Bedtime spike

Hi - we are about one year in with my six year old. He is using Omnipod. I have been T1D since 1982, but I am stumped.

Every night when he falls asleep, he sugar spikes. I have his basal set to a MUCH higher rate that most of the day, and that starts 1.5 hours before he goes to sleep. For example while he is in school I use .05 and .1 per hour and bedtime is .6.

The rise will take him above 400 some nights. But here is the kicker. It is not every night. Some nights he stays low and I have to put him on a temp basal so he doesn’t crash.

Please don’t bite on this next part too hard, but I am wondering about his dinner bolus. He typically eats at 6 PM, and his bedtime is 8 PM. Should I be extending his bolus for a while out? I could add that I have had issues with him crashing 1.5 hours after his dinner bolus, so perhaps his carb ratio needs to be reduced (for more insulin) but have the bolus extend out?


@Mbennettbrown adult night time hormones are different that child overnight hormones which often include crazy things such as growing. In my opinion, if you have a CGM then just watch it and correct as necessary. If you don’t have a CGM then consider getting one. The pod allows you to control corrections remotely so all you have to do is watch and treat. If it becomes every night all the time then it’s time for a basal or bolus adjustment - remember bolus is for the first 4 hours after a meal and basal is for fasting. again IMO. Your experience and rules for treating it will be different than your childs. It’s never a bad idea to discuss strategies with the Endo. Cheers🍀

Thanks for your response. Looking for a bit more than that. We use the sensor and I watch it climb around 8PM. When IOB will let me, we give a correction. Sometimes every half hour. Sometimes I use a temp basal, but the basal rate is already so high (for him) it is easy to make him crash.

I am mostly wondering if anyone else has seen this, and if possibly extending his dinner bolus could help. Better yet what is the cause so I can best understand how to handle it.

Dealing with it is one thing. Solving the issue is another. Hopefully the new pod will be out soon and looping will help.

Extending a bolus is great if he is getting low after eating and then a rise later on. 3 units bolus is 3 units given up front or over 2 hours. For eating really slow carbs or mixed meals (fat and carbs) the extended bolus (when needed) more closely matches carb absorption. What you are describing is a (random) high requiring more total insulin. An extended bolus will, very likely, not help that, unless you are also decreasing carb ratio for more total insulin. Also, the right basal rate isn’t a number it’s the rate that doesn’t cause a rise or fall when you aren’t eating. 0.6 or 6.0 it’s whatever works and for kids it’ll change as they grow.

1 Like

Be careful giving corrections so frequently - it’s called stacking insulin and can lead to a crash later on. I’ve done it countless times in the past - your number is high, or higher than you would like - and possibly even rising. Instinct says to take more to bring it down. The glitch is, insulin simply takes time to work - 3-4 hours depending on the type. Unfortunately you have to watch and wait. I find the drop starts gradually - literally just a couple of points at first but I start to see real progress after a while. Stacking will not just bring numbers back to normal but could cause them to go low.
Discuss with your doctor how long you should wait before making additional corrections. Unless s/he eats something more it probably is not a good idea. Not criticizing - at I said - been there/done that.
I try to drink sugar free liquids if I’m high - just in case I have ketones, to wash them out of my system. My highs will not come down if I don’t do that, no matter how much insulin I take.
I know you’re trying to work out how to avoid getting those numbers in the first place and I haven’t answered that - this is just something to keep in mind.
PS - apologies - I was reading through responses and see the one you wrote about dosing for highs. I forgot you’re experienced with T1. Consider it gentle reminder.

1 Like

Hi Mark @Mbennettbrown , interesting discussion going on here for 4 people well experienced with diabetes management; kind of shows that diabetes management can be crazy.

I’m going to address this from another angle, especially because these spikes are not "every night and there is less than two hours between when he eats and tries to sleep. Try looking at the foods he eats on evenings he spikes as opposed to what he doesn’t eat on evenings without a spike - keep a log. I’m assuming that you use your experience “counting carbs” to calculate his 6 PM meal-bolus. The next thing might be to adjust his Insulin:Carb ratio; secondary is to add a higher carb count for him when he eats those foods that may be causing his spike.

I have found that the “claimed carb count per ounce” for some foods isn’t always what my body thinks is correct - for certain foods my experience tels me to make carb adjustments. Another thought is to find out what afternoon activities he enjoys on days when he doesn’t spike.

Hi! My 7 yo daughter sometimes has random spikes like that too, hers usually starts late afternoon and lasts through the evening. I am probably bad. I worry about her bg being over 400, so I knock it down with a bit of extra insulin and I usually can tell about how much extra by how fast she starts coming down, but I only do it if I can sit and watch her numbers on the cgm and even set alarms every 15 minutes to make sure I catch when to start giving her carbs which if she is coming down fast, is around 200. Sometimes I have to give her double the normal insulin, plus a unit extra that I plan to feed her for, but after about 4 hours, whatever was happening to release so much sugar stops and she’s back to normal.

Hello. Now and then a random idea will cross my mind to consider: kids - even little ones - can be creative when it comes to sneaking foods, and the parent don’t know there’s something additional that needs to be covered with insulin. Could that be the case? This is no indictment on your little one or your parenting skills - just something to check out for the process of elimination (or inclusion, as the case may be).
Wishing you all the best in solving the mystery.