# what would u do in the night



## hkk1970 (Sep 18, 2013)

Harry's levels are so unpredictable at the moment. At 630pm we have readings of approx 6 which is great. He has 1 slices of bread for supper at 10 carbs. We then find he peaks at 10pm to maybe double the 630 reading so we 
correct on his pump. We then find he goes down to 4 about 3am and we give him a biscuit with no insulin to keep him steady and not go hypo. By breakfast he is then about 12. Should we not have given him the biscuit and let him go hypo which I knew he would. Thanks. Helen


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## Redkite (Sep 18, 2013)

hkk1970 said:


> Harry's levels are so unpredictable at the moment. At 630pm we have readings of approx 6 which is great. He has 1 slices of bread for supper at 10 carbs. We then find he peaks at 10pm to maybe double the 630 reading so we
> correct on his pump. We then find he goes down to 4 about 3am and we give him a biscuit with no insulin to keep him steady and not go hypo. By breakfast he is then about 12. Should we not have given him the biscuit and let him go hypo which I knew he would. Thanks. Helen



Hi Helen, it sounds as though you need to tweak his evening and nighttime basal rates.  He needs more basal between 6.30 and 10, then once you have this sorted, his BG at 10 shouldn't need correcting.  If he is dropping low around 3am despite no correction dose being needed at 10, then he needs lower basals perhaps from midnight to 3am, then probably a little higher for the last part of the night.  You shouldn't be having to wake him for a snack on a regular basis, but you do need to prevent hypos, so tailoring the basal is the way to go 

P.S.  if you do need to give a correction at nighttime, I find my son is more sensitive and a higher correction factor is needed (ie less insulin) than in the daytime.  E.g. His correction factors are currently 1:4 in the day and 1:4.5 at night.  If he's been doing anything energetic, I would also manually knock a bit more off the correction dose, so he doesn't drop too sharply.


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## Hanmillmum (Sep 19, 2013)

Hi, firstly is the 10g for a slice of toast correct - our bread is more like 16g? And do you bolus for the this or not?

Also we find the same as Redkite that a correction dose is much less overnight than through the day, so you may need to look at that if he is heading down to 4 after correction (once you have looked at the basal though.)

I tend to use TBR and make a reduction if I find a lowish number, it's easier than waking my daughter who will not comply with food overnight.


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## hkk1970 (Sep 19, 2013)

hi, thanks for your replies. He has the 50/50 crusts away bread which is approx 9.8 carbs. Last night I upped his basal, and even though he went up to 14 , I didnt correct just to see where he went. He came down to 10 and was stable all night , then woke up at 7.2 this morning.  
Do you think I should up the basal again to stop him going up to 14 or will this make him go lower by the morning.

Its such a guessing game isnt it, we are still 7 months in with the pump and still learning !!

The consultant wants us to basal test but harry just wont eat protein on its own or nothing at all. Surely you can still see patterns without having to basal test on someone so young..?

Helen


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## hkk1970 (Sep 19, 2013)

Forgot to say, we do bolus for the bread...


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## Redkite (Sep 19, 2013)

If he's having the bread at 6.30, you can basal test from 10/10.30 throughout the rest of the night when he's fasting due to being asleep!  Ideally you would need to test every 2 hours which is quite gruelling.  I'm a single Mum now, but when there were two of us, one of us could stay up late and test at 10, 12, and 2, and the other could get up early and test at 4, 6 and 8am for example.  It sounds as though he probably needs three basal rates overnight - perhaps 6-10pm a bit higher, then 10-3 a bit lower, then 3-7am a third rate.  But you can only find out his needs by doing the basal testing unfortunately.


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## hkk1970 (Sep 19, 2013)

Hi Redkite, thanks for your advice. Since Harry's diagnosis, I automatically wake up every 2 hours anyway and still frequently test due to his varied readings. I find it easier just to get up myself and do it , my husband never wakes up automatically !!  I would have to punch him to get up and then I would be wide awake anyway...

So last night, I suppose I basal tested, do you reccomend I up the basal from 7pm until 11pm ? His target range set by the consultant was 6-10 in the night anyway so he is at the higher end of what they want him to be.

Readings last night were:

830pm 14
11pm 12
1.30am 11
4.30am 10
7.30am 7

Its hard getting up in the night isnt it, do you still test your son?

My mum says she doesnt know how I do it, getting up in the night and working 3 full days a week. I suppose you just have to dont you ? I feel better for testing him and then I know he is ok...

Take care. Helen x


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## Redkite (Sep 19, 2013)

Oh dear Helen you must be shattered.  I too am chronically sleep-deprived, not much fun is it?!!

We are not allowed of course on the forum to give specific advice on adjusting doses, but I can give you a "what I would do".  If this is a typical night, it looks like my son's levels when he was on Lantus, except the drop would be even more dramatic, ie 16+ at bedtime and down to the 4's by morning.  With the pump you should be able to even that out, so he stays roughly between 6-10 all night.  I would start by increasing the basal from 6-10pm, and when you are achieving a good BG at 10, monitor the knock-on effect on the rest of the night.  From the figures you have given, if he were to be in range at 10pm, you would need to reduce basals after that to keep him stable and prevent him dropping further.  It will be trial and error I'm afraid, but so long as you are checking the effects of your adjustments it will be fine.  Don't expect to find a basal pattern that will last long-term though, as the trouble with growing kids is that their insulin needs are constantly changing too!!


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## Mumlé (Oct 19, 2013)

Hi Helen, just looking through the parents posts (I have to ask myself WHY- when I have a couple of hours to myself while des takes the kids!!!) very hard not to think about D though, so used to thinking about it constantly. I have to say, don't know what your doc is thinking of trying to get a wee one to not eat carbs so you can basal test. My wee one is also 4 and they need fuel all day long! We have a similar night time pattern at moment (hopefully you got yours sorted by now anyway - but I would find a whole biscuit too much at that time of night, I would give her 2 or 3 grapes on a 3am 4BG, or just do a zero temp basal for an hour or two to lift her levels, maybe a couple of nights with an extra check? If you're like us, starting the day on a high is not good - really hard to get down again. It's hard though isn't it. I have found that after 3 years on the pump I have kind of got used to the sleep deprivation. I'm lucky in having an other half who does the night time check every other night, although we invariably wake up when the alarm goes but dont have to actually get up! I think your body gets used to having to cope with not enough sleep, but it still means you get cross easier etc. Its learning to live with that kind of thing, and recognising it for what it is - do you know what I mean? Anyway, enough waffle - must properly enjoy my coffee and maybe something to eat without having to carb count!!!! Doesn't take much anymore!! Charlotte


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## trophywench (Oct 19, 2013)

The body can use PROTEIN and (eaten) fat instead of carbs, it just has to work harder, that's all.  Actually carbohydrate - so beloved of the NHS! - can be cut out completely if you wanted to, except you'd lose some minerals and vitamins and of course, roughage.

As both of them last a lot longer than carbs anyway - I mean you feel full much longer after eating them than you ever do with carbs, owing to the long digestion period no doubt.

My DSN always says when mentioning the words 'fasting test' - "But if you get desperate, just have a 2 egg omelette"  LOL


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