Spiking at night

My daughter is spiking in her sleep. She is on novolog in the day and basaglar at night. All of a sudden 3 weeks ago she started spiking. She would go to bed between 120-190 and by 230 am shes 300. Her endo just says increase basal but that’s not helping. I correct her but by morning for school shes 190 and stays 190 by lunch if I correct her for breakfast. I’m at my whits end . Any suggestions? Shes 8 and diagnosed at 3. Unless shes was sick this has never happened . No symptoms of sickness and appetite is very much in tact

I’m wondering if she’s eating a snack at night, especially if her numbers are on the lower end? Some of us do to prevent going low, but the food could be causing the rise. If she is having something to tide her over overnight, her nutritionist could recommend some choices that could keep her even without rising so much.

After dinner if she wants a snack at 7 I do but if she doesnt I dont but it’s still a spike either way. Pickles are her favorite before bed and thats not even high in carbs

Thank you for sharing. Some people on the forum have shared that a particular formulation works better than another - Novolog works great, Humalog not so well - and the same can be true of the long acting insulins. I don’t know if that typically occurs after you’ve been using one for a while, but it might be worth checking into along with other suggestions I’m sure you’ll be seeing.

Ok thank you. Novolog definitely works well for her . Originally she was on lantus but because of insurance she had to be switched to basaglar which was ok then she was on levemir which worked but didn’t last past 8 hrs now she is back on basaglar and having issues. I’m not sure how long it takes for it to start working because if she is continuously going up after 6 hrs I’m not sure if it’s even working . But this is all of a sudden before 2 weeks ago it was fine

Hi @stixxs512. Many people have higher basal insulin requirements at night. I do. My overnight insulin requirement is 30/50% higher than my after lunch requirements. Children go through growth and both the growing and the changing hormones require changing basal insulin strategies . Many people split basal insulin injections to 2 at 12 hours apart for better coverage. I could never get a good basal from shots and that’s the real reason I use a pump.

Insulin requirements change. Especially in kids. I urge you to work with a CDE or endo until you are happy with her control

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I understand Ndidi @stixxs512 the frustration you are experiencing while trying to help your daughter regulate her diabetes.

Lantus and Basaglar are both “insulin glargine”, so there really should not be a difference in how they affect your daughter; although she may be the exception. I agree with her doctor’s recommendation about increasing her basal insulin as a beginning point. It may need to be increased again or the timing of injection changed.

I didn’t notice if you mentioned doing a finger-stick BG Check three hours after she supper. I suggest that you do these checks for a while, write down the time and BG value and share this information with the doctor; the doctor will possibly change the bolus:carb ratio for that meal or suggest a correction. If the doctor or CDE has not educated you in calculating a correction dose, ask for instructions. Always be very cautious with correction dosing, especially in the evening and at night.

I’m NOT a medical doctor and my suggestions are based on what I know has worked for me while adjusting my insulin dosing for more than 60 years.

Do you know of a difference levemir and basaglar?

Ndidi @stixxs512, I haven’t had personal experience with Levemir [Insulin Detemir] other than that the makers claim that it “is similar” to Lantus. I make note that the manufacturer does NOT claim that Levemir is the same as Lantus or Basaglar.

Your daughter’s doctor is the one to make the decision that it is appropriate treatment - this is a prescription medicine needing doctor specific approval.

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I started taking my Lantus twice a day, and it has helped me tremendously. I take half the dose at 7am and the other half at bedtime around 10pm. I also take 1 unit more or less at bedtime when I have been especially active or eaten a heavy carb meal. You might ask your doctor if that’s an option.

I’m not sure if she is on a CGM, but another experience I had was high sugars during the night and in the am due to hypoglycemia during the night that was not waking me up.

I wish you the best. You’re a good parent. :slight_smile:

First, I highly recommend a pump. Personally, I’d go with Omnipod, because the tubeless pump provides better freedom for kids to be kids, running around, etc.

Also, as kids grow up their bodies change. I have 2 boys diagnosed at 7 and 13, and have had to constantly change their profiles. They are now 10 & 16.

Finally, consider Fiasp for quick-acting insulin. We recently switched from Novalog and LOVE it. Hits the system much quicker. Just my 2 cents.

