Saturday, April 2, 2011

To carb or not to carb... that is the question

Okay so we all have our goal for overnight and while they all vary I am sure we all face this same issue.  When do you add carbs and when do you just wait it out?  Here is what is going on with us. Joshua is supposed to be between 150-350 over night. Yes that is a huge gap but remember he is just now 2.  We strive for between 150-300.  Anything over and we are to give insulin. Anything under and we are to give carbs.  Sounds simple right??
Here is what has been happening lately. We check at midnight and at 3am.  He will be in the 170-180's. It sounds like a great number and for some of you it would be.  But to us it means far less sleep then a high or low. it is just unknown. Joshua is like a gas tank. When he is between full and 1/2 it takes a while to go down but when you get to 1/2 he can go empty fast.
So that 170 could be going up... or it could be going down. If it is going up then okay great. If it is going down... well we all know how fast that could happen... and what if, I miss the 3 am check.  So I am left hanging out for another hour to see what happens. now it is 1 am and his number has moved only a little in either direction. Still no idea and so then we wait some more... now it is almost 3 am.  What if he is 160? do you go ahead and put carbs on board, just incase?? We did once and boy did we regret it we woke up to a 468 bg.  We didn't add carbs one night and he woke up to a 62 at 3am.  What if I had overslept? what ifs are causing me to loose a lot of sleep.
What do you do?? What is your magic number and do you have a curve on that?


  1. I think its very different for you since hes only 2.

    For Justice his goal at night is 120-160. When he was MDI he had a snack everynight, and we didnt correct unless over 300 or he had ketones, because he would drop so fast.

    Since pumping those highs can indicate a bad site, and now because of proper basals he can cruised low 100s all night.

    But still I worried. Until we get our Dexcom. Have you considered a CGM?

  2. Because your little guy is only 2, you need to be cautious. Since the pump, I can keep Bekah at 115 with out worrying that she might bottom out. I don't let her go below 100 at night now with out giving some carbs. On MDI, I wouldn't let her get too far below 150 before adding some carbs. The smaller the kids the more sensitive to carbs and insulin they would be I'd think. I don't think I have much wisdom to offer here. ((hugs)) I hope you get a solution figured out.

  3. R's blood sugar is quite volatile. At the hossy we asked them this exact question, and they said, oh its what you are feeding him, whether he holds or not. But be cautious with him being so little. This is what happened to us last night - we gave a warm milky malt drink at 9pm, then off to bed. His before bed BGL was 14.0mmol/l. At 1am he was 13.5. At 2am he was 7.7, so we gave a small squirt of condensed milk. An hour later he was back up to 10.5. then at 4am he was 3.7. (hypo). precisely why I dont sleep. If we had a CGM, I guess I wouldve seen some down arrows, at some time through the night to indicate he was dipping so fast.

  4. Tough with him being so young for sure Shannon. And, as Heidi said, the young ones are extremely sensitive to BOTH insulin and carbs. Is Josh pumping? If pumping, I would give Joe fast acting sugar. Like 1 glucose tab for a 160. If on shots...maybe a 4 gram PB sandwich cracker (4gs). Joe is not nearly as labile as he was when he was 3,4,5. I hope that last sentence provides you with some comfort. The MDs had always said that they "stabilize out" a bit once they hit 7 or 8. Joe is almost 8 and I can honestly say his numbers do seem more "tolerable".

    Love to you and the family. Have a great w/e.

  5. The only suggestion I have is a CGM so you can tell what direction he is headed. Does he have one? Or is he to young?

  6. This is why we love the CGM. Elise might be 110 at 3:00 am, but I can see by the arrow and the graph that she's holding steady.

    We have to be so, so careful with giving Elise insulin or carbs at night because she is just so sensitive. For example, last night she was 408 at 1:30 (thankyouverymuch stupid pizza). I gave her 3 units of diluted humalog and at one point she dropped as low as 116. That's a correction factor of 1:500 when you translate it to full strength insulin. We've even found that 3g of banana can shoot her up by 50.

    Having said all that, her Bg has become somewhat more predictable overnight as she has gotten older. Hoping it does the same for Joshua.

  7. What a wonderful question and one that we still have not found the best answer to for Cara. I felt the same exact way at night time, you never know which way they are going!! and it seems anyway you go they are either too high or too frustrating!!

    Since we have made the switch from Lantus to Levemir our nights are much more predictable!! Cara will stay in the same range through out the night with levemir. So if she was 13mmols at bedtime check she will be somewhere between 10-15 mmols by 3am check no crazy drops or highs, most the time!

