My son uses the omnipod and we're dealing with dinnertime lows PLEASE READ AND ADVISE!

Hi Everyone,

I am new to this group. I just found the site today.  I am so excited to have found you!!  My son is 10- he was diagnosed on 1/8/10.  He went on the pod in AUgust.  We had very few problems until the week before Thanksgiving.  He got a stomach virus and was sick for 5 days.  Not crazy sick but enough that he was home.  Since then, every night at dinnertime his sugars go through the floor.  I have been up every night with him trying to get his numbers up and then after around 3 lows he'll shoot through the roof and I have to bolus him down.  Seems crazy and the docs don't seem to have an answer.  We went off the pod for a week and it didn't help.  His numbers were more out of control.  Today he woke up at 23.  I couldn't get him above 65 until 1 pm and he had eaten a ton with no bolus.  This is the first day where he has been so low.  Usually it's the night.  I am scared at this total lack of control...We pulled him off the pod again per the docs and he hit 33 at 6:45 tonight.  7:45 he is low.  What should I do?  Have any of you experienced this?  I am so upset and my whole family is experiencing total burnout.  Help  :)

 

Kristina

Tags: lows, nighttime, unexplained

Views: 61

Replies to This Discussion

Hi there!

Has your son's doctor recommended changing his dinner IC ratio?  Within Caleb's first couple of years I found that there was great variability in his numbers - I still do to some extent.  I am often making changes to his settings to deal with his changing insulin needs.  In the beginning I found the hours of 8PM and 11PM to be of the greatest variability which I attributed to growth, although I will never know for sure.  

From what you have described, if it were Caleb, I would begin to change his dosing - to dial it back - and continue to check his bgs more than normal until they come back into a reasonable range. 

I would try to keep as much as I could consistent until I was able to get things a little more predictable again (though things never seem to really be "predictable").

Hang in there!  

 

Welcome Kristina.  Do you have a CDE or someone who trained you on the Opod?  Have you talked to them about suspending his insulin delivery for a bit when he is really low and changing his basal program for that time of day?

Good luck.  I always say that helping a child deal with this must be so much harder than dealing with it yourself.  Your son is lucky to have you as his advocate. 

I agree with Lorraine.  Adjusting the IC ratio may help.  Those are some wicked lows and they are scary!!!!   We had a week of lows last week our self ( not that low, but some 40s). I cut his basal in half and then sometimes at night I just turn him off completely for a couple of hours.   He's probably having a delayed response with those early morning highs.  Is he eating good protein?  I know that's a basic, but I know when we got on the pump we felt such a freedom with food, that sometimes Will wouldn't get a good amount of protein, and he'll drop.  We do icecream for bedtime or if he some other type of faster acting carb then he'll eat cheese with it. I do think he needs some adjusting though.  Hang in there. 

My advice is turn down his basal rate for the time of day he is going low.  Maybe even adjust his carb ratio.  After 3 days in a row, you can call it a pattern and adjust for it.  As to why???  Million dollar question, honeymoon?  growth spurt? hormones?  weight loss?  Body being weak from recent flu, having to work harder to build back up? I don't have that answer, nor do I have the experience of being 10 with diabetes.  But I know the frustration of unexplained lows - and I feel for you!!!!!   Good luck!!!!

Hi Kristina,

My son is also 10, and was diagnosed 2 1/2 years ago. 

First of all, I have read that it's pretty common for it to take a while (like sometimes months) for your stomach to fully recover and be able to absorb food like it did before you have a stomach bug.  And so it can take that long before your insulin needs come back up also. 

Secondly, I'm surprised your doctors don't have any ideas - do you have a CDE or an Omnipod rep that could help out?  When you are low for a while and are treating it, it's easy to have either a rebound high, or just a late high from absorbing stuff too late (which makes sense after being so sick) So I agree that the 8-11 pm time is probably where he needs some adjusting - either a lower basal, or a different I:C ratio (or both but you probably only want to adjust one at a time).  And if he's waking up at 23, I would definitely change his basal for the whole night for at least a couple of days - you'll know you've done too much if he starts going high, but until he does, I would take some small steps every three days until you feel like he's where you want him to be. As long as he's getting insulin, a little high won't hurt.

 

Hope you figure it out soon!

Natasha

I would definately try and talk with your doctor (or perhaps a second opinion) about adjusting either basals or bolus's or both.  Also, you might want to talk to a dietician about proper foods and timing of them that can help mitigate this issue.

It could also be that if he is really active he is getting his reactions from the activity then. You might look into the actual food he is consuming as well.  Maybe he needs more proteins, especially before bedtime? 

