The Place for Parents

[popjim]

What happens if Savana is asleep and goes low??? How will I ever know??? How did the rest of you handle this situation?? I dont think I have slept soundly for the entire month and a half since shes been diagnosed....Is there anyway to prevent this from happening???

[greeneyedmom]

Hello, 

Well, at first you will lose sleep. It will get better.  It has been over a year for us and we still are awake checking at 2:00  in the morning. But, for our little one, we give a little snack just before bed right after checking the bedtime sugar. We make sure the little one eats the snack and goes to sleep, then we wait until around 1:00 or 2:00 in the morning to check to see if the sugar is high enough for the entire night. Sometimes it is not. And on those times, we are sure glad we checked. But, if in doubt, check your little one's sugar. At least it will help ease your worry. I hope that helped. That is still my fear too. The little one going low while sleeping. But, I take a deep breath of relief when the sugar is where it needs to be.  Then I can sleep. 

[katies_dad · Accepted solution]

Hi PopJim,

I can help you a little with this, but as everything is for me, there is some math.  I swear that at some point I am going to condense these into something that can be a reference guide / sticky.  So here we go.

I am assuming Savanah is on some kind of long and short acting insulin?  Knowing no better, I will guess Lantus and Novolog.

Lantus - Lantus is reported to work for 24 hours and to have a "steady" release.  Reality is that Lantus takes a couple of hours to actually get going and may or may not make the full 24 hours.  If you are giving your Lantus at night with dinner, and you are having issues with going low overnight, think about whether you are consitently givin evening corrections with the dinner bolus.  If you are, or if your dinner bolus is more aggressive than the morning bolus then it is likely that your corrections are for a hole in the basal dose of Lantus.  Consider splitting the basal dose, giving some with the AM and some with the PM.  We had to do that for Katie.  If this is not your experience, then don't sweat this part.

Novolog - Novolog has an average action time of 4 hours.  This means that from the time you give it, it will be used up (assuming average) 4 hours after the injection.  This little bit of info was really useful to us.  It is our practice to eat dinner between 6 and 7 PM and do a final check on Katie at 11 PM before we go to bed (she doens't even wake up).  By then all of the bolus insulin has worn off.  This means that if she is 130 at 11 PM then we can expect her to get up near to that in the AM.  (We never did corrections except at meals while on injections.)  We go to bed and sleep through from there.

You can make this knowledge work for you and your tuning (adjusting) of the basals and boluses.  Start with the knowledge that Novolog is only going to work for about 4 hours (again assumes average response - YDMV).  Say you check Savanah 4 - 5 hours after dinner (her last bolus insulin) she should hold relatively steady at that number until she gets up in the morning.  Get up at 2 AM and check her, is she higher or lower than at the previous check.  When you get up in the morning, check her again, same assesment.  Do it for a week and plot the trend.  Remember, you aren't so much interested if she is high or low as is she higher or lower than before and by how much. 

If she consistently drops after the bolus insulin is used up, then you need to adjust the basals downward.  If your splitting the Lantus like we did, you adjust the evening dose for overnight and the morning dose for daytime changes.  Don't forget they are both active for ~24 hours, so you can trim either one and get a response.

For me, I plot everything.  You can get graph paper in the school supply section of most stores.  Plot out the BG's between your final check and the morning using time for the x-axis, connect the dots.  Do it for several days and see if the lines all tend to slope up or down.  The slope of the line is the clue you want to follow.  You want to get a flat slope (sometimes up sometimes down a bit - say +/- 30 points), but if it's consistently down (or up) you need to make a change in the basals.

PopJim - I write this last bit for any casual reader - not so much you.  I know it will be yelling, forgive me.  For the record, we always correct anything at 70 or less - but after 4 years we have the overnights pretty well sorted out, with Katie being steady to + 20 most mornings.

IF YOUR CHILD IS LOW OVERNIGHT LOG THE POINT AND CORRECT THE LOW.  DO NOT LET THEM LINGER LOW JUST FOR THE TEST.  FIX THE LOW.  NEVER LET YOUR CHILD RUN LOW JUST TO SEE WHAT HAPPENS.

One final note, if she is running low overnight, set a higer BG target for after dinner.  Raise it to 150 (or higher) so that you have some breathing room.  After you get her to hold steady overnight you can lower the target again.

POP, I just added a plotting logsheet under a new topic.  Take a look and see if its useful for you.

Good Luck and God Bless,

[Pam01]

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katies_dad wrote:

You can make this knowledge work for you and your tuning (adjusting) of the basals and boluses.  Start with the knowledge that Lantus is only going to work for about 4 hours (again assumes average response - YDMV).  Say you check Savanah 4 - 5 hours after dinner (her last bolus insulin) she should hold relatively steady at that number until she gets up in the morning.  Get up at 2 AM and check her, is she higher or lower than at the previous check.  When you get up in the morning, check her again, same assesment.  Do it for a week and plot the trend.  Remember, you aren't so much interested if she is high or low as is she higher or lower than before and by how much. 

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Am I misreading this, or did you mean to list a different insulin instead of Lantus??

[wildflower142]

do you do overnight checks?  I check my daughter twice during the night (sometimes more if need be). Normally she gets checked at midnight and 3am. I have caught several low blood sugars that needed treated. And several high blood sugars that warrented extra insulin.  

[katies_dad]

Pam,

If I ever write that book you are guaranteed to be on the editorial board!  I meant "Novolog".  I have corrected the post.

Thank You,

[katies_dad]

Hi Wildflower,

I see your daughter is on a pump, that opens up a whole new world of possibilities with painless (sleep through) corrections and combo boluses.

On "normal" evenings, evenings where we eat "normal - not really fatty or high in protein" foods, nights where we use a standard bolus, we simply check before we head to bed.  We usually eat between 6 and 7 and go to bed at 11, so there is 4 - 5 hours lapsed since the standard bolus.  We have Katie's correction factor dialed in pretty well, so even if we make a correction we don't get up again to check.

On "combo bolus" evenings (mexican food, heavy pasta or large protein servings) we will check her again sometime over the evening.  If we go to bed at 11, nature will usually call one of us sometime around 3 AM and so we will check.

I have to be honest in that most of our settings and boluses are conservative when we do Combo's.  We rarely go low on combo's (at this time - but have been there in the past) and mostly are doing small corrections for being 50 - 100 points high.

There is one exception here and that is on evenings when there is a lot of activity.  If we are at a party and Katie is running around after dinner and "partying" with her friends, we definately give her an extra check.

When we correct lows, we correct back to a target of 100.  Currently Katie has a BG rise of ~ 10 points per gram of carbs, so if she is hovering at 60 we give 4.5grams (1.5 X 3 gram gummy life savers).  We only give one if we are 70 and we don't correct unless we are below 80. 

Our experience right now is that Katie is having an early morning rise of ~ 20 points.  We are working to correct that out, but is minor and a rise so we are making changes very slowly and giving a week to evaluate.

[sandyfreitag1]

Going low while sleeping.... I still get up during the night to check my son.  It has been 2 yrs since diagnosis. I must say I am used to it now. I do make a point of keeping everything we might need to correct it in my room.  If I have to walk to the kitchen, then I can not go back to sleep for hours.  I bought a college dorm fridge when they went on sale. Stocked with juice boxes and chocolate milk singles. I also have a stash of 15 gram candy to bring him up.  We check BG before bed, and give him a snack. If he doesn't seem to be high enough to make it through, I will not have him bolus for all of his carbs.  It takes time to get used to the comfort range, and just when you do it will change. Good luck. Your not alone when your up at night.