Is a 10:1 carb ratio high for the morning?

[akrickard]

Ginny runs about 60 lbs. I know YDMV, but I wanted to get an idea of what other kids are set at. Despite being set at 10:1 with a .4 basal, she's still spiking well into the 300's after breakfast. I'm going to talk to the CDE tonight, but 10:1 just seems like a lot of coverage for a little kid.

[thebestnest5]

Liv is 8 years old and about 65 pounds. She has a 8:1 ratio...her Endo had told me to try changing back to 8:1 from a 9:1.

[Mama2H]

Hailey is 80 lbs and a bit older but right now her breakfast is 5:1 :eek:

[Nancy in VA]

How long after breakfast is the 300 reading? If its within 3 hours, its probably less the I:C and more the fact that many people spike after breakfast.

My 2 year old is 38 pounds. She is 10:1 ratio - but unless we pre-bolus about 15 minutes, she spikes into the 300s after breakfast - but then comes back into range by lunch

[akrickard]

Alright, so it's not all that high. I'm guessing the CDE will have us up the ratio a bit and maybe progam a higher basal for a few hours in the morning.

The high reading comes about 2 to 2 1/2 hrs after breakfast. Does that mean changing the ratio may not help much?

Thanks everyone.

[AmberO]

Nikki is on 10:1 and has been almost for 2 years now. We also have the higher basal starting at 5:30 in the morning. (may temp change for xmas vacation and getting up later)

[Nancy in VA]

Alright, so it's not all that high. I'm guessing the CDE will have us up the ratio a bit and maybe progam a higher basal for a few hours in the morning.

The high reading comes about 2 to 2 1/2 hrs after breakfast. Does that mean changing the ratio may not help much?

Thanks everyone.

at 2 to 2 1/2 hours the insulin is still working. If you search back, you'll see many threads where many of us are suffering from post-breakfast spikes. Have you taken a 3 hour reading? What is the reading right before lunch ? That will give you an idea of how long the insulin is working and give you a better idea whether the I:C is correct or not

[Twinklet]

Emily is on 10:1 for the mornings and she's about 72 pounds. Her morning basal is also more than double what it is the rest of the day at 0.5. We still have to pre-bolus by 20-30 minutes to keep her below 200 after breakfast.

Your child requires what his/her body needs. There is no "good" or "bad" with insulin doses, so long as there isn't a problem with absorption.

[wilf]

there's no such thing as a "high" ratio, just whatever insulin the body needs at this particular time to cover the carbs..

[twodoor2]

at 2 to 2 1/2 hours the insulin is still working. If you search back, you'll see many threads where many of us are suffering from post-breakfast spikes. Have you taken a 3 hour reading? What is the reading right before lunch ? That will give you an idea of how long the insulin is working and give you a better idea whether the I:C is correct or not

I agree with Nancy, if she's getting back into her target range at lunchtime, the carb ratio is probably sufficient. It is very difficult to combat breakfast spikes, and dawn phenomenon - which is a naturally higher BG in the morning. My 4 year old DD is 54 pounds and is 17:1 at breakfast, she spikes and that spike can last a couple of hours after breakfast, but by lunch she is well within her target zone.

At the beginning of our lantus/novolog regimen, the spikes were really horrible, in the 400's at times, but we are now prebolusing part of the grams and the correction before breakfast, and wait 15 minutes if she's in the 100's, or a 20 minutes to a half hour if she's in the 200's, before we feed her. It has helped us get the spikes down to half as much. Sometimes the basal needs to be adjusted as well, but since we give the basal in the morning, it really doesn't help us, since it takes hours to really get working.

We have also lowered her carb intake in the morning for breakfast, and that seems to help. We just give her more generous portions at lunch and dinner. She still eats very well. Some people also give more protein (not fat) at breakfast instead of carbs, and that helps to combat the spikes as well. If she likes eggs, try giving that to her, just an example.

Good luck!!

