# Last Night



## mumtokieren (Jan 25, 2011)

Well when we did our now routine 3am check this morning, my sleeping son was 4.1 so we woke him up for a digestive biscuit ~ would you have done the same?  thanks


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## novorapidboi26 (Jan 25, 2011)

I am really not qualified to comment but I think you done the right thing................


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## Robster65 (Jan 25, 2011)

The only alternative would be to test maybe half an hour after to see if he was dropping further or remaining stable or climbing.

In the circumstances, I would have done the same as you. 

Rob


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## mumtokieren (Jan 25, 2011)

Thank you


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## ruthelliot (Jan 25, 2011)

HIya,
we've often been in that situation and I always give Ben something. He will often then be a bit high in the morning - 12ish or so, but we tried checking every half hour rather than feeding and he always went low. He's only 3 so i maybe only need to give 1 or 2 jelly babies and that works well. We've had same problem with finding the right time to give Levemir and have tried every time of day and split doses but nothing is perfect - I think it just took me a while to accept that maybe striving for perfection was a bit much! At the moment we have picked a regime that gives us problems at the easiest time to deal with but hopefully when he gets a pump things will settle more. I'm always conscious of not overcorrecting a hypo or feeding too much at night but I'd rather occasional have him a touch high than have him really low first thing and then have to send him off too nursery worrying he'l have more hypos.


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## bev (Jan 25, 2011)

mumtokieren said:


> Well when we did our now routine 3am check this morning, my sleeping son was 4.1 so we woke him up for a digestive biscuit ~ would you have done the same?  thanks



Hi Mumtokieren,
What does Kieren normally have for hypo treatment. Personally, I would only give drinks as I find a child is too sleepy to chew properly and makes them wake up too much to have a biscuit. I would have given a can of coke (or similar) through a straw so its quicker and works much quicker than a biscuit which takes longer as it has fat and other things in which slow the absorption down. Also, dont forget the 15/15 rule - 15 carbs and another test 15 minutes later to make sure levels are within range.Bev


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## mumtokieren (Jan 25, 2011)

bev said:


> Hi Mumtokieren,
> What does Kieren normally have for hypo treatment. Personally, I would only give drinks as I find a child is too sleepy to chew properly and makes them wake up too much to have a biscuit. I would have given a can of coke (or similar) through a straw so its quicker and works much quicker than a biscuit which takes longer as it has fat and other things in which slow the absorption down. Also, dont forget the 15/15 rule - 15 carbs and another test 15 minutes later to make sure levels are within range.Bev



Thanks Bev for your reply, however that goes against the advice we have been given - we have always been told that for a hypo, we need to give some 'fast acting' sugar, i.e. glucose tablets/coke/lucozade/jelly babies, then check his BM again 10-15 mins later - if still below 4, repeat, but if over 4, then we MUST follow with 10g (ish) of slow release carbohydrate, i.e. a digestive biscuit/crisps/bread etc.  The reason being is that the likes of coke will raise his blood glucose levels quickly, but that equally they can then 'crash' again and send him back into hypo, so the slow acting carb is given to stabilise the rise.  As Kieren was not actually hypo in the early hours (albeit very close!), I decided that 10g of slow acting carbs would help keep his levels up slightly before he awoke 
Hope that makes sense!!


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## bev (Jan 25, 2011)

mumtokieren said:


> Thanks Bev for your reply, however that goes against the advice we have been given - we have always been told that for a hypo, we need to give some 'fast acting' sugar, i.e. glucose tablets/coke/lucozade/jelly babies, then check his BM again 10-15 mins later - if still below 4, repeat, but if over 4, then we MUST follow with 10g (ish) of slow release carbohydrate, i.e. a digestive biscuit/crisps/bread etc.  The reason being is that the likes of coke will raise his blood glucose levels quickly, but that equally they can then 'crash' again and send him back into hypo, so the slow acting carb is given to stabilise the rise.  As Kieren was not actually hypo in the early hours (albeit very close!), I decided that 10g of slow acting carbs would help keep his levels up slightly before he awoke
> Hope that makes sense!!



Hi Mumtokieren,
Most teams now dont advocate the use of a 'slow release' carb after a hypo because it normally is too much and sends levels too high. Of course, if it was a hypo and then some activity was scheduled - then yes give a 'free carb' - but overtreating a hypo can all add onto the hba1c load and isnt good long term. The problem with giving the biscuit at a level of 4, is that you dont know (unless your child is on sensors) whether Keiren's levels were on their way further down, and so by just giving the biscuit you may have allowed his hypo to drop even further as the biscuit just isnt quick enough to deal with it. I am not being critical at all, and you must do what you feel is right for your child, its just that the latest advice is that most people dont need the long acting carb once levels are within range.Bev


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## mumtokieren (Jan 25, 2011)

Well I wonder why we haven't been told this then - I will raise this issue with our team at our Clinic appointment in a couple of weeks, as our dsn was really particular about this


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## bev (Jan 25, 2011)

mumtokieren said:


> Well I wonder why we haven't been told this then - I will raise this issue with our team at our Clinic appointment in a couple of weeks, as our dsn was really particular about this



Hi Mumtokieren,
The difficulty is that if a team doesnt seek out the latest advice then they will just stay with what they know. It doesnt make them a 'bad' team - it just means that people get comfortable with doing things a certain way. I wouldnt want you to fall out with your team - but perhaps you could ask them if they know of this latest advice. Do you have pumps at your clinic.Bev

p.s. Our old team were adament that Alex could have a 10gram 'free snack' between meals - and I always told them it sent him high, but now with our new team they wouldnt advise this - although being on a pump makes it different anyway. But on MDI Alex could never eat anything without having insulin for it.


