Sleeping in with the pump

[ShirleyB]

I keep reading, how you can sleep in with the pump.  I want to know how you can do this.  I checked my daughter this morning and she was already at 73.  How can I let her sleep in, and not go too low?

[JDRF-Team-SS]

ShirleyB,
Hello again...as I mentioned before I am not a medical professional.  I am a volunteer, but I will do my best to give you my 2 cents:)

My son sleeps in when he does not have school.  If I woke up before him and tested him and he was 73, I would squirt a little gel frosting in his mouth and let him go back to sleep and then re-test in 15-20 minutes.  (This is just what I would do and I know I would not have to really wake him to do this)You see, a 73 may not necessarily wake my son.  

More info...I was told that to make sure the basal rate is a good one, the blood sugars should be give or take 30-40 points.  Most of the time, we see this with our son, but not always.  Sometimes when the numbers are farther apart, for him, I believe it is due to meal boluses.  As you know, it is not always easy to add up carbs, especially when you go to a restaurant.  (no matter what carb book you have with you)  

Also, I have noticed that certain foods affect the BG differently.  For my boy, they would be pizza, pasta, ice cream, chocolate...If he has these, we do a dual bolus because I believe these foods take longer to metabolize or absorb, so if we do a NOMRAL bolus, he would go low and then we would treat the low with some carbs and then boom an hour or so later (when the pizza or ice cream fully kicked in) he is high!

As you know, this is an unpredictable disease.

As a rule of thumb, I want my son 100 or above whe going to bed.  I would say that if her BG before going to sleep is more than 40 points different either way from when she wakes up, you should talk to he endo about her night time basal rate.

As I mentioned, my son does sleep in when he is off from school, but that does not mean that we do not ever experience a morning low where I happen to test him or when it occasionally wakes him.
Please talk to your daugther's Endo.

I hope I said somethng that made sense...I feel like I am blabbing and talking in circles.  I hope I helped a little.

When did she start on the pump?

We are very happy with the pump and have more good days than bad, but sometimes we still have those unexplainable lows or highs and I believe that most of you will agree with me that this is part of the disease.

We are all praying for a CURE!!

[JDRF-Team-LRS]

Hi Shirley B,
I'm a long-time diabetic and a pumper.  We can sleep in, and your daughter's low reading might mean that her basal rate for one or more hours is too high.

Work with her pump trainer or certified diabetes educator to begin to test basal rates.  Initially, it takes some time to get them right.  By definition, basal insulin is what our bodies need when we *eat nothing*.  So, once our basals are set correctly, we can eat (and then bolus for whatever we eat) or not eat (and take no additional insulin or have to treat a low) and keep our bg's rather steady.  Steady means within say, 20 points or so (up or down).

It's a delicate balancing act and since your daughter will likely undergo some growth and maturity changes, you can expect her basal needs to change over time also.  Here's a good book that's useful for learning the concepts and osme of the details.  Many non-pumpers find it useful too:
_PUmping INsulin: Everything You Need for Success with an Insulin Pump_ by Walsh & Roberts.  YOu can review the Table of Contents at Amazon and probably your local bookstore or library can get it for you.

Good luck.

[JDRF-Team-SS]

LRS is absolutely right about the basal rate possibly being a tad bit high at a certain time.  This is what is so awesome about the pump....that we can set many basal rates throughout the day/night.

[ShirleyB]

Thanks again all.  I never thought about it, but you are right, she should not go low without eating.  I still have a lot of learning to do.  She has been pumping since May this year.  

Her rates could be high and at times they seem too low!!  She is 12!!!  Hormones are starting to kick in and she is growing like crazy, so her numbers have been at both extremes.  We are trying to keep up with it, but I am sure you all know how fast things change.  

I do love the different boluses.  We have trouble with pizza too.  It seems anything with a high fat content.

We will keep trying and keep working with her diabetes team.  I just was curious how to go about it.

[moonlanding2]

Hi Shirley,

My 11 year old, seventh grade, son sleeps in every chance he gets, sometimes more than 12 hours!  I have found that as soon as the last 3 hour bolus wears off, his blood sugar should be checked and corrected, if necessary.  If the correction bolus, or giving of carbs, is accurate at that point, his blood sugar usually levels off near his target blood sugar number (we have his pump set at a target of 90).  He usually sleeps for at least 5 or 6 hours maintaining a blood sugar number near his target.  If I check him during that time and find him low, I usually give him a marshmallow (6 carbs each), which I calculate will make his blood sugar rise 4 points per carb, or about 24 points. That calculation, as you probably know, is based on the number you have also entered in your pump for how many points your blood sugar goes up for every 15 carbs consumed.  My son's blood sugar goes up about 60 points for every 15 carbs consumed, thus 4 points per carb.

We, like other diabetic families, worry about tooth decay occurring from consuming sweets during the sleep intervals, so I usually lighten up the correction bolus a bit during any that are needed before, or during, sleep.  That way, it is unlikely we will need to give a snack during sleep.  

Usually a small correction bolus for a slightly high blood sugar number will suffice, since a person sleeping is not burning up any carbs due to activity (exercise).  But, remember, it's all in the pump settings you program.  They have to be close to accurate, and you can probably fine-tune those settings yourself as long as you understand how they work.  Also, you can adjust correction boluses up, or down, from what the pump recommends, as the situation may merit, like I reduce any bedtime or sleeptime correction boluses a bit, to "play it safe".

We also have trouble with pizza, and other slower release foods, and get kicked in the butt with a 300 blood sugar number after the insulin wears off in 2-3 hours (usually).  There is actually a pump function, that can be programmed, which will spread out the release of the meal bolus over a number of hours, which is designed for pizza (and such).  We haven't used it yet, but I can see now that I better get it going.

By the way, we use a Deltec Cozmo pump.