  8. Saw your post and thought I'd leave you a quick comment (I know I ALWAYS love any suggestions when I send out a cry for help).
    Our little guy is also two years old (diagnosed a year ago this month). We have him on a pump and CGM, so I'll share with you what we've observed from watching the CGM, but I realize it might not apply since I'm assuming your on shots, but then again, it might give you one more window into what might be going on. With the CGM, we've noticed that there are periods at night when Robby is more insulin resistent or more insulin sensitive, as well as periods where he has natural rises in his BG. I've also read a bit about this in verious books. Some nights are level (but it's pretty rare for us). Most nights we'll see his BG rise from about 8:00-11:00pm, but the hours from 1:00am-5:00am are very stable and insulin sensitive, and then he'll start to naturally rise from 5:00-8:00am. With this in mind, we can set our pump settings to match these rhythms. You could ask your MD if these are typical natural rhythms for children his age. With that in mind, if he's at 170 at 10:00 don't feed him because he's more likely to be going up those hours than he is going down. And then if he's at 170 at 2am, you might want to feed him just a bit becuase those hours might be more insulin sensitive (by the way, our favorite night time carb is Danonino yogurts. They have a little protein in them and they are only 7 grams so we usually only need to feed our little guy half or maybe a whole yogurt. Plus they are a little thicker than regular yogurt or pudding so it doesn't fall off the spoon when I'm trying to feed a sleeping child ;) ) and again, if he's at 170 at 5am, you might not want to feed him because he may be in a natural pre-morning rise. Like I say, I don't know how much of this applies to MDI or Lantus, but it might be worth looking in to. I just know that before we figured this all out, we had many nights where we'd feed a low of 100 at 8pm just before puting him to bed and an hour later, he'd be at 320. I hated finding out that I was feeding into a naturally occuring rise and he would have been better off if I had done nothing! SOOOO frustrating!
    I feel your pain, sister! This D stuff is tough. Hang in there! (and I'm just hoping that what everyone says is true and they do start to level out as they get older)

  9. Emie is 2 yrs old and has been type 1 for almost a yr now. We have her on a pump and CGM. her night range is 150 to 180. we do nothing unless bg is below 150 or above 200. The cgm is a gift from god because I have the baby monitor in her room and can hear anytime she beeps on top of the 1 am bg check. If she is tiping to either side of the tight rope i tend to treat ahead of time but this is doable because of the cgm showing me her trends. I prefer her to run slightly higher then lower because a low will kill them a lot faster then a high and with her little brain growing at this fast pace I don't want to kill any of her little cells lol. It is hard I know but with me being type 1 myself I had it slightly easier then a non D parent. Good luck!

  10. This is an issue for us at bedtime as well. Just in the last couple of weeks she has stayed a little more "stable" through the night, but she usually has dropped some by her 11pm and 2am check and then is usually lower in the morning when she gets up. We only give insulin if she is over 300 at bedtime, and we only give her a 1/2 unit. We did that last week though and she ended up too low by 2am, so most of the time we do not correct with insulin. I usually give her a couple glucose tablets and a peanut butter cracker sandwich or two at bedtime depending on her BG. She usually needs to be around 180-200 at bedtime for her to not have dropped too low by the time we check her again. I try to not treat her with juice in the night unless she has gotten down to 130 or so, and yes, that means I am up checking her more, but I hate to send her sky high too. I'm hopeful after reading everyone's comments that they do eventually level off when they get a little older, but that time seems far off for us right now!

  11. Justin does the same thing... he can go either way and fast. AND I do the same thing you do... wait and keep rechecking.

    There are some nights though that I can feel the exhaution and I worry that I wont get up(I have slept through my share of alarms). On those nights... I will bump him up a little just in case. You can just give a few carbs according to what his bg is.

  12. Whoa - my head is spinning after reading all of those comments. It's hard --- since Nate started pumping and we have the CGM I run him much tighter than I would without.

    I try to keep him between 120 - 160 but usually won't correct until he creeps up to 200. Anything over that will be corrected.

    Our insurance stopped covering our CGM sensors and I cried for days. Luckily, a sweet D mama sent us some sensors and my dad has agreed to buy more when we run out. My decisions rely heavily on what that CGM is telling me.

    I know it's hard. I'm always here. I think you are doing a great job and you are a dear friend!! <3

  13. So many good questions.. and answers! I know this is a tough time- you are strong and have so much support to help along this winding path.

  14. Night time can be so hard. You just want to sleep but you are too worried to sleep.
    I am thankful we don't have this problem now but a remember how hard it can be.

    If you don't want to go the CGM route you could try a couple on nights of very regular testing to get some idea of trends. You could do an reading every hour (alternating with you hubby so you get 2 hours sleep for you between tests)
    Just an idea.