# Tips on dealing with child high at 2am



## colinprice72 (Mar 3, 2014)

Hi all.

No problem if you tell me if there is a thread already on this.

My daughter is 4yrs old with Type 1 diabetes (Well, I'm not here due to boredom) and I thought I would ask for tips from fellow parents on dealing with your child highs at 2:00am in the morning.

All thoughts welcome.
Thanks.
Colin.


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## Redkite (Mar 3, 2014)

Hi Colin, and welcome to the forum 

It depends!  What insulin regimen is your daughter on?  What is her target BG range for nighttime?  And are the 2am highs coming after she has had a normal BG at bedtime?  I have a feeling I know what you're going to say....


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## HOBIE (Mar 3, 2014)

Hi Colin & welcome.  There are a few things we need to know ?  Is it every night & how high, What insulin is given & when.  Hope we can give you some help


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## colinprice72 (Mar 3, 2014)

Hi Redkite / Hobie (et al) and thanks for the quick reply.

My daughter is now 4, target=4-8 and her bm's are not bad (from the stories I have read, I have cruised through at the moment), so I suppose I am trying to prepare myself. Where a low has an obvious path to follow (a biscuit, OJ, jelly baby, glucose gel, etc), besides drinking water, I was wondering what tips people could give.

FYI - She is on 6 glargine in morning; then the 3 NovoRapid injections after meal. At this point of this adventure, she is having highs & lows but nothing permanent; it just jumps around for seemingly no reason (well, except that she is 4 and growing).

Thanks again.
Colin.


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## colinprice72 (Mar 3, 2014)

Oops - Me and the English language eh ? I assume it is obvious but please insert the following in the above:

...........", besides drinking water, I was wondering what tips people could give me when it is high."

Actually, to give you more, I will give a scenario;
If my child was between 17 - 20 for instance but had no ketones.

Thanks again.
Colin.


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## bev (Mar 3, 2014)

Hi Colin,

Sorry for more questions but it will help to pin things down more!Are you carb counting food? Do you give the same amount of Novorapid for each meal? Have you been taught how to give correction dose's of insulin when high? Do you know how much 1 unit of insulin brings BG down by?Bev


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## Redkite (Mar 3, 2014)

It's hard to advise without specific details re: (i) her meal doses (do you adjust the novo for the carbs eaten?); (ii) bedtime BG level; (iii) any snack at bedtime? (iv) how does the Lantus work for her? ie does she drop steeply overnight?

Her levels could be rising due to growth hormones which are secreted in the first part of sleep.  Or it could be that her Lantus insulin is running out at that time of day.

To put into context, my son was on MDI from the age of 6 (and before that the nightmare that is mixed insulins!).  The Lantus had an awful profile in him - it would cause a dramatic drop in BG in the hours following injection, then would run out after about 19 hours, leaving him with no basal.  When he was having the Lantus injection in the evening, he would need to be a horrendous 16mmol at midnight to prevent a hypo before morning, so I couldn't correct.  Nowadays he is on a pump, and I would correct any BG over 7.  I really think your daughter would benefit from an insulin pump - have you considered one?


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## colinprice72 (Mar 3, 2014)

This feels like a bit of a car crash thread but I will persevere.

From above
=================================================================
(i)   her meal doses (do you adjust the novo for the carbs eaten?); 

Yes - They vary from 2.5 to 5 (5 is the max I have been told).

(ii)  bedtime BG level; 

It varies (not just the bedtime level) which is the crux of the problem. From the same food content / quantity, same type of days, her BM's vary wildly from 2-22 (but with only trace ketones) which I have come to think it is just her age and growing.
This doesn't mean I am settling and I am still fighting the good fight.
Fortunately, they never settle at low or high between any 2 or 3 tests and we do get some good 4-8's.
Hence my initial question to canvas opinion on any tips when a child is high at night.

(iii) any snack at bedtime? 

Yes - Dependant on what she has had in the day but usual a couple of biscuits.

(iv)  how does the Lantus work for her? ie does she drop steeply overnight?

See answer (ii)

(v)   Are you carb counting food? 