[sammysmom]

sammy is at 1:12 for breakfast and has HORRIBLE morning spikes, like over 400. We have played with everything to control the spikes. During the christmas vacation, he is going to do a trial on the symlin. His endo and I are working it out this week. hopefully it will help.

shannon

[Mama2H]

Hailey always has a post breakfast spike :( It has gotten better (no longer spiking in the 400's) but we just cannot seem to preven it. Our endo advised against raising basals to help prevent this because she will often skip breakfast and sleep in on the weekends/during breaks. She is in range at breakfast, around 230 at the 10 am check and then back down to around 90 or so by lunch (3 1/2 hours after breakfast)

[Nancy in VA]

Another thing is to look at the foods eaten at breakfast. Most traditional "breakfast foods" have a pretty high glycemic index, which is going to cause higher spikes. We have tried to reduce the glycemic index of breakfast a lot AND we make sure she ALWAYS has protein at breakfast - sausage, eggs, cheese - and that helps combat the spikes.

[Kaylee's Mommy]

Kaylee is almost 5 and is 39lbs her breakfast is 1:17.. we've lowered it to help avoid spikes, but it doesn't help.. she still spikes and then crashes.. most people have a problem with a morning spike.. if she comes backdown into range within three hours then it shouldn't be the ratio.. :)

[Kirsten]

Griffin's breakfast ratio swings between 1:10 and 1:12, but it really doesn't matter how much insulin we give at breakfast, the spike is there. The only way we can deal with it is pre-bolusing. I pre-bolus for 15g 30 min before breakfast (I know that sounds scary, but for Griffin his BG will not budge in the am for a good 45 minutes post-bolus.) He usually eats 20-30g, so I bolus for the rest after he starts eating.

We also have an increase in basal rate for an hour before breakfast on school days. Our basal program is completely different for weekend/vacation.

GL!

Kirsten

[payam7777777]

Amy,
and everybody,

if she (or any other kid in this forum) is spiking into 300s after breakfast then we gotta do something about it. post bkfast spikes as you may well know happen to be one of the hardest things to control. we had them too but with the help of people here we finally overcame it. here are some suggestions from me. i'm sure [and i urge] other parents here give more suggestions. post breakfast spikes can/do happen but they CAN be eliminated.

. try to bolus 15 minutes before eating. bolusing 20 minutes before eating may help but can cause dangerous premeal hypos (at least for us it's the case) so please be very careful if you decide to bolus more than 15 minutes before bkfast, it's tempting, it can help, but it might be dangerous.

. the i:c ratio for bkfast is different from that of lunch or dinner. for us the bkfast i:c ratio is 21 while lunch ratio is 41

. try to use foods with fiber and some protein in them for bkfast. we dont have'em here in iran but i hear there exists certain types of cereals out there in the states that contains more fiber in them.

. although increasing basal rates early in the morning helps fight the spike but we found out that we better not change the morning basals (even reduce them) and instead of that give a bigger bolus for breakfast... it's kinda like a superbolus approach. i want to take the opportunity to emphasize (sp?) on this approach. imo it's well worth the effort to give up the 'let's increase the basals' method and work on a low basal high bolus method.

. use low glycaemic index foods especially for breakfast.

. certain types of food can have a bad bg rise for certain people. try to find the 'bad' breakfast foods and eliminate them from your bkfast menu.

. i know it's hard but try to test bgs 1hr after breakfast in addition to 2hr after breakfast. it gives a good insight on the way bg rises after breakfast. we now routinely do that. you'll be surprised by how high the number will be. let me tell you that (at least in our case) the 1hr post bkfast is prettymuch always at least 50 points higher than the 2hr post bkfast ie if your 2hr postbkfast is in the high 300s then the 1hr post bkfast may well be in the low 400s. the good news is that it IS preventable (at least we did it by using the low basal high bolus approach). (please dont bombard me now with the YDMV)

i now want to urge all the parents here to please share with us their tips for overcoming bkfast spikes here in this thread. let's put an end to 200+ post bkfast spikes. i know it's possible. let's make this thread a final/complete reference for fighting postbreakfast spikes. i just can no longer hear about little kids having to go thru this.

