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[IPp] 4 year old pumper with night time lows

In a message dated 2/25/2002 6:29:58 PM Mountain Standard Time, 
email @ redacted writes:

> Her basal rate is set at .3 but the pump is
>  off from 3:00 pm to 5:00 pm.  For some reason she gets low during this time
>  frame.
>  We have not been able to get the night time down yet.  We still test her 2
>  to 3 times during the night and often have to give her a drink box in the
>  middle of the night because she is getting low on us.  at night her basal 
>  changed at 12:00 am. to .2 and then again at 3:00 am. to 5:00 am the pump 
>  off again.  But we still have lows throughout the night.  Which is my
>  biggest fear of when she will go low.

I don't know which kind of pump you have, but even if it's not an Animas pump 
you should be able to set basal rates as low as .1 units per hour (as well as 
0.0 units per hour), which is why I'm curious as to why you have higher basal 
rates (.3 and .2) and then just turn the pump off -- a zero basal).  Here are 
some thoughts I had:

First of all, if you want to prevent lows through adjusting basal rates, you 
need to look at adjusting the basal rates that are happening 1-3 hours BEFORE 
the time period when the lows are occuring.  So if your daughter tends to go 
low between 3 and 5 pm, you'd probably want to be lowering the insulin that's 
being pumping into her from at least 1 to 3 pm . . .

Second, I would look at lowering basal rates to the lowest possible level 
(probably .1) instead of having them higher at some periods of time and then 
"shutting off"  the basals completely at other times.  If this isn't enough, 
you can try alternating periods of the lowest basal rate your pump allows 
(either .1 or .05) with a zero basal rate (either alternating hours or blocks 
of two hours depending on how many basal rates your pump allows you to set 

There should be no reason that you have to check her 2-3 times per night 
because she's frequently running low and you're needing to give her juice at 
night.  If her night time basals are set right, she should wake up with her 
BG level being somewhat higher (maybe 30-50 points higher for a young one 
like her) than what she went to bed at.  If she's dropping, and having lows 
at night, the most basic rule of diabetes management says she's getting more 
insulin than she needs.  That means you need to to make some significant 
reductions in her night time basals (probably starting at 8 or 9 pm), do some 
 several night time checks for 2-3 days, and if she's still dropping or only 
rising a little, then that tells you that you need to reduce them further.  
If you don't feel comfortable with making these kind of adjustments on your 
own, by all means, discuss it with your CDE or endo, but you should know that 
there is no reason that a child on the pump should be having night time lows 
like this -- it's a VERY fixable problem.

I hope this helps give some idea of what some of your options are.  Feel free 
to come back with more questions -- and be sure to keep us posted on how 
things go!

Happy pumping!

Pumpmama to Katie (11, email @ redacted)  happily pumping with her Animas pump "Elvis" 
since 6-1-01
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