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## mumtokieren (Jan 25, 2011)

Yes they do have pumps - so if Kieren is low or borderline low in the early hours then, would you advocate giving him a mini can of coke as opposed to a biscuit?


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## gem123 (Jan 25, 2011)

i would have done the exact same as you hun, i too was told to give a slow releasing carb after hypo treatment but she was always to high in the morning, and wouldnt eat her brekkie as well so i now give a mini can of coke, shannon used to eat for me but since shes been poorly shes refused flately to eat, i was told to check her bloods half an hr later etc to see if she crashes and that her body should bring her sugar levels up  but she never did so i treat it as soon as im aware hope this helps in reassuring u your doing great


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## bev (Jan 25, 2011)

mumtokieren said:


> Yes they do have pumps - so if Kieren is low or borderline low in the early hours then, would you advocate giving him a mini can of coke as opposed to a biscuit?



Hi Mumtokieren,
If this were Alex then I would only give a can of coke and test in 15 minutes until he is within range. I think you should speak to your team before you make any changes because they are your Medical Professionals. But, perhaps you could try treating a hypo during the daytime with just a can of coke, and see how this affects levels. Do remember that if the first can doesnt work after 15 minutes then you will need to repeat the treatment until levels are within range.Bev

p.s. Just to clarify - if Kieren is under 4 - are you giving him a fast acting (lucozade or coke or similar) before you are giving the biscuit.


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## mumtokieren (Jan 25, 2011)

Thank you   I'm ever more confused now, don't know what I should be doing for the best tbh


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## mumtokieren (Jan 25, 2011)

Hi Bev

Yes I may do that, try this out during the daytime when I can keep a closer eye on how it affects him.  Kieren is 10 years old btw.  And yes, we always give 'quick acting' sugar first to bring his levels back up in a hypo situation, only once he is back in range do we give him 10g of slow release carbs as instructed


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## mumtokieren (Jan 25, 2011)

Right, well he's just had his bm taken and its 4.something, so this time I have allowed him a mini can of coke, before he goes to sleep (and a little chunk of cheese, his fave evening treat!) - I hope this goes ok!


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## bev (Jan 25, 2011)

mumtokieren said:


> Right, well he's just had his bm taken and its 4.something, so this time I have allowed him a mini can of coke, before he goes to sleep (and a little chunk of cheese, his fave evening treat!) - I hope this goes ok!



Hi Mumtokieren,

Great. Did you do the re-test, and if so, what level was Kieren. I would also do another check before you go to bed to see what is happening.Bev


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## mumtokieren (Jan 25, 2011)

I will, although I am going to bed myself about 11 as I am really tired and struggling to get back to sleep after the 3am checks, so I will test him about 11pm and then 3am - I do hope he doesn't plummet


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## bev (Jan 25, 2011)

mumtokieren said:


> I will, although I am going to bed myself about 11 as I am really tired and struggling to get back to sleep after the 3am checks, so I will test him about 11pm and then 3am - I do hope he doesn't plummet



Hi MumtoKieren,
If he is still low at 11pm - say about 6 - then I would give perhaps a half a can of coke and then see what he is like at 3am. This way, you will build up an idea of what levels it is allright to put him to bed on and how much he drops by 3am.Bev


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## mumtokieren (Jan 25, 2011)

He is 10.7 right now


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## bev (Jan 25, 2011)

mumtokieren said:


> He is 10.7 right now



Hi MumtoKieren,
That is a big increase isnt it. See what he is overnight and post on here tomorrow - it could be that, for Kieren, he doesnt need quite so much as a full can - perhaps two thirds might be enough - its all trial and error isnt it.Bev


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## mumtokieren (Jan 25, 2011)

Yeah it would seem so! 
Anyway, yes I will post his 3am and 8am readings in the morning!


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## mumtokieren (Jan 26, 2011)

3am - 10.3

8am - 10.2


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## bev (Jan 26, 2011)

mumtokieren said:


> 3am - 10.3
> 
> 8am - 10.2



Hi Mumtokieren,
I am not sure how you are feeling about this as you havent said anything else. But what this tells me is that you have now worked out that if the level is around 4 - then Kieren needs perhaps only half or two thirds of a can of coke - and also that the coke did keep levels stable without the 'crash' that was expected. It also tells me that night-time basals are good - they didnt fluctuate (allbeit too high) - so from 11pm until this morning at 8am they have stayed on the same level - that is great - and you should give yourself a big pat on the back as you are now starting to see 'patterns' and will be able to build up a picture of what works for Kieren - which is great.Bev


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## mumtokieren (Jan 26, 2011)

Thanks for replying Bev, sorry yes I was rushing around this morning trying to get us all ready for work and school so just briefly posted 

Anyway, yes although they were a bit high, I was pleased to see they remained pretty stable right through from 10.30pm to 8am the next morning!  And like you say, if he is around 4 before bed next time, I will try just giving him 2/3 of the can and see what happens (as well as his chunk of cheese of course!! ) - of course if he is lower than 4 I would still give him a whole mini can and if he was between 5-7 would allow him his 10g carbs instead.  That is how I intend to work it for now anyway, but will keep watching the results!


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## Ruth Goode (Jan 26, 2011)

I'm doing the same as you, give Carly a fast acting e.g 100ml orange juice and then a slow acting e.g a digestive biscuit 10 minutes later.  I do find her level get higher after hypo treatment - I think I will give it a go without the slow acting so how long do fast acting normally lasts?


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