. one other thing came to my mind... the 1st bg reading in the morning is THE most important bg of the day. it's worth the effort to make sure it's below say 120, even if it means waking up earlier in the morning like 5am and give a correction just in case.

[Mary Lou]

I agree with Nancy, if she's getting back into her target range at lunchtime, the carb ratio is probably sufficient. It is very difficult to combat breakfast spikes, and dawn phenomenon - which is a naturally higher BG in the morning.

You know.... if she's spiking into the 300's, she needs more insulin. It's easy to be freaked out by increasingly smaller ratios, but they need what they need. Brian just moved to a 8:1 from a 12:1, but turns out he grew half an inch.

Those big swings in BG are going to make her feel crummy and be bad for her overall health in the long run.

"Dawn phenom" is caused by rebounding from an untreated low in the night. There is not a natural higher number in the morning, but children do tend to need more basal from 3 am to waking.

Like many other CGMS users, I have been surprised at the after-meal spikes. It's truly a new outlook on diabetes care to have that continues glucose testing. Our meal ratios have decreased dramatically, and our kids are healthier for it.

Like many others, we are HUGE fans of pre-bolusing. The only way I can get both boys pre-bolused is to do it while they are still in bed, so the insulin takes affect while they are getting dressed and coming down to breakfast.

[/QUOTE]
We have also lowered her carb intake in the morning for breakfast, and that seems to help. We just give her more generous portions at lunch and dinner. She still eats very well. Some people also give more protein (not fat) at breakfast instead of carbs, and that helps to combat the spikes as well. If she likes eggs, try giving that to her, just an example. [/QUOTE]

Actually, both fat and protein are carb-blockers and will reduce an after-meal spike. Fat is necessary for children's development, and in fact, in pre-pubescant children, it is the primary muscle builder. It is only after puberty that protein takes over this function.

We also have at least 5 grams of soluable fiber in the boys' breakfasts (Kashi cereals, plus FiberSure in their milk). "The Rule of 5" as our nutrionist likes to call it -- slows the carbs and is good for overall health.

[Twinklet]

"Dawn phenom" is caused by rebounding from an untreated low in the night. There is not a natural higher number in the morning, but children do tend to need more basal from 3 am to waking.


Mary, I think you're thinking of the Somogyi effect, which is rebounding after a low during the night.

Dawn Phenomenon has to do with horomones and circadian rhythms. Many people, especially during and after puberty experience insulin resistance in the mornings and need a higher basal and/or a higher ICR. This is pretty well-documented.

[Mary Lou]

Mary, I think you're thinking of the Somogyi effect, which is rebounding after a low during the night.

Dawn Phenomenon has to do with horomones and circadian rhythms. Many people, especially during and after puberty experience insulin resistance in the mornings and need a higher basal and/or a higher ICR. This is pretty well-documented.

You're right about the terminology. I apologize for adding to any confusion.

I would like to make the point that we don't have to accept a higher number in the morning, though. An increase in the child's basal rates will bring BG into range, and negate these affects.

Thank you for the correction. Lord only knows how long I"ve been mixing these terms up!!

[sammysmom]

We have done just about everything possible. Right now, if sam has over 20 grams of ANYTHING (any kind of carb, high or low GI) he has that nasty spike. We have to set a temp rate, properly timed of course, to combat the spike. We can not correct him becuse he will end up crashing to a nasty low. So we are out of options. Sam's endo, who is not afraid to think outside of the box, is trying him on the symlin during christmas break. Of course we are not going to do the normal routine, we will use a teeny tiny dose and adjust the basal rate and carb ratio accordingly. It is our hope that the digestion of the food with the symlin will really help the spikes.

