{Sunday Survey} Nighttime Corrections

by Leighann on May 29, 2011

Last week I asked:

Would you send your child to day camp?

This week I have a question about high blood sugars.

Our endo and CDE are always telling us not to give corrections for high blood sugars at bedtime or in the night.

Our overnight basal is set to keep our daughter even through the night (as it should), so if she’s high at bedtime, she will likely be high at breakfast. And I fear that 8 or 9 hours above range will wreak havoc on her A1c.

So my question this week is:

Do you correct for high blood sugars at bedtime or in the night?

Nighttime Blood Sugars

Survey Results: 49% of respondents said they do correct for high blood sugars in the night, but give a smaller amount of insulin. Another 42% said they give the full amount based on the blood sugar. Less than 9% don’t give any insulin for high blood sugars at night.

Iā€™d love for you to leave a comment about how you deal with bedtime and overnight high blood sugars.

Have an idea for a Sunday Survey? Please let me know.

Read all Sunday Survey topics.

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{ 18 comments… read them below or add one }

1 Penny May 29, 2011 at 9:16 am

Hi, I’m on my iPad and it won’t let me do the survey, so I’ll just give my thoughts for now. I’m not sure I’m understanding why someone wouldn’t correct a high at bedtime or during the night. I’ll just speak from my own gal’s experience, but her nighttime basals have three different settings and her insulin sensitivity is changed for nighttime too, she is much more sensitive to insulin then. So yes, absolutely I correct, with my endo and CDE telling me the opposite, that I should. I’m just wondering how we all get such different advice on this journey, huh?! It makes for some interesting discussions. Do you get a feel that your endo and CDE are worried that if you correct, she will crash? Is that their feeling on correcting at bed and at night?

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2 Crystal May 29, 2011 at 9:39 am

Hey Penny;

Different advice isn’t it; Different suggestions based on book knowledge. Diabetes is trial and error. Every body is different in how it deals/handles the D life. As kids grow up, things change, a lot. I was diagnosed at 6, a lot has changed since then.

You live, learn, adjust then continue living. šŸ™‚

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3 Katszr May 29, 2011 at 9:19 am

If I have any worry though..that this correction might cause a low..then I set an alarm and check. Last night…at 12 am he did a pod change. (teenager…out late..had friend over) So I told him I would check him at 4am just to make sure pod was working… at that time he was 220 and I did a correction. He is still sleeping.. but I checked him and he is 118 now. So he will wake up feeling good. When he was high all the time…before we got things going better… I would check and correct at 3am EVERY night. Now it is just on an as need basis.

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4 Crystal May 29, 2011 at 9:37 am

I would like to know Why the Endo said No, just curious. After 26 years, my personal experience, I don’t like giving corrections at night. This is my body though and after a lot of trial & error.

If I know why I am high (food intake/type) then I usually give the full bolus when grease/fat is involved, no matter what I Will wake up high. I follow up with check after check.

For sleep I need to be between 150 and 200. Below 150 I Will wake up low. Above 200 and I can’t sleep; restless, so I give a small correction, wait an hour (no CGM) to check and see where I am at.

As you know, Leighann, I am not an Doctor and this is not for Q to Do (or you). This has just been my experience through the years.

Your Body May Vary. šŸ™‚

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5 Diane May 29, 2011 at 10:44 am

We correct my daughter overnight when she gets high but her correction formula is half of what it is during the day.

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6 Matt May 29, 2011 at 12:35 pm

We correct at night for my 6 year-old. He isn’t on a pump yet. Our correction dose is the same, but the blood sugar at which we begin to correct is slightly higher than what we would correct for at meals; our endocrinologist has us correct .5 units for every 75 over a glucose of 170 (so at 171 he would get a half unit, 226 one unit, etc.) Seems to work out just fine for us.

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7 Cobi May 29, 2011 at 1:08 pm

We’re on MDI and I always correct at night, if needed but only if she’s over 300. If I correct a 250, she’ll be low by morning. I always check 2-3 hours later to see what her body did with it, though because sometimes it “takes it and runs with it”. On more than one occasion I have caught a low this way. On other occasions, I’ll give her a correction and she’ll stay high anyway. “Your Body May Vary” is so true! Even the SAME body may vary! LOL…

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8 Cobi May 29, 2011 at 1:14 pm

Forgot to mention, correction dose is also half of what it would normally be…

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9 Denise aka Mom of Bean May 29, 2011 at 2:33 pm

We correct Bean at night if she’s high….sometimes the full amount, sometimes less…just depends on what she’s eaten for her bedtime snack, if she still has IOB, and what my gut is telling me. šŸ˜‰
I’ve found that it works better for her to to a temp basal increase of 0.05u for a couple hours instead of a ‘blast’ of the correction. (not that I remembered that last night when she needed a correction at 5:30!!)

