my daughter has been on the Animas Ping for about 2 weeks. Her glucose is good during the day but starting about midnight she is around 300. This didn't happen with the nightly Lantus shot. My wife thinks it is because she is not active but I am not so sure. It is hard to bring her down too. Is this common to be so high during sleep while wearing a pump?
Sounds like you need to increase evening and nighttime basal rates. Talk to her endo or CDE and see. You shouldn't be high at any time while wearing a pump... your basal rates should keep you running steadily in range 24/7. It takes a lot of adjusting though.. be patient.
[quote user="Amanda"]
Sounds like you need to increase evening and nighttime basal rates. Talk to her endo or CDE and see. You shouldn't be high at any time while wearing a pump... your basal rates should keep you running steadily in range 24/7. It takes a lot of adjusting though.. be patient.
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umm the pump isn't a "magic" tool that suddenly makes sure you are in a steady range for 24/7.
I agree with Amanda, her overnight basal must be too low. It takes a while to find the right basal rates (I was on the pump for 3 months and NEVER found the right rate. my hourly rates changed daily for me).
I would talk to her endo about raising them a bit at a time to see if it helps, so do like 3nights at one rate, test at the same time, have her eat the same thing/take the same amount of insulin for carbs those 3nights. that's what i was instructed to do, but i would still talk to her endo.
forgot to add this. it might be that at some point in the night too, only one or two hours needs to have a higher basal rate. so if you are using a single over night rate, it might need to be set to X from midnight-3am and then X from 3am-5am and then X from 5am-8am, kinda thing.
if you're having problems being her down, i would try a shot for the correction as it might be a problem with the site itself or the tubing. if it goes down easy with the shot, then there's something wrong with the site/tubing, if not..then i'm not sure what could be causing that except possibly needing a higher correction ratio.
It just seems weird that she goes from 140 at 9:00 pm and then at midnight is over 300 without eating anything.
Her night basal is a little higher than daytime. We will try raising it .25 units per hour per night until this is better.
word of caution though-- even though .25 u/hr more or less does not seem like very much, that much of an increase or decrease can have a drastic effect. My cde always suggested I go up or down by .05, or maybe .10, u/hr. Just be prepared if you try .25, she may drop low. Especially if her basal is relatively small right now during that time (only, say, .50 u/hr and you increase to .75 u/hr). That would be a very big increase.
hence why you should talk to her endo BEFORE doing anything.
Terry,
My daughter also has the Animas Ping. I don't think the issue is the pump, but rather getting the basal rates set correctly. Sarah started off with basals which more or less matched her Lantus dose (she was taking 6 of lantus, so started at 6 basal of Novalog per 24 hour period). Anyway, with Sarah the pump has really reduced her need for insulin, so now she takes about 3.5 units of Novalog basal, but the amount she gets differs between day and night. She gets more at night and less during the day because we found she was constantly battling pre-meal lows. Anyway, I would absolutely suggest talking to her Endo about it, and see if there's an on-call maybe because if she's 300+ every night, you probably don't want to wait to get an appointment. If she's been 300 every night, I'd consider making minor adjustments. Usually we adjust by very small increments and watch what happens.
Note that some foods can cause this late increase. I rarely let Sarah have ice cream at night because she can eat ice cream at 8pm and by midnight she's pushing 300 - even though I do a combo bolus (spreading out the insulin over a period of time) and give her the correct amount for the carbs. On a "normal" night (defined as no ice cream, no pizza, no mexican food...) she will go to bed around 120-150 and wake up anywhere from around 100-120 - this is very consistent and tells me that her basal is set correctly. On abnormal nights (again, ice cream, pizza, mexican food), I just plan to check her around midnight and give a correction.
Last note on corrections when newly on the pump: we found that we needed to make some adjustments in Sarah's insulin sensitivity ratio as well as the time for her Insulin on Board. In the beginning, the corrections were quite a bit too much, so I most often undercorrected just to be safe (it's easier to give another correction later than deal with a middle of the night low...). I think the Animas has default settings; Sarah's was set at 100 for insulin sensitivity and 4 hours for insulin on board. We ended up changing her to 130 insulin sensitivity and 3 hours insulin on board. I know that every child is different, so obviously I don't mention this because it's the correct formula, but rather as an example of how minor adjustments with the pump can really make a difference. It probably took us about 6-8 weeks of serious tweaking before we got all the settings where she stays in range most of the time on a "normal" day.
