Let me briefly introduce us. My son was diagnosed with T1D in October, roughly 6 months ago. He’ll be 8 at the end of this month. We are still currently on MDI and do have Dexcom G6.
I’ve been pulling my hair out with bedtime snack/bolus. Often just 1/2 unit of insulin (humalog) is enough to cause a low an hour or two later, even if he’s high going into the snack and gets 10-15 carbs. For example, he may be 220 going into the snack, he’ll get 15 carbs and 0.5 units insulin and 1 and 1/2 hour later he’ll be 100 with an arrow (sometimes 2) down.
If he is in range at bedtime snack, I’ve been keeping the carbs at 6-8 so as not to bolus for because I’m exhausted dealing with lows when we all just want to go to bed. He will have a glycemic response to those carbs, often bringing him up over 200, but he will come down on his own through the night (likely honeymooning)
His sensitivity factor through the day is 70; I increased that to 150 and still have problems. Because of the issues we are having, I’m not confident in his carb ratio at that hour, but have been using a conservative 1:50 (daytime he’s between 1:15 and 1:25).
A favorite snack of choice is either honey roasted almonds (about 6 carbs) with FairLife chocolate protein milk (only 2 carbs but about 15 G protein). I go with that if I don’t want to bolus (but it will raise his sugars). He also likes peanut butter crackers (about 18 carbs) also with the FairLife milk. He had that last night with a BS of 188 going into snack (finger stick-of course a dexcom sensor failure last night) and I gave 0.5 units humalog at 8pm. By 9:15 he was at 98 (again, finger stick). Because of his trends, I gave him another PB cracker, figuring he’s dropping, and even if he wasn’t I like him over 100 at night. 20 min later he was at 80. I went ahead and gave him 5 skittles. By about 10:30 he settled around 150, verified by both fingerstick and the new sensor kicking back on. So it seemed the extra crackers and skittles were about right. He dropped from that and settled around 115 the rest of the night.
Had I not bolused for his snack last night, we would have avoided the low, but he very well would have gotten well over 250 or more and parked it there for hours before coming down a bit on his own, and he likely would have only come down to 180-200.
Another factor I’ve considered is IOB. Dinner and bedtime snack are our closest meals, usually only 2-2.5 hours apart. So I’m wondering if IOB from dinner is having an impact (albeit not enough to fully cover a snack). It also seems to be complicated by what he had for dinner. A few days ago he had tater tots at dinner. He was quite high at snack time (over 220). I allowed a generous 20 min prebolus and then he had his crackers/milk, and again only 0.5 unit. He came gently down to 150 and stayed there- no spikes or more drops. It was great, but I couldn’t help but wonder if a delayed spike from the tater tots was helping him out.
I just don’t know what to do. I’m tired of the dreaded lows right at bed time, but realize heading to bed with highs isn’t great either. But since we are on MDI, 0.5 unit is as small a dose I can reliably give. And I don’t want to limit his snack choices, I’d much rather be able to confidently dose for his snack of choice!
Sorry for the long post, and thanks in advance for any input! I’ve learned so much already reading through many of the threads here!