Yes

(vi)  Do you give the same amount of Novorapid for each meal? 

No - We have a varied amounts dependant on BM (See (ii))

(vii)  Have you been taught how to give correction dose's of insulin when high? and Do you know how much 1 unit of insulin brings BG down by

No - Sounds silly/innocent/ignorant but I don't think I have been chatted to about a correction dose. I will check.
Yes - 1 unit will take over usually 6 but can be 4-8.
=================================================================


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## Redkite (Mar 3, 2014)

Sorry for all the questions!  We don't mean to be unhelpful, but there isn't necessarily a clear answer.  It is obviously not desirable for her to be up in double figures for several hours of the night, but what happens when you do nothing?  Does her BG remain high, or does it drop to normal range by wake up time?  As I said above, when my son was on Lantus as a basal insulin, he crashed overnight and so had to be artificially high at midnight so as not to be hypo by morning.  If I had injected some novo to bring him down in the early hours, I would have precipitated a hypo, so my hands were tied.  If, however, the Lantus had acted as it is supposed to, and kept his BG steady overnight, I would have injected some novorapid for a high BG at 2am.

You may find it useful to give some novorapid with the bedtime snack if she ends up high at 2am more often than not.  Two biscuits are around 20g carb (depending what type!) so quite a lot to have without insulin.  I would also recommend doing some more frequent testing for a night or two (exhausting but worth it ) - to have a picture of how the BGs are varying e.g. 8pm, 10pm, 12am, 2am, 4am.  If she is perfectly fine 3 hours after her bedtime snack and it starts rising after that, you can narrow down the cause to either growth hormones or Lantus running out.  Since you give her the Lantus in the morning, she may have inadequate basal by the early hours of the following day, and therefore a correction may work for you.  But you will only know for sure by doing the intensive testing I'm afraid.

Finally, I would really recommend you look into getting an insulin pump for your daughter - the variability throughout the day is so much easier to tackle with a pump, as you can program different basal rates for each hour of the day to suit her varying needs.


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## colinprice72 (Mar 4, 2014)

Thanks for the replies. Keep them a comin'
I will check out the pump out and I agree about the 2 hr checking throughout the night.
Thanks.


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## bev (Mar 4, 2014)

Hi Colin,

I agree with Redkite - pumps are great at dealing with these ups and downs of background basals and all sorts of other tricks that diabetes throws at us! My son was only on injections for 6 months but we soon realised he was so insulin-sensitive that we needed tiny amounts of insulin that injections couldnt compare with. On a pump you can do tiny increments per hour which is what is needed - its rare that anyone has the same 24 hour profile of basal and injections for some just doesnt cut it.

Its allright not to know about correction dose's its not your fault if you havent been told. Ask your team about this as you need to start off carefully especially in a child. There is a formula on how to work it out but just cant remember it at the moment - am sure someone will be along to explain. 

On another note - my son always had high levels (and sometimes very low) on  injections as our team told us he was 'allowed' a 10g snack a couple of times a day. WRONG! We quickly realised that for us it just didnt work - ALL food needed insulin no matter how tiny. Perhaps the snacks at bedtime are adding to the issues? 

There is a huge amount to learn with Type 1 and its early days for you so dont feel your not doing well - you are - we have all been there and its exhausting trying to get your head round it all. The best advice I can give you is that what works for my child wont work for yours - you have to get to know your daughters diabetes like the back of your hand and its a lot of trial and error! An example is that it takes 8 hours for a pizza to fully digest for my son - and we spread his insulin out over 8 hours to cope with that - but for others it seems they can give a straight bolus and levels are fine! There is no easy way to work this out other than to test test and test again I'm afraid and to keep a diary to work out various tricky foods. Keep asking questions and dont be afraid to ask anything - we are all here to help and know how tough it can beBev


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## HOBIE (Mar 4, 2014)

No prob colin keep asking ??  You have a lot to learn & at times it isn't easy but things are improving every day with gadgets & tech. I am in 48yr of T1 & full time employment & two lovelly kids of my own. Keep at it


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## colinprice72 (Mar 18, 2014)

Just a quick thank you for the replies. Very interesting and informative


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