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Monday, June 21, 2010

I take it all back... we suck.

Calling on all my D-Peeps for some help here. Fred and I are stumped beyond belief at a trend of numbers Elise has been having lately. I blame it on my proclamation that we are "freaking rock stars".

Anyway... for the last three days, when we check Elise for her pre-bedtime snack, she's in the mid-300s. We give her a snack and her bedtime NPH, and usually somewhere between 9:30 and 11:00, she falls low. We give her some carbs and she rebounds into the 300s during the night, waking up in the mid-200s. The timeline looks like this:

5:00 pm - shot + dinner. Usual carb ratio.
7:30 pm - bedtime check. In the 300s.
Between 8:00 - 9:00 pm - bedtime snack (15g) and NPH.
Between 9:30 - 11:00 pm - Elise's BG is i
n the 70s. We give her carbs.
1:30 am - BG in the 300s.

Is it possible that her fast-acting insulin she gets at dinner (diluted Humalog) is peaking 4 - 5 hours after she gets her shot?

Is it the combination of her DH and NPH making her go low (are we giving the two shots too close together, which is approx 3 1/2 hours apart)?

Is the NPH now peaking earlier than it ever has?

Keep in mind, we are doing EVERYTHING the exact same as we have before. Same schedule, same carb ratios, same snack. I just don't get it. The weirder thing is the numbers are pretty much IDENTICAL for the past three nights (for example, last night at 7:30 she was 331 and tonight at 7:30 she was 331... WEIRD).

As far as I've been told, Humalog starts to work in about 20 minutes, peaks around 2 hours, and is gone by hour 4. NPH (in most people, we've found differently with Elise), starts to work in 1 -3 hours, peaks by hours 4 - 9, and is gone in 14 - 20 hours.

So... anybody have any pearls of wisdom for us? We're going to try giving her a few more carbs for her bedtime snack to see what that does to her BG at around the 10:30 mark. Otherwise we're out of ideas.

I never should have opened my big "rock star" mouth.

11 comments:

  1. Does Elise have any signs that she might be coming down with something? I know when Lily and I start to get sick, our blood sugars are off the first few days. My only other thought...I think I remember hearing from Lily's endo that part of the reason they don't use NPH much anymore is because the absorption rate can be different from night to night, even within the same patient (meaning, some nights 90% is absorbed, some nights only 75%). Not sure if that's true or not though. Can you fax her numbers in to the clinic and see if they have ideas for you?

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  2. BIG (((HUGS))) Joanne, I am going through some similar issues myself with Miss E's numbers!

    These crazy high BG's are really throwing me for a loop lately, I wish I could offer some advice but I am feeling just as confused as you are :( Darn diabetes...just when you think you've got it all figured out it goes and gives us a smack down!!!

    I hope that you are able to see some better numbers really soon!

    Also wanted to thank you for the tip on the light to use for nightime blood sugar checks!!! That sounds like something that would make my juggling act at 3:00 am be a little less stressful :)

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  3. @ Cindy - I've heard that about NPH too, but up until now, it has been pretty consistent in Elise. I thought we had it figured out.

    The CDEs at our endo are, how do I say this nicely... less than helpful. We love the doc that we see, but have pretty much been on our own and without help (from the educators) since about 6 months post-dx. And to get to the doc, you have to pretty much go through the educators. It really is a crappy system.

    I'm pretty sure Elise isn't getting sick, because all her other numbers have been okay. It's just these night time ones that are giving us a headache. I'll keep my eye out though, thanks for the advice!

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  4. Hmmm...I wondered if she wasn't getting sick , too. Could it be a growth spurt wreaking havoc? Has her activity level or the types of activities she's doing changed? Could the summer heat be affecting her?

    Lately, Jack seems much more sensitive to both his insulin and the carbs we give him to treat lows. We can't seem to pinpoint why. Could be the summer's heat, swimming, camp activities, who knows what. Whatever the reason, we've discovered that we can give him only 12-15g to treat a low in the 50s, whereas a month ago, he needed 20-25g. Go figure...

    Wish I were more helpful! I know how frustrating this is! If you figure it out, let us know.

    Good luck!!!

    You're still "freaking rock stars!" :)

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  5. It's summer...extra exercise, or even the heat can make a difference at that time of night. Have you tried riding out that 70 and see where she goes...she might go up nicely to the 100's on her own. Maybe a 5 carb snack when she is low at that time? I'm just throwing stuff out there. I'll keep mulling it over...I'll call you soon, we need to catch up!

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  6. PS You guys DO NOT suck!! D does!

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  7. Wow - you do this all without the benefit of a good CDE? I'm impressed!

    I don't have any sage advice for you, but I wanted you to know I'm thinking about you and sending you good thoughts of stable numbers. I've found (and I'm sure you have too) that sometimes you just need to ride out the crazy numbers, and then they suddenly bounce back to normal.

    Good luck!

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  8. Hey Elise,
    Do you know how much the 15g carb raises her blood sugar? It seems that the 15g is kicking in later than you think and not 'meeting up' with the NPH if you know what I mean. Have you tried just sitting with the 70 and checking her every 15 minutes when she hits 70 and seeing what happens? Maybe she comes up on her own. If that's the case, then I would back off a little on the NPH dose between 8-9 pm.

    I honestly think it's growth hormones, as it's doing it at night. A surge and bam, you have other levels and doses you need. All the time, adjustments. She is having a growth spurt at night with her hormones I think. Then again, just my thoughts...

    You So do not suck, you are great at this - look at you trying to figure it all out!!!

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  9. Yeah I was going to say the same thing growth hormone is causing wacky stuff to happen it did with my oldest son . Im sorry I am not more helpful . yeah meri is right d sucks not you guys .

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  10. Joanne, I agree with the others...if she's not getting sick and her other numbers are good, the timing of the bad ones and all means it's most likely a growth spurt. Like Meri said, maybe try riding out the 70 and see if she comes up on her own. One of our tricks for when Lily has a just-a-little-low in the night is to use Hershey Kisses-3 grams of carbs in each little one and the fat in the chocolate helps give the blood sugar some stability.

    Like the others said, you're still a "freakin rock star"! Seriously, to get that great of an A1C, and without the help of a diabetes educator, is awesome! Hang in there! Diabetes is always changing the rules of the game on us, but we keep beating it's behind anyway!

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  11. Well firstly, you most definitely do not suck.

    Caleb was on Novolog and NPH before pumping. In the weeks before he started pumping, I noticed that he would be in the 80s before bed, give his schedules snack and then he'd rise. I ultimately just got rid of the snack and he was fine. The NPH peak was apparently needed for the growth or whatever, was happening at that time of night.

    When we started pumping, that period of night gave me the same trouble. He just needed more insulin (a lot more) during that 8ish to 11ish time period. I have always attributed it to growth but who knows.

    The above may all be rubbish as it relates to Elise though. Caleb was on injections for about 3 months after diagnosis, so we were dealing with a very strong honeymoon at the time (his TDD was less than 2 units) and then this very heavy growth (or whatever) issue.

    Good luck. You will figure it out. You didn't get that 6.6 because you were just lucky, afterall.

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