Ellie my five yr old, now almost 6 in june has been t1d for 2yrs in august. She gets 1unit of humalog for 30 grams, and 3.25 lantus at 8am. Well i'm waiting for a heart transplant (dad) so I sleep a lot and at weird times. So this results in Ellie and staying up until 2- 3 am every night, and then we sleep until 1-2pm.
This is where the trouble starts. If Ellie is around 200 blood glu. everything is fine. If she is at 250 everything is fine, she will drop alittle down to about 220- 200. BUT, if she is at 150 she will drop until, well I always try to stop it around 100, but even tonight she was at 52. It happens without fail. So to recap.
if she is at 150 she drops dangerously.
if she is at 200 she is fine.
if she is over 270-300 she will slowly climb above 350-400.
Well this has started happening between our endo appts and the last appt was with the pa and she wasn't very good at her job, every time I asked about this she would quickly change the subject.
Have any of you parents or t1d's ever gone through this. I've tried everything, fatty foods, high carb foods, no food, less humalog, more humalog, less lantus,more lantus, you get the picture. I'm scared to sleep at night and my failing heart could use a break and most importantly my daughter needs a break and to be safe at bed time. PLEASE HELP!!
Does she play really hard during the day? A delayed low could explain the night time lows. One thing I would suggest is to stop stopping the lows at 100 wait until she is at 70 or lower. I have done that a few times but its not the right thing to do. If Riley is under 200 I fear her dropping to low over night. She can go from 378 at 8p.m to 120 by 6-7 a.m. Now in mind that means if she starts lower than 200 she will have a low no matter what. Its just not so. Last night at 9 p.m I checked her and she was at 118. So I check at 10, 11, 1, 3 and just now at 5. Her lowest was 90 and she actually went back up to 95. Now I know she had little to no exercise yesterday so I wasnt worried about anything catching up with her while she slept but more than once last night I had to fight off the urge to give her juice. Second with the delayed lows its a pain because you just dont know and if like me most parents are not going to say you cant play or you might go low later. Riley had a week of lows and takes her long lasting insulin at night so on days she plays really hard for a long time I give her a unit or two less and it helps. I also give her less of her fast acting insulin at dinner time.
Is her sleep pattern the same all the time - bed at 2-3am, wake up at 1-2pm? If so, you're waking her up at 8am to give her lantus then she just goes back to sleep?
Also the sugars that you're referring to are her before bed sugars? Then at what time are you testing to see the 2nd bs - how many hours after the 1st test?
If she goes to bed for the night at 2-3 am is she getting a snack before bed?
Yes to every question jaco. The 2nd check is lower if under 200, higher if over 270. I normally wait 1.5-2 hours before sleep check. Ellie will not eat hardly at all during the day, and then at night she pigs out. She'll eat 3-4 times in three hours.
Ellie is an animal I swear. She could play hard in a rubber room. She is under that fine line of being hyper active, she behaves and listens most of the time. And she isn't destructive, well not always. She'll go outside around 1-2 pm during the weekends when her sister is home from school and they will play outside from 1:30 until 8pm. I mean running, riding bikes, hide and seek, just being a bunch of crazy kids. We live in an apartment complex that are all flats with a massive U shaped sideway away from traffic, it's a 5mph drive in the complex. So anyhow there is like 20 kids my kids age. Always play play play!
Perhaps the problems is the eating 3-4 times in three hours. If she eats 30 carbs you give her 1 unit of humalog. Then one hour later she eats another 30 carbs then you give her another unit of humalog, etc... So do you really know her carb ratio is 1 unit for 30 carbs and not 1 unit for 20 carbs at that time of day (my carb ratios change throughout the day)? If she eats close to bedtime and her bs is 200 and the humalog is still working its bringing her bs down too far. Also what is she "pigging out on"? There are times of the day that we all are more resistant than others. In the morning - I can't touch high carb food s- I don't eat cereal, toast, bagels, oatmeal, fruit, etc... nothing - my bs spikes too high then comes down too fast. I normally don't eat until I'm up for 4 hours or so (if I do eat it's usually a hard boiled egg or glass of milk, etc). My "breakfast" isn't until around 10am and I wake up at 5am. Before bed it's the same - I can't eat certain foods (especially ice cream which was my favorite dessert) then go to bed. Again, I spike.
So I would try to see if there is a correlation between what she's eating in those 3 hours (how many carbs is she taking in, how much insulin are you giving her) and what happens during the night. Kids are difficult to nail down but it may work out better if she eats more when she's the most active and less when she's less active.
Have you talked to her endo or thought about her lantus dose. If the long-lasting dose is "correct" (and it will change constantly b/c she'd growing and changing!), the blood sugar should stay more or less stable through the night assuming she doesn't eat anything or take short-acting insulin. As well as making sure you're not stacking short-acting like Jaco mentioned, I'd wonder if she needs a little less lantus. If she's high after meals on less lantus, her meal ratio could be adjusted. I'm on Lantus and if I go to bed at 120, I usually wake up around 90...
What Jaco said about the eating makes a lot of sense to me. It depends on the kind of food she is eating - if it's high on the glycemic index, it will cause her blood sugars to drop very quickly after spiking them. She needs a little fat, fiber, and protein in what she is eating to keep her blood sugars at a more constant rate. I've heard of Extend bars and Night Bites that have cornstarch in them to slowly release sugar over an extended period of time. Maybe these would help stabilize her blood sugars in the 100s.