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10 Jer May 29, 2011 at 9:18 pm

Funny, my little girl is also my Bean! And, also a type 1. I saw the post and had to double check the poster’s name to ensure that I hadn’t posted in my sleep. Beans sure are wonderful, aren’t they!?

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11 Wendy May 29, 2011 at 9:42 pm

I usually give the advised correction…but…there’s always that pesky little variable of whether or not the correction factor is set right or not. If the basals or ratios move up a twinge, then the whole charade could be thrown off, including the correction factor. This is one reason I love that IOB feature, because if she’s eaten then it will automatically deduct part of the dose. So I do give the entire dose advised, but it may have already been reduced because of the active IOB from her last carb intake.

I also have to consider exercise. If it was a particular active day, I may reduce based on my gut instinct and previous experiences with how her body responds to high levels of activity during the day.

So many variables, but yes — I always correct for a number of 180 or higher…even at night.

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12 Chandra May 29, 2011 at 10:34 pm

We do correct, but our daughter’s pump is set to our sliding scale that the doctor set. Our daughter gets less of a correction after 9 p.m. Pump automatically calculates. Plus I get up 2 hours after I give a correction to make sure she is low.

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13 Reyna May 30, 2011 at 6:54 am

I will correct if Joe is over 250. His correction factor is weaker from midnight to 6am, so he doesn’t get as strong of a correction that he would get through the day. I also check a BG 2 hours after a correction. I know some people also change the “target” for night time on their pumps (ie BG target during the day is 120 @ night it is 150) to soften the bolus amount.

Great survey idea Leighann.

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14 Amy @ Tiny Blessings May 30, 2011 at 7:44 am

Yes and no. šŸ™‚ Isn’t that helpful?

At night my daughter’s blood sugar range is set for 100-200 on her pump. (I am far too tired to think of the proper terminology right now, but basically the pump won’t give her a correction if she’s below 200.) I don’t let her sleep below 125. And if she’s below 230, I rarely correct that, due to her long-standing history to drop like a rock during the night. Two seizures and countless scary lows have left us, and the endo, with the preference that we run a little high rather than risk it.

So…. I correct super highs, but we definitely prefer that she runs a little higher at night.

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15 Amanda May 30, 2011 at 1:04 pm

We have a developed a little routine that seems to work quite well for us – high before midnight, correction bolus. High after midnight(up to 16-17) temp basal, increase to 150% or thereabouts. High after midnight 16 and above, correction bolus. Usually works well but as we all know too well with this disease, the unpredictable happens!

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16 Sara May 30, 2011 at 10:20 pm

I won’t correct Ellie (5 years old) if she’s around 200 – 250 at the beginning of the night. If she’s really high at bedtime then I’ll correct the full amount and just wait up for 2 hours to see if she’ll level out. But if she is high at 2am (like over 250) then I don’t have a problem correcting at that time but usually knock a little off the suggested for safety sake. If I’m really really tired and don’t trust myself or the CGM I will allow her to run a little high overnight to be sure she’s safe. Sometimes I just can’t trust myself to wake or the CGM isn’t doing that great of a job and I can’t count on it.

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17 Julia May 30, 2011 at 10:58 pm

We have had two different pedi-endos since dx. One gave full corrections, and had a very low bedtime target and did not agree with bringing BS up to a higher number, if BS was 80, for instance. The other had a higher bedtime target of 120 to 130, and would suggest we give half corrections. What works for us is the higher bedtime target of around 120, and a higher insulin sensitivity factor in her pump for overnights. So she will get less correction for high blood sugar, but not as low as half. We adjust ISF immediately day or night if she has had a lot of exercise that day for a 24 hour period. Recently, with extreme exercise, .30 unit correction dropped her about 100 points. We were not prepared for that much of a drop, but exercise effects her overnight blood sugars intensely. Yes, we always stay up until all insulin has left her system; in fact, we rarely get to bed before 3 or 3:30 am.

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18 Rachel May 31, 2011 at 9:13 pm

I give 1/2 doses when my 8yr old Joshua if over 250, sometimes it stays the same and others it lowers it just enough where it’s at a safe #, He needs to stay above 150 to avoid waking up low and the 1/2 doses work it most of the time. I do a 2hr check after correction, and basal keeps it the same # or a bit higher until he wakes. But when he is really high, 400+I do usually have to correct every 2 hrs (1/2 doses) about 3 times to get it in the low 200’s. But it’s worth it to prevent a low in the middle of the night!

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