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[IPp] Re: pop-digest V1 #249

> We have been pumping for three weeks now, but new things keep happening to
> us.  My daughter had a series of mild highs (all in the 200's) overnight.  I
> bolused to bring her down twice with little change.  I didn't bolus the
> third time, but she was in the same area at breakfast time.  2 hours after
> breakfast she was 44.  Could the insulin from the earlier boluses been held
> or trapped somewhere and suddenly all gone into her with the larger
> breakfast bolus?
> This was the second day of a site that seemed to be working fine and her
> sites have been lasting 3+ days.
> This has happened once before, where I couldn't bring down mild highs over a
> long time and then boom, she goes low for no reason I could figure out.

I've had a similar experience with my son.  I believe it is related to
growth hormone secreted in the early ours after onset of sleep.  The growth
hormone causes glucose to be released from the liver and a relative decrease
in insulin sensitivity.  Correction boluses you give overnight seem to have
little effect because they are encountering a very active process in the
body.  After the morning the body suddenly switches back to it's regular
level of insulin sensitivity and the "tail" from all that insulin now has a
much more dramatic effect than it had overnight.  It's a frustrating problem
because the child doesn't act the same way every night.  Some night she
grows, other nights she doesn't. So you can't have one night time basal rate
that will keep her in range every night.

My son is now 3 1/2 and he "grows" several times a week, but certainly not
every night as he used to.  My husband generally works late after we all go
to sleep.  He checks my son at hourly intervals.  When he sees his blood
sugar rapidly rising he'll blast him with a correction bolus plus an
addition.  Then he checks him again, hourly, to make sure he hasn't over or
under shot, and often has to hold a basal tick or give juice near dawn, as
the resistance falls.  I could not function on the amount of sleep he gets.

Since your daughter is older you may find that her mysterious highs are only
a few nights out of the month.

I've also found that our greatest risk of hypoglycemia seems to be around 10
or 11 am.  My son seems to need much higher ratios for his breakfast, but
then the "tail" of the insulin may send him crashing.  Consequently he gets
checked a lot in the morning, and will need a snack by 10 am.

Toby, mom to David dx 11 mo, pump since 14 months.
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