Dawn Phenomenon and Pump News

Alyssa has experienced high blood sugars in the morning for the last two weeks or so.  High for her morning level is anything over 150.  As I have mentioned before, Alyssa's blood sugar usually drops about 100 over night.  So my goal is to have her sugar somewhere around 200 at bedtime.  If her glucose level is below 200, she'll have a bedtime snack and if it is close to 200 she will not.  What was odd, I was seeing high blood sugars in the mornings and even after the nights she didn't have a bedtime snack.  Could this be the 'dawn phenomenon' I've been hearing about?

Dawn phenomenon is the term used to describe early morning (usually between 2a-8a) high blood sugars in diabetics.  It is thought that the body releases hormones over night, like the growth hormone and cortisol, that cause insulin resistance.  Alyssa takes Lantus in addition to Novolog, which is a slow release insulin that normally works for 24 hours.  I've heard though it can often be unpredictable with schedule changes.  Of course other reasons can be incorrect dosing of insulin or eating too many grams of carbs before bed.  In my opinion, I think it is tied to activity level as well. 

What this means?  I will again be waking at 2 in the morning checking blood sugars to see if there is a rise in the middle of the night for a few days and see if adjustments need to be made to her diabetes plan.

Pump news: We looked at 4 insulin pumps the other night.  It was really cool because Alyssa got to touch them and see how they worked.  After the pump class, I read all the information and narrowed down to either the Omnipod or the Ping.  We have chosen to go with the One Touch Ping.  I really thought Lu was going to push for the Omnipod because it is tubeless and stays on, but she liked the Ping best.  The cool thing is that it is 100% waterproof and Alyssa also liked their infusion sets the best, which are easily inserted and come in different colors :).  So yesterday, I faxed all my insurance info over the the rep and we have started the process.  Next step will be to see how much they will cover!

http://www.animas.com/

What is A1C??

I have had several readers ask, "What is A1C?"

Of course, prior to Alyssa's diagnosis, I didn't know either.

Basically, A1C is a blood test that reflects patients blood glucose levels for the past 2-3 months.  Specifically, the A1C test measures the percentage of hemoglobin (the protein in red blood cells that carries oxygen) that is covered with sugar.  The higher the level, the higher average of blood sugars and the higher the risk of complications.

A normal A1C is between 4.5-6%, which means an average of 80-135 mg/dl (blood sugar levels).  An A1C 6.5 or higher indicates diabetes.  There is also pre-diabetes which is an A1C of 5.7-6.4%.  For most adults with diabetes, the ideal target is an A1C of 7% or lower (average bg's 170 or lower).  With children, the target is 8 % or lower (average bg's 205 or lower).

Changes

The endocrinologist made a few changes to Lu's regimen because her hemoglobin A1C had gone up .2 since our last quarter visit.  Yesterday was the first day of the dose change and also her 3 hour cheer practice.  I was a little nervous to give her the higher doses with breakfast, but didn't want her to spike before the 10:30 practice time.  Her Lantus was increased from 9 units, to 10 units and her Novolog rate was increased from 1 unit for every 20 grams of carbohydrates, to 1 unit for every 15 grams of carbohydrates.  I gave her the updated dose with breakfast at 7:30 and on the way to practice, checked her blood glucose levels.  258 at 10:15.....we are back to those post breakfast spikes where the insulin is taking a little longer to kick in.  Practice immediately started with warm-up and practicing jumps.  After about 20 minutes of that, they started tumbling and that lasted about 30 minutes.  At 11:30, we did a recheck of her bg's and she was at 115.  She had a snack, apple slices, peanut butter crackers and low-calorie Gatorade.  They practiced their competition routine and around 1:00, she gave me 'the look', which I knew meant that she didn't feel good.  Re-check, bg's 62.  Quick juice and a snack and the timing was good because the team decided to take a break.  10 minutes later,she perked right back up and finished practice with energy left over.