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RE: [IPk] Charlie Dalton


I've had some thoughts about what might up with Charlie's high daytime and 
low nighttime blood sugars.

High daytimes:
Scenario 1: Too little intermediate/long-acting during the day; so there 
should be more in the morning injection

Scenario 2: Too little Regular before breakfast and lunch, so that carb is 
not covered in the short term.

One way to check what's going on would be less than fun for Charlie and you, 
but if he could fast from bedtime on a Friday night until noon on a 
Saturday, for example, you could see what his blood sugars do overnight/in 
the morning hours (testing 2 a.m., 4 a.m., 6 a.m., 8 a.m., 10 a.m., and 
noon) when he's on only the longer acting insulin (so he would have his 
normal insulin before dinner on Friday night and no breakfast on Saturday, 
and _just_ his longer-acting insulin that morning, and then some Regular 
with a good-sized lunch).

Low nighttimes:
Scenario 1: Too much intermediate/long-acting insulin (as several others 
have suggested)

Scenario 2: At what times does Charlie eat dinner, go to bed, and tend to 
have super-lows that cause fits? Does he eat dinner at 6 and go to bed at 8? 
If so, his dinnertime Regular is just about to hit its peak when he gets to 
bed, and his intermediate/long-acting has not yet set in. If he is having 
too much Regular with dinner, then his bg will drop low soon after he has 
gone to sleep. Then, when the intermediate/long-acting insulin takes over, 
at perhaps 10 or 11 p.m.--whoosh!!!!--down goes Charlie's bg to a dangerous 

Scenario 3: Is Charlie quite physically active? Or has he been more active 
than usual on the days preceding the really terrible lows at night? If so, 
he may have experienced the glucose-going-back-into-the-muscules phenomenon. 
When I go for a three-mile run sometime between 4 and 6 p.m., I must go to 
bed on a bg of 11 or I wake up with a bg of less than 3. If my bg is between 
9 and 10, I set a low temporary basal rate and let my bg rise a bit 
naturally. If I'm under 9, I eat an apple or some yogurt with sugar (I aim 
for 20-30 g. carbohydrate) and then set a quite low basal rate for a few 

With my pump I could theoretically sidestep the higher bedtime bg altogether 
set a really low (like .1 u/hr) basal profile for three hours (like 12 
a.m.-3 a.m.) and see if that does it, but then if I miss a workout and 
forget to change that basal to something like 1 u/hr, I will have a bad high 
bg in the morning (judging from past experience!). I learned about the 
necessity _for me_ of a highish bedtime bg from my diabetes educator in the 
U.S. She emphasised that three post-dinner hours of a bg around 11 are way 
less dangerous long-term than 10 hours at 11 and also less dangerous in the 
short term than 1 hour of a bg around 1, especially if the higher bedtime bg 
allows me to wake up with a great bg in the morning.

One way to check what's going on would be to reduce Charlie's dinnertime 
Regular insulin and let him go to bed with a bg of about 11 and see if he 
wakes up with a brilliant bg and has slept soundly through the night. If his 
bg goes down significantly--from 11 to about 6--then too much 
intermediate/long-acting insulin is likely the issue. The next step is to 
let him go to bed with a bg of 9 or so and reduce the 
intermediate/long-acting insulin one unit at a time, giving each lower dose 
three or four days' try before reducing by one unit again. If you can get 
the nighttime bgs sorted on a most-of-the-time basis, then sometime when 
he's had a couple of hours playing actively and running around in the 
afternoon, try testing his bg through the night (like at 10 p.m., 1 a.m, 3 
a.m., and 5 a.m., and then as usual when he wakes up). If you see that it 
drops sharply between any of the tests, you may want to make a practice of 
reducing Charlie's evening intermediate/long-acting insulin by, say, 10% the 
next time he's had a big afternoon on the playground or the pitch. Then 
repeat the testing through the night and see what you find out.

The point is to get the Regular right so that Charlie goes to bed on a 
decent bg and to get the intermediate/long-acting right so that the second 
insulin _maintains_ that good bg overnight. The peaking of 
intermediate/long-acting and the delayed effects of exercise on blood sugar 
can really pull punches when it comes to getting a smooth line on the ol' bg 
graph! (The exercise is really worth it, though!!!! We just have to figure 
out how to make it work best _for_ us rather than _against_ us.)

Okay, another morning when I woke up 1.5 hours ago to do Latin and e-mailed 
instead! At least I can still get in a good 1.5 hours before class....

Best of luck and all good wishes to you, your husband, and Charlie. If I 
might be of any help off-list, please be in touch.

IDDM 8+ years; MiniMed pumper 6 years; nerd 20+ years

P.S. One more factor: if Charlie has a dinner that's lower in fat than 
normal, he may need less Regular insulin to cover it than he would normally 
take. If one regularly has, say, 20 grams of fat in one's dinner and then 
one night one has pasta with meatless tomato sauce and a salad, the 
onslaught of more carbs at once than usual may well lead to a higher 
pre-bedtime bg, but the insulin taken to correct it will probably work well 
(possibly a little too well). Keep in mind that fat slows the absorption of 
carbohydrate (which is why, sadly, chocolate isn't our best bet for fixing 

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