The horrible spikes are now effecting his school work and that really stinks! He will wear his dexcom during this trial just to catch any lows with the symlin and we will see how it goes. I for one find the blood sugar spike unacceptable and will try anything to get rid of it, even if it means "thinking outside the box".

shannon

[czardoust]

its not too high if its what she needs right now. their bodies change, and the ratio changes, sometimes like your socks. if you are worried its too high, for sure you'll know on the first try. so have some juice and crackers ready. :cwds: ask the endo..... katerina is on 1:15 in the mornings but her high time is in the afternoon, late afternoon where she's 1:12. Shes also 60 pounds.

[Twinklet]

You're right!!! :o

I knew you know what both things are! I often get tongue-tied myself. :cwds:

[payam7777777]

It is our hope that the digestion of the food with the symlin will really help the spikes.

Shannon,

one thing about symlin... bringing up a low while on symlin is VERY HARD. be ware. symlin as you know slows down absorbtion of carbs and you may god forbid have some serious problems with lows. if you have a low with a lot of active insulin (IOB) then you might be in trouble so please be very careful.

on a side note i have not heard about kids on symlin.

[sammysmom]

Shannon,

one thing about symlin... bringing up a low while on symlin is VERY HARD. be ware. symlin as you know slows down absorbtion of carbs and you may god forbid have some serious problems with lows. if you have a low with a lot of active insulin (IOB) then you might be in trouble so please be very careful.

on a side note i have not heard about kids on symlin.


Oh absolutely! He will be wearing his dexcom until we get it all straightened out.

About kids and symlin....well, we have to start somewhere don't we:) Remember that lantus is not approved for under 6yrs old and the cgms are pediatric approved for 7 and above, but as parents, we do what is best and what is needed for our children.....I guess I will have to be the pioneer with a 6 yr old on symlin. I will keep everyone updated as to how it goes:cwds:

[twodoor2]

Amy,
. try to bolus 15 minutes before eating. bolusing 20 minutes before eating may help but can cause dangerous premeal hypos (at least for us it's the case) so please be very careful if you decide to bolus more than 15 minutes before bkfast, it's tempting, it can help, but it might be dangerous.


There is a chart that someone, Becky I think, recently posted that helps you decide how long to wait to eat after the prebolus. I think if the BG number is very high, at least 240, wait a half hour. Then if the number is lower, wait a shorter increment of time, minimum 15 minutes I think. If someone has the link to that chart, let me know. That helps to avoid the dangerout premeal hypos that payam is talking about.

In our case, if she's in the 100's, I only wait 15 minutes before eating, and if she's in the low 200's, I wait 20 minutes, and anything higher than that, I wait at most, a half an hour, before feeding her. I also only prebolus a half unit if she's in target (8 grams in our case), and the correction + 15 grams if she's higher than target. However YDMV.

[akrickard]

The only issue with a pre-bolus is she eats immediately after getting up, because it takes her forever. I suppose I could do it as I'm waking her up, though. At least then, I'd get a jump start on it. Just heard from the school nurse...the rest of the day was great. I think tomorrow, I'll do the early bolus and bump her ratio up to 8:1. Then I'll just be sure to check her before she gets on the bus. I told the nurse the plan and she'll check her as soon as she gets there in the morning.

I'll report back and tell you guys how it goes.

[Nancy in VA]

The only issue with a pre-bolus is she eats immediately after getting up, because it takes her forever. I suppose I could do it as I'm waking her up, though. At least then, I'd get a jump start on it. Just heard from the school nurse...the rest of the day was great. I think tomorrow, I'll do the early bolus and bump her ratio up to 8:1. Then I'll just be sure to check her before she gets on the bus. I told the nurse the plan and she'll check her as soon as she gets there in the morning.

I'll report back and tell you guys how it goes.

I'm not sure I'd make both changes at once - then you won't know what worked best. I would EITHER change the ratio OR do the pre-bolus to see the results.

[akrickard]

Maybe I'll just do the ratio change then. I forgot to mention that I'm not sure if she'd come down by lunch, because I've been asking the school nurse to correct her. Seeing as how the correction is taking and bringing her into perfect range, I think I'd lean toward a ratio change being the more likely solution.

Again, thank you. I really appreciate the advice I get here. It's been tough feeling like I'm starting all over again.