I am not sure how it works with kids, but if he is really active- you might want to give him a glass of chocolate milk right after the activity.  When I exercise, I drink that right after to help rebuild gylogen in my muscles- which in turn helps prevent future lows.  I am not sure how it works in growing bodies though- so this is where a dietician will come in handy.

The other thing to look at could be his insulin reacting time.  Figure out (if you haven't already before) when his insulin peaks and then adjust the basal that amount of time before the lows start.  For me it is an hour to an hour and a half, whenever I adjust my basals I have to start it that amount of time before I get consistent lows or highs.  So for instance- if I get low at 5:30 pm, I will adjust my basal rate at 4 or 4:30pm. 

 I remember getting overnight lows quite a bit growing up- I used to keep a juicebox on my night stand- and sometimes with a package of peanut butter crackers.

 

Do you have a CGM?  If not you might want to consider talking to your doctor about getting a loaner while you figure this out.  Good Luck!

This reminded me of what I was going to add about the 8-11 time frame.  My son is like clockwork as far as blood sugars dropping 6-8 hours after sports.  If he plays outside after school - he's low at 9 PM.  If he has an evening sports practice, he is low in the middle of the night.  We have a higher I:C ratio at dinner because it's 6 hours after recess.  So you might want to keep track of when he's most active - if there is a low that's coming significantly afterward.  I was told at a sports seminar that it's because that's when the body restores the glycogen - so it pulls sugar out of the blood to do that.   Eating or drinking something with protein or fat right after the activity would probably help with that - we haven't tried it but it makes sense to me.  Maybe we'll give that a shot after basketball this week!  Right now we are just trying to remember to check him 6 hours later - or if we're really on the ball we lower basals about 5 hours later, but I usually don't remember to do that so we are treating a low 6 hours later instead.  

Good idea we go in tomorrow!  Thank you

I have had issues with my settings when I have been sick.  I usually need less insulin.  Also, it might help to extend his bolus which helps me when I eat foods which absorb slowly.   By delaying the insulin delivery I (generally) avoid a low and the subsequent high when I eat everything in sight to treat the low.  It is not an exact science, but it does help.  With Chinese food I extend up to 3 hours and get better results than an immediate bolus.

 

I have had better luck working with my CDE rather than with my Endo.  My CDE appointments are 30 - 60 minutes while my Endo appointments only last 10 - 15 minutes.  My Endo wrote orders which permit my CDE (an RN) to change my oPod settings.

Hopefully you were able to get some help today at the CDE.  Definately find the SUSPEND button at the bottom of the menu.  Two hours is the max it will allow and then it should reset itself to basal.  It is hard to get up when you are still getting too much insulin no matter how much you eat.

 

Lows can be scary.  If he is consistently low overnight, I would use the "Temp Basal" function to dial back the basal insulin until he is consistently around 100 through the night (still checking him every two hours or so). It is pretty easy to use, you just enter the % to decrease the basal for a time period.  Make sure that you are decreasing and not increasing!  My son uses this when playing hockey because he needs less insulin during and for several hours after skating.  When you find the right %, then the CDE and you can make a permanent change to the basal rate.

 

We recently lowered my son's basal for the afternoon period also.  He was consistently in the 60s at 4pm when he should have been around 100 at a 6 - 7 pm dinnertime.  On MDI, he was always high in the afternoon especially after eating pizza for lunch.  We think his 10 pm Levemir was actually gone by the next afternoon and he was actually not getting any afternoon basal.  With the pump, he needs some afternoon basal insulin but not as much as morning.  

 

I know you are exhausted.  His lows are so low, that I would be tempted to just temporarily decrease his basal by 40 - 50% for a day to see if he would consistently stay above 140 and then adjust the % each day to bring him back to 100.

 

 

 

Hi Kristina,

 

I agree with everyone's input that his basal rate for late afternoon to evening needs to be lowered. Best way to figure it out is to test more frequently, write down the results and look for the trend. Your endo should adjust the basal rate according to the info you give them. I've had tons of diabetic education so I constantly tweak my own basal rates as my current doc isn't exactly on the cutting edge;o).

 

As for the nasty lows, when I hit the low 30s, I usually suspend my insulin delivery for 30-60 minutes while I treat it and restart when I hit 90. I've only been on the pump for about 6 months and love this feature. Also, ask your doctor to prescribe a Glucagon emergency kit. I use to have get one a year when I lived in Canada (used 1 in 16 years) but got looked at funny when I moved to the US and ask my doc for one. It's a good thing to have if his sugar drops too low and you need to call 911, you can administer it while waiting for the ambulance.

 

If you can, find a diabetic educator that will take the time to teach you how to adjust basal rates and take into consideration all the things that happen in life to make our BS go all nutty.

 

Best of luck to you. You will get the hang on this and be able to teach your son to control it instead of it controlling him.

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