She doesnt qualify for the pump because she only uses a certain amount of bolus daily

I currently split her dose. Her doc increased her basal at night

She was 150 at bed which is 8 pm I gave her half her dose 3 units . By 1258 am she was 345. Doc increased her basal from 4 units to 6

How did you adjust the hypo so that you wouldnt be high in the morning

Hi,
If I understand you question correctly, I stopped taking additional Humalog before bedtime if my sugar was 200 or less to prevent the hypoglycemia. I take 1 unit of Humalog if it is between 200-250 and 2 units if 250-300 at bedtime. (This is different than what I do during the day.)

I currently take 7 units of Lantus in the am and 6 units at bedtime for comparison sake.

I was advised by a doctor to adjust my Humalog dose by my sugar reading, not by carbs, to simplify things. During the day, for every 50 units over 100, I take 1 unit of Humalog. So if my sugar is 250, I take 3 units of Humalog to bring it down. If I have sugar of 250 before a meal, I add the amount of insulin based on what I am eating to the 3 units. I’m able to do this as I’ve had diabetes for lots of years and know how each meal affects my sugar. (I’m probably adjusting for carbs in my head.) It works for me as I check my sugars multiple times a day and take multiple injections.

Diabetes for me becomes difficult when doctors try to put me on a regimen that does not fit my lifestyle. Change is hard for me so it rarely works out the way it’s supposed to when they give me a directive. I have found that setting small increments of change over a period of time works better for me. For instance, instead of trying to adjust from constant sugars of 250 down to consistent readings of 100, I make the goal to get the sugars to 200-230 on a regular basis and then when I am comfortable with that, make another small adjustment. My current goal is 120-150.

Many endocrinologists in my area have scared me away with condescending attitudes over my 7.0 A1C. However, my family doctor tells me that’s great and keep doing whatever I’m doing! So I see both of them for my diabetes and take what I need from each one as far as advice and support. There ARE some really fantastic endocrinologists though!!!

I mainly do fingersticks, and I limit myself to wearing a Dexcom infrequently as it really stresses me out, and I chase sugars rather than using common sense about how I feel and what I am doing and eating. But I do find the Dexcom helpful to use as a tool occasionally to verify that what I am doing is still working. :slight_smile:

I hope any of this helps, and I’m sorry if I said too much. We are all different, and this disease looks different in everybody. I went to diabetes camp as a kid, which was awesome, but my sugar readings never compared to the other kids when they fed us all the same stuff and adjusted our insulin the same. I was an oddball. But that’s okay. I would definitelly recommend camp though if your daughter has not been. Usually they do not charge if you’re unable to cover the expense.

Very interesting. A lot like my daughter’s situation now. She currently sees a pediatrician who is also an endo and the stress levels for me have decreased . He focuses more on her numbers instead of counting every carb. She currently is on 1 unit novolog for 200 and 2 units for 300 etc. This suits her fine it’s just nights have become an issue over the past month. I will definitely be taking some of the suggestions provided to me . Her doc is great it’s just because I see my kid everyday and I’m not just okay with increase her dose . I do that but i notice other things like it wearing off when i give her basaglar all at once instead of splitting her dose. But the split maybe shouldn’t be half and half because it seems like between 8pm and 3 am she spikes more so I’m thinking she needs more basal during those hours. We do fingerpricks because that’s what she is used to and I want to make her as comfy as possible. I am looking into camp her endo suggested one in our state. Thanks so much

My daughter is 7, diagnosed at 3. She also spikes about 2AM. She wears a pump and her basal rate is the highest from about 1-3am. It’s strange because when she was first diagnosed they said to get up during night to poke her finger because that’s when she would be lowest.
I don’t have any real advice except to slowly keep increasing basal rate until you find the right balance. I just wanted you to know that you are not alone.
I hope your daughter wears a CGM, they are very helpful.

Clair

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Another thought here. Our bodies adapt a "“setpoint” after living with a certain daily pattern for some time. It’s hard to change that setpoint, and it will boomerang on you if you do it too fast.
What happens is that when she drops below what her body assumes, from experience, to be too low there is an automatic release of glucagon to raise her bg back to “normal” levels. So if you try to adjust her readings down too rapidly they may well stay up there regardless.
So rather than trying to adjust her bg range down all at once try adjusting by half as much, stay that way for 2 or 3 weeks (may be less, very different for each person) until she has a stable, somewhat lower bg pattern, then repeat with another small adjustment.
In any case it’s always best to hold ANY adjustment for at least a week, more likely 2 weeks, so that the body stabilizes there, before changing again EVEN if the early results aren’t what you expected.

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