what happens.

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I agree with Brett, I wouldn't eat 10g of carbs before going to bed with numbers like those. Also, do you usually inject novorapid after his meal ? If it was pasta, I think it would be better to inject 5mins or so prior to eating. What are his waking levels like ? Keep a diary ( if you don't already ) and discuss with DSN.


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Cheers all.

Dinner was standard dad dinner of leftover sausages, pasta, chopped tomatoes and a few veggies mixed in.

The more I read other people's similar problems the more I'm convinced it might be a hypo as soon as he goes to sleep. We usually inject before meals -- the injections-after-dinner experiment was an occasional attempt on my part to stop BG trundling up after bedtime. Might give that up and go back to injecting before all the time so we know for sure it's not a hypo.

Our nurses are great, but don't deviate from the script when it comes to bedtime, so it's tough to get over humps like this.

He's in single figures more often than not during the day, so these spikes are totally frustrating.
 
Maybe the tea time ratio needs adjusting ?also when i gave my daughter a 10carb snack it always sent her bloods rocketing how bout low carb snack like ham and cheese ? I used to correct her wen she was asleep and sometimes that took a while to work as she was asleep not active .i no how frustrating this all is for you its really hard and worrying and takes time trying different things till you find out what works .we have just got the pump so the corrections can now be tiny this has a lot .


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It's very difficult when this happens but, like dolly daydream, I've never been able to eat pasta successfully in the evening as the slow release goes on well into the early hours. Even with a pump this food is the toughest to control. But if it's happened 3 nights in a row I'm assuming on the other nights he had a different supper? As others have said, at 8.6 maybe try without carbs or a rich tea biscuit - I find 1 of those doesn't seem to send levels soaring at night. All the best.
 
Personally, I'd give him his main meal at lunch time when he's active and a lower carb meal at tea time.

Smidge
 
After tea 2 hours later check sugar levels the rise should only be about 2.8 if more the ratio may be out ,at this time if a lot higher we give a correction of more insulin ,the expert meter tells you how much to give .we check 2 hours after every meal and note it down to check ratios and the effect certain foods have .also look into the GI of food when you get time ,giving a low GI food will slow the rise down .hope this helps i no how hard it is to get your head round it all but you will x


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I'm sorry you are having a difficult time with your little boy - I find that the overnight glucose control is the hardest thing by far to get to grips with.

Controlling blood sugar is plate spinning basically; there are lots of things that can affect it and you have to try and narrow it down to what could be causing the problems. I tend to overthink things though; often it's a simple issue of too high bloods = not enough insulin.

I'm well aware how the fear of night hypos makes it hard to manage but it something we all need to work around.

If you are giving Novorapid it will last about 4 hours; so test 4 1/2 hours after the short acting; that will show you what is going on with no short acting insulin being present. If it is high then you need to think about changing the night time ratio for the short acting insulin; i.e. increasing the ratio so more insulin is taken. If his bloods are ok at 4 1/2 hours but then rise after that the implication is that the background insulin is too low.

I think there's a lot of 'creative advertising' with the effective action of long acting insulin; I'm on Levemir which I think is good stuff but I split my doses; i.e take half the full dose in the morning and half the full dose at night; this means that you can be sure that the insulin is doing what it's meant to. I think it's nonsense that it lasts 24 hours; in my experience at best it lasts about 16 hours.

The advice to have snacks is related to the time when everyone was on single/twice daily injections and you had to eat to your insulin. My boys who are 3 and 5 would never have snacks after their tea and so there is no reason why your son should and as has been said it makes the whole thing much harder to balance; I'd cut those out straight away (making sure that any additional insulin taken for them is also stopped).

Would your clinic agree to giving you a constant glucose monitor to see what is going on for a couple of weeks? That might give you some clarity here?

The other thing I would suggest is reading 'Think Like A Pancreas' by Gary Sheiner - that has some very good clear explanations of everything that is going on.

Also here is a blog by a mother about how she has got control of her Type 1 child's blood sugars. I'm sure she would provide you with some advice?

http://diabeticalien.blogspot.co.uk/

Good luck with this; I'm sure you will be able to get to grips with this.

Best

Dillinger
 
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Thanks again all.

His before/after meal paired readings are usually pretty decent. Tonight he was 7.0 at 5.30pm before dinner then 7.1 at 8:15pm (unusually close today). He's off to bed with just a 3g biscuit. Looks good as I've just tested him at 9.1 at 10.30pm whereas on bad nights he'd be up to 16 by now.

He had no milk with his biscuit tonight. After seeing a few people on this forum say milk spikes their BGs I thought I'd cut the milk out for a while and see if that's perhaps giving him a bad reaction. Next stop, no pre-bed snack to see how it compares.

We did split the slow-acting dose for a while, but found the overlaps were contributing to loads of hypos. Although we were a bit all over the place with his BGs at the time, so maybe it'd be a more successful strategy now he's a little more stable.

Anyway, the experiments continue.
 
Hi Sad!

Fingers crossed! Milk certainly spikes me badly - there is on average 5.5g carb in 100ml milk - and a small glass is still around 300ml, so that would contribute a significant amount of carbs. Clearly your little lad needs milk at his age, but you might find you need to give him his milk with one of his meals and calculate the carbs into the dose of rapid-acting insulin.

There is a milk drink called LactoFree. It comes in skimmed, semi-skimmed and full fat just like proper milk, but it has had all the lactose removed or converted to glucose. It has about half the carbs of normal milk, but I don't know how suitable it is for the main milk for such a young child. Might be worth a look.

Smidge
 
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