I know everyone isn't doctors but I want to see what you guys think. Lately my son has been really high at nighttime. Do you think this is because of not enough insuiin with bedtime snack or basal rate needs to be increased? My son is 9 years old and he is on the pump. Usually if I give him a bolus about 3-4 am it will bring his bs down enough so he isn't quite so high at 7 am when he gets up.
Hi, Jennifer. Can you tell us what his blood sugars are like throughout the day? When is he eating his meals, and what is he eating?
Not enough insulin with the bedtime snack is a likely culprit. Also could be complex carbs or fat still being digested from dinner. I don't use a pump, but some folks set different basal rates for different times of the night.
Has your son grown recently? Growth usually requires a basal adjustment.
You might want to check in with the doctor, since it can be a lot of different things including snack bolus, basal adjustment, or even dawn phenomenon. That's where your liver releases glucose in the early morning. It usually doesn't start until college age, but can begin earlier in kids with diabetes.
When you talk to your doctor, you may also ask about using a glucose monitor. It's like a CGM, but you just wear it for a day and it helps confirm if basal rates are accurate.
His blood sugars vary so much one day he is high all day long the next day he is normal to low all day long. Sometimes if we give him a bolus to bring his bs down then sometimes it makes him go low. It doesn't matter what he eats because he can eat at McDonalds one day have perfect bs afterwards and then the next day he eats at home and he is sky high. I have to get up and check during the night and check his bs atleast twice just to make sure he doesn't have lows. He could have had a growth spurt I suppose. I just kind of wanted to see what other people thought. Thanks to eveyone that responded.
My 3yro goes through the same troubles and often we’ll blame unexpected lows on differing activity level day to day, we check a lot at night too but she still does injections. Would love to know what you and your endo decide will help!
Puberty? I am just curious because i was like that a lot through my early teen years. I do not know how different it is for boys though. I would adjust his bedtime bolus. For myself, i used to use the same bolus at night as i did through the day, but then I was having lots of night time lows. I also eat late, so i dont tend to have a snack before bed. Maybe you should increase his night time bolus, or avoid giving him a snack right before bedtime.
Im no doctor, but those are just some ideas.
I'm confused by this: "It doesn't matter what he eats because he can eat at McDonalds one day have perfect bs afterwards and then the next day he eats at home and he is sky high."
Isn't this evidence that what he eats does affect his glucose levels?
What is his diet like?
The growth hormones make insulin less effective. So sometimes growth spurts can cause unexpectedly high numbers. Illness and stress can also raise blood sugars.
How long ago was your son diagnosed? In the first year or so after diagnosis people with diabetes can have a honeymoon period, which is where the body still makes large amounts of insulin. That can make it difficult to adjust insulin.
I'd definitely visit with his doctor. Ask for a CGM for a few days or test a lot (even once or twice in the night) for a few days straight to see if you can find a pattern to the blood sugars.
Wow didn't realize it has been so long since I been on here. We have been to the doctor twice since I posted this and each time they have increased his basal rate overall for the whole day he has 3 different basals. And they changed his sensitivity a little. They feel he is getting enough insulin for his food not just enough for basals and in the last 6 months he has grown 3-6 inches. So we will try these new settings and see our doctor again in October and see if things need adjusted again. I couldn't remember what jenna had called the Glucose monitor when we went last month but now that I have seen this post again I am gonna email the Dr and see about that. Thanks for all the ideas,
Wow didn't realize it has been so long since I been on here. We have been to the doctor twice since I posted this and each time they have increased his basal rate overall for the whole day he has 3 different basals. And they changed his sensitivity a little. They feel he is getting enough insulin for his food not just enough for basals and in the last 6 months he has grown 3-6 inches. So we will try these new settings and see our doctor again in October and see if things need adjusted again. I couldn't remember what jenna had called the Glucose monitor when we went last month but now that I have seen this post again I am gonna email the Dr and see about that. Thanks for all the ideas,
How long ago was his diabetes diagnosed? It could be he is "brittle diabetes" and you will experience a lot of inexplained highs and lows - about 45-50 years ago, before self blood sugar monitoring, I was told that I'm brittle. Regular BS testing and self awareness [difficult for a 9 year old] may help.
I suggest that you experiment and if his bedtime BS is above a certain number [say 150] that he skip the bedtime snack. Be sure to check BS between 2 and 3 AM to make sure he isn't too low. If he is still high at breakfast for a few consecutive days consider increasing the basal rate, in steps. Alternatives would be to increase snack bolus - DECREASE the bolus ratio number - insulin or increase his overnight basal rate.
Please don't make both bolus and basal changes to his pump on the same day; make one of the changes and observe what happens for a couple of days and then if needed make the other change. One other thing, young boys like to sneek extra snacks - yeah, I was a young boy once upon a time.
Hey Dennis-
I respectfully disagree with the idea of "brittle diabetes." I've never had a doctor able to define the term and find it's usually used in a derogatory way to explain uncontrolled blood sugars. Frankly, anyone would be "brittle" with the old insulins and once or twice a day shots that were the best available to diabetics in the past.
The reality is that the human body's insulin needs vary through the day and are affected by a lot of variables. But thanks to pumps and glucose testing, we know that blood sugar usually can be controlled with the right dosing. Of course it takes a lot of work and you have to trade off perfect control with real life sometimes. But I'm convinced that anyone can have well controlled blood sugars, unless they have gastroparesis.
-Jenna
Jenna, I agree with you that "brittle" might be one of those technically undefined terms.
My diagnosis came during / following eight days as an inpatient at Joslin Clinic in 1973 (+/) while my exercise, food intake and insulin dosage was very closely monitored. The alternative diagnosis was that my pancreas begun turning itself on and off - this fifteen years after my diagnosis of diabetes.
That's cool that you were a patetient at Joslin's back then. I know in the 70's brittle was used, but that was a long time ago. Thankfully a lot has changed in diabetes management since then.
Have you hit your 50 year anniversary with diabetes? Have you done the current Joslin 50-year study? That study was eye opening to me that people can definitely live long, healthy lives with diabetes. I hope the study is still around when I get to my 50 year anniversary.
Take care.
-Jenna
I have enrolled in the 50 year program but have not yet participated in that survey.