[twodoor2]

Maybe I'll just do the ratio change then. I forgot to mention that I'm not sure if she'd come down by lunch, because I've been asking the school nurse to correct her. Seeing as how the correction is taking and bringing her into perfect range, I think I'd lean toward a ratio change being the more likely solution.

Again, thank you. I really appreciate the advice I get here. It's been tough feeling like I'm starting all over again.

If she's not coming down to range by lunch, the carb ratio definitely should be changed. Going from 10 to 8 is good, I would never jump from 10 to 5 for example. The smaller the carb ratio, the bigger the units of insulin you have to give for each incremental ratio change.

I'm always changing ratios. She was fine for a week, and last night I had to change the dinnertime ratio, and the bedtime I made slightly higher as a result - her numbers were beautiful last night as a result. This morning, now I have to slightly adjust the breakfast ratio from 17 to 20 after a few days of lower than target numbers at lunch. It's especially precarious when they're honeymooning. The one thing I haven't changed in the longest time is the ISF or the basal. It seems if I give extra insulin at one meal, I end up needing to take away some at another.

[akrickard]

I think someone just asked this yesterday, but I'm drawing a blank...sorry. What is ISF?

[Nancy in VA]

I think someone just asked this yesterday, but I'm drawing a blank...sorry. What is ISF?

The ISF is basically the "sensitivity to insulin". Its the number at the bottom of your correction factor equation. It tells you how many points your child will drop with 1 unit of insulin.

For us, its 225. So, if she's 300 and her target is 140, then we would do this:

300-140 = 160 points (the amount we want her to drop)
225 = amount she drops with 1 unit

160/225 = .7 units to drop her into range

[payam7777777]

isf stands for insulin sensitivity factor. isf otherwise known as correction factor shows how much one unit of insulin will brin down the bg.

[twodoor2]

I think someone just asked this yesterday, but I'm drawing a blank...sorry. What is ISF?

ISF is "Insulin Sensitivity Factor" - it used in the formula that gives you the correction dose. Basically, it's how much 1 unit of insulin will bring down your fasting blood glucose level. For example, my DD has an ISF of 150. Adults, on the other hand, have ones more like 50. The endo will provide it, but it takes weeks of getting TDD (total daily dose) averages and good BG days to confirm it.

[akrickard]

Oh, okay. Our CDE called it a correction factor. We ballparked her at 150 on Friday, but have already discovered that she's closer to 125. At least...that's what's working for us right now.

The poor kid has been running so high at school for so long, that she keeps telling the nurse she feels low when she's only in the 130's! I'm so glad to be rid of NPH. Once we get these breakfast ratios sorted out, I'm going to do a very happy dance.

[Nancy in VA]

Amy: Also know that most everything changes from shots to the pump. And running high is VERY TYPICAL in the first two to three weeks on the pump - they would usually try to err on the side of caution to run a little high than to risk severe lows. Just stick it through - it'll get better

[hold48398]

Nikki is on 10:1 and has been almost for 2 years now. We also have the higher basal starting at 5:30 in the morning. (may temp change for xmas vacation and getting up later)

Our basals go up at 5am as well. Mia is 52 lbs, 6 yrs old and has a 1:13 ratio.

[saxmaniac]

I'm in the same boat here. Alex is spiking during school (9-11:30) and it's probably affecting his behavior at school. I really need to work on ironing out these spikes.

It's a hard to aggressively bring these down, when he's not in my care most mornings! I can't test him hourly at school. But, that's what home days are for. This morning he woke up at 69 so no prebolus, ugh. I'm not that aggressive yet.

For what it's worth, he almost always has high GI food (kashi, wheat toast, milk) for carbs and it still happens.

[Nancy in VA]

For what it's worth, he almost always has high GI food (kashi, wheat toast, milk) for carbs and it still happens.

I assume you meant LOW GI foods - right - usually wheat toast is a lower GI than white toast. And Milk is actually a pretty high GI -its pure sugar. Natural sugar but sugar no less - its in and out pretty quick.