Anyway, good luck with everything. Sarah absolutely loves her pump and it's become such a normal part of her now she'd never want to live without it. Once you get all the settings right, it absolutely makes things much easier!
[quote user="Amanda"]
word of caution though-- even though .25 u/hr more or less does not seem like very much, that much of an increase or decrease can have a drastic effect. My cde always suggested I go up or down by .05, or maybe .10, u/hr. Just be prepared if you try .25, she may drop low. Especially if her basal is relatively small right now during that time (only, say, .50 u/hr and you increase to .75 u/hr). That would be a very big increase.
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You are right. The adjustment we made was .025. Not .25.
It made no difference last night so we raised it another .025 again today. We check her BG every three hours.
This is really important when changing basal rates:
Don't assume that the basal rates need changing based on ONE night's reading(s)! (Unless she is drastically low one night; then being conservative with insulin is always a good idea.) It's a good idea to wait at least 3 nights between basal rate changes because any specific night's readings could be influenced by food/stress/illness/exercise/whatever and may not indicate a general pattern.
[quote user="Terry"]
[quote user="Amanda"]
word of caution though-- even though .25 u/hr more or less does not seem like very much, that much of an increase or decrease can have a drastic effect. My cde always suggested I go up or down by .05, or maybe .10, u/hr. Just be prepared if you try .25, she may drop low. Especially if her basal is relatively small right now during that time (only, say, .50 u/hr and you increase to .75 u/hr). That would be a very big increase.
[/quote]
You are right. The adjustment we made was .025. Not .25.
It made no difference last night so we raised it another .025 again today. We check her BG every three hours.
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Okay good. Just keep being careful and try to get some rest yourselves :) It's tough but hang in there, you'll eventually get it pretty much adjusted so you only have to make changes maybe every few months.
Terry, it sounds like you guys are doing everything you should be to get her basals figured out. It's a long and frustrating process. And basals can change over time too. I'm playing around with mine a lot right now because I've been having lows. But all in all, I still love my pump! I hope things go well for your daughter when the basals get more fine tuned.
When I started pumping in 2007, I was also having 200-300 readings at night. I programmed increasing basal rates throughout the night. I presently have a different basal rate for every hour from midnight until 8 AM. They increase gradually until 4 AM, then they jump to much higher rates. This has eliminated my highs and I wake up with a 80-110 number every morning.
You will need to keep a log of the testing numbers at least every two hours for the evening and during the night. With that data you can begin experimenting with basal rate changes. Make small changes at first, and then tweak them for better and better results.
[quote user="Terry"]
It just seems weird that she goes from 140 at 9:00 pm and then at midnight is over 300 without eating anything.
Her night basal is a little higher than daytime. We will try raising it .25 units per hour per night until this is better.
[/quote]Terry - our endo told us that young kids tend to spike in the 8pm - 2am range rather than the dawn phenomena spike that teens and adults tend to see. Apparently in young kids, they tend to fall asleep so hard right after going to bed and that is when their bodies release a big rush of hormones, etc. All hormones raise BG, insulin is the only one that brings it down.
My son did the same thing - his bedtime number (8 pm) could be 120-160 and when I would test at my bedtime 10 or 10:30 pm, he would be 250 or higher. We just had to keep increasing the basal rate from 8pm to 12 am until he stayed constant over that time period. My son's basal is 4x higher during that span than most other times during the day.
Work with your endo to adjust the basal rates - I usually just increment by the smallest amount possible for 1 hour before I start to see a rise like he is fine at 8pm, but starting to rise by 9, so I set the basal to run higher at 8pm) Then just guess at ending it at 12 am. Try that for a few days, and if it still isn't right, then adjust the amount. Remember that it is super common to have lots of adjustments to the pump settings in the first couple MONTHS of using the pump.
These are all great suggestions. I myself just started pumping about 3 months ago. Basals are really tough to get right. I just adjusted some of my basals again a couple days ago.
I would suggest buying the book Pumping Insulin by John Walsh. He is a CDE who is also T1. There are some great suggestions and information in that book.
Just a quick question here... Are these numbers coming from a meter, or from a CGM? If from a CGM, definitely check with a meter a few times in the night to figure out her real patterns. I find that mine (a Dexcom) can be totally wacky during sleep. It'll tell me I'm in the 200s when I'm really like 105, or it'll start saying "low" when I'm just fine.
Just something that came to mind.
the numbers are from testing. We have it under control now. We raised her basal .025 units per hour 2 nights in a row and that kept her on target. it's interesting that so little insulin made such a huge difference.