Have you considered adding protein - eggs, ham, cheese, sausage - with those foods. I bet you would flatten the spike a little if you did that and nothing else.

[twodoor2]

isf stands for insulin sensitivity factor. isf otherwise known as correction factor shows how much one unit of insulin will brin down the bg.

Actually, the correction factor is derived from the ISF. They are not the same thing.

Correction Factor = ((BG - TBG)/ISF) - IOB

Where BG is the pre-meal blood glucose
TBG is the Target Blood Glucose level you're trying to get to
ISF is the Insulin Sensitivity Factor
IOB is the insulin remaining in the system from the last dose. This value is usually calculated automatically on pumps, but there are formulas for it. I derive it in a spreadsheet since we're still doing multiple daily injections. The IOB is determined by other formulas based on the DIA or Duration of Active Insulin which is a YDMV kind of thing.

[fortristan]

I am so glad you guys talked about this. I just put our 8 yr old on 1:10 for mornings he's 52lbs I thought I was doing something wrong. I just posted a thread about hitting walls with our ratios would love to hear your thoughts.

[MelStan]

Here's the link for the article someone mentioned, called 'Strike the Spike'.


http://www.diabetesselfmanagement.com/articles/High_Blood_Glucose/Strike_the_Spike/1

if you go to page 4, and click on 'Bolus timing in relation to meals'.

Hope it helps!

Mel - mum of Eilish, 10, dx'd at 3
Pumping (Cozmo)

[akrickard]

You guys rock, thanks!

[saxmaniac]

I assume you meant LOW GI foods - right - usually wheat toast is a lower GI than white toast.

Eh, good point I got them backwards! Better to get the word backwards than the food!!

And Milk is actually a pretty high GI -its pure sugar. Natural sugar but sugar no less - its in and out pretty quick.

Huh?? Every place I've looked it up says it's fairly low (http://www.southbeach-diet-plan.com/glycemicfoodchart.htm). Could you provide a reference for me?

Have you considered adding protein - eggs, ham, cheese, sausage - with those foods. I bet you would flatten the spike a little if you did that and nothing else.

Already there. He has eggs, cream cheese, cheese, a little bacon, pretty much every day for breakfast. I didn't mention them because they aren't carbs.

A typical breakfast would be:

2 slices French toast (w/wheat bread and vegetable puree) and no-carb syrup, (50% egg, 50% egg-beater)
2 slices wheat toast with cream cheese
Eggs (50% egg, 50% egg-beater, w/cheese and vegetable puree) and a slice of toast

[akrickard]

I upped her to 8:1 and she still went up to 371 about 1/2 hour later and then was the same 2.5 hours after that. ::sigh::

I realized something this morning, though. Prior to last week, she always had a 45 g breakfast and got 9(!) units of novolog and 12 of NPH in the morning cover her day. Now, admittedly, she would have a 30 g snack around 9:30, so I was trying to cover both with the novolog, but still, that's a lot of insulin to get when you're only eating 45 carbs! I'm beginning to think she may be like a 5:1 kiddo with her breakfast bolus and possibly need 2-3 hours of increased basal at the same time.

[akrickard]

She hasn't been under 300 all day. The nurse just called to tell me she's 479. My husband is on his way to get her. I feel like I'm killing her. I'm trying so hard not to just lose it at my desk right now.

[twodoor2]

She hasn't been under 300 all day. The nurse just called to tell me she's 479. My husband is on his way to get her. I feel like I'm killing her. I'm trying so hard not to just lose it at my desk right now.

Maybe it's just a pump malfunction. Who knows. Don't stress it, a number is just a number. You'll get a handle on it, and make it better when you see what's going on. I've had over 300 days all day like that too. You're doing a great job, and I think you are going to eventually get her numbers in control sooner than you think.

[nebby3]

I realize there have been a lot of responses so this may duplicate what others have said but . . . if it were me I would try a very low carb breakfast for a day or two and see if she still ends up high. If she does I would change basals instead of I:C ratio. If she ends up inrange with low carb breakfast I might change I:C but also encourage lower carb breakfasts and possible also up the basal a little before breakfast time. Wiht my dd I find we need to have higher basals running up to breakfast in order to counter the post breakfast spike. BTW my dd is about 54 lbs and gets 1:12 at breakfast so your ratio sounds about right to me.

[Nancy in VA]

She hasn't been under 300 all day. The nurse just called to tell me she's 479. My husband is on his way to get her. I feel like I'm killing her. I'm trying so hard not to just lose it at my desk right now.

Well, I'm pretty certain that has nothing to do with the breakfast ratio. How long has it been since a POD change? When I have highs like that that I can't explain, its usually time to change the site

[akrickard]

I changed it last evening, and she was fine after dinner and overnight.

[Nancy in VA]

Hum, well it could be some other things. But, you'll figure out it and no permanent damage will be done!

[payam7777777]

I upped her to 8:1 and she still went up to 371
what was the pre breakfast number?
did you prebolus?

[payam7777777]

She hasn't been under 300 all day. The nurse just called to tell me she's 479.
give her plenty of water and check for ketones. you might be on the verge(sp?) of ketoasidosis.

[payam7777777]

i'd test the 1:8 ratio tomorrow too. it seems soon to change to 1:5 now. mayebe we're having a pod failure. i suggest you to give a correction by a syringe or a new pod.

[Twinklet]

If she's still in the 300's after correcting, I'd do a pod change.

I also agree with the idea of trying a very low carb breakfast (try to have it lower fat, too if she's sensitive to fat like my child is) and see what happens.

You may also want to try the same food for breakfast several mornings in a row and try different timing and carb ratios.

[akrickard]

After the nurse called me, Ginny told her she was making igloos out of sugar cubes before going to test, and the nurse felt she may not have properly washed her hands -- made her re-wash, re-test and she came up at 300. Not great but nothing for me to cry about. Husband got there and corrected it. Now, the babysitter called and tells me she's at 68! Man, I can't wait 'til we've got this figured out...

She was 179 pre-breakfast. I think doing the same breakfast for several days in a row may be a good idea. I'll talk with my husband about it today. Worst-case scenario, I'm on vacation next week and will keep every day as similar to the others as I can so I can figure stuff out.

[twodoor2]

After the nurse called me, Ginny told her she was making igloos out of sugar cubes before going to test, and the nurse felt she may not have properly washed her hands -- made her re-wash, re-test and she came up at 300. Not great but nothing for me to cry about. Husband got there and corrected it. Now, the babysitter called and tells me she's at 68! Man, I can't wait 'til we've got this figured out...

She was 179 pre-breakfast. I think doing the same breakfast for several days in a row may be a good idea. I'll talk with my husband about it today. Worst-case scenario, I'm on vacation next week and will keep every day as similar to the others as I can so I can figure stuff out.


That 400's number didn't seem right to a lot of us, I'm glad it was nothing too serious.

[wilf]

Boy, sounds like you're having a hard time just now.

There are 2 ways to deal with after-meal spikes:

1) tweak the insulin regimen, eg. by pre-bolusing

2) give lower glycemic index foods (ie. ones that don't cause BG to spike as much), or add protein to the meal

[akrickard]

She just needed a little correction, she was at 199. I think we're almost there with the dinner ratios...

[payam7777777]

She was 179 pre-breakfast.

its important to try to be in the say 100-150 range before breakfast even if it means waking up early in the morning and giving a correction.

[akrickard]

Things are going better today, but last night I adjusted her basal so she'd be getting .2 more for an hour before breakfast and a few after. I was hoping to have her closer to 100 before eating. She woke up at 149. Then, I wanted to be sure I had programmed the higher basal to start at the right time, and when I checked it, saw that I hadn't properly saved all the changes I made! She was still on the same basal. So, I re-did it, and she was 309 before the bus. I corrected her and she was down to 240 by morning snack at school. Hopefully, with the basal adjustment, I'll get a better grip on whether or not to adjust her morning carb ratio in the next couple of days.

[payam7777777]

what time exactly did you have bkfast?

what time was the 309?

what did you have for bkfast?

[akrickard]

She had a scrambled egg, a banana and 8 oz of skim milk at 7:00.

The rest of the day is going beautifully, 138, 116...

[payam7777777]

i'd like to suggest you to start tweaking the i:c ratio before changing bkfast basals. i'd try 1:7 instead of 1:8 tomorrow. and later proceed to 1:6 if the postmeal highs continue.

[akrickard]

I'll give it a shot, but I wanted to change the basal so she could start the day a little lower.

[Nancy in VA]

I'll give it a shot, but I wanted to change the basal so she could start the day a little lower.

Well, if she's waking up too high then changing the basal is definitely the right approach - since that is a fasting basal time period its pretty easy to see.

If she starts the day in range and then has the spikes, then the change in the I:C, the pre-bolus, etc are the right approach. I just encourage you to be careful with lowering the I:C too low. You might not be seeing a drop because lunch comes along at school before the breakfast bolus is done but skip lunch and you could see an extreme low - we are finding lows in Emma if she eats lunch late - as a result of the long tail on the breakfast dose or the basal rate (We're still trying to figure out which one is causing it, but skipping lunch is the trigger)

[akrickard]

Yeah, that's one thing that kind of stinks about her school day. She eats breakfast at 7:00, a snack at 9:30 and lunch at 11:20. Then there is no more scheduled eating for the day. I wish things could be a little more stretched out for her.

[Nancy in VA]

Gosh, why do they have a snack at 9:30. At our school (which we dont' attend anymore), the only ones who get a snack are those that don't get to eat lunch until 12:30 - that seems like a lot of eating, followed by a lot of NOT eating.

[payam7777777]

but I wanted to change the basal so she could start the day a little lower.
please do change the basals so that she can wake up a little lower (that would be increasing the basals of say 5am and 6am) but do not increase the basals to 'help' boluses (do not increase the basals of 7am or 8am) leave them intact.

this is of course my suggestion. i believe it's better to overcome the bkfast spike by increasing boluses rather than basals. this also reduces the lows before lunch.

[akrickard]

this is of course my suggestion. i believe it's better to overcome the bkfast spike by increasing boluses rather than basals. this also reduces the lows before lunch.


Not only that, but as Nancy said, there is a lot of eating followed by a lot of NOT eating going on at school, so I'd rather have high in her range at lunchtime so her risk of going low after lunch (on the bus) is decreased.

[payam7777777]

how was the breakfast today Amy?

[akrickard]

At 7:1 with a slightly higher basal starting at 5 am, we stayed under 200 yesterday and today! woot!

Unfortunately, we had another pod error out on us last night. While my hubby and I were out shopping and my MIL was babysitting! She shocked the hell out of me though by not panicking, and asking if I could try to walk her through placing a new pod on Ginny! I've said a lot of bad things about that woman over the years, but she really came through like a pro last night. Ginny was a perfect 150 when we got home!

[payam7777777]

At 7:1 with a slightly higher basal starting at 5 am, we stayed under 200 yesterday and today!
great : )

[twodoor2]

At 7:1 with a slightly higher basal starting at 5 am, we stayed under 200 yesterday and today! woot!

Unfortunately, we had another pod error out on us last night. While my hubby and I were out shopping and my MIL was babysitting! She shocked the hell out of me though by not panicking, and asking if I could try to walk her through placing a new pod on Ginny! I've said a lot of bad things about that woman over the years, but she really came through like a pro last night. Ginny was a perfect 150 when we got home!

You see, you got it figured out in a jiffy!!! I knew you would. Now is my day for frustration because after days of great numbers, she's in the 250's all day today after we ate out at a restaurant last night.

Oh well, you do the best you can :)

[akrickard]

That stinks. Restaurants have been the toughest thing for us since podding. This season, you go out more than usual, and I've been shocked that none of them have had their nutritional info on hand.