When are the best times to test bg?

[mph]

Pre-meals and bedtime, of course. But what about at 1hr, 2hrs, 3hrs, 4hrs post meal? What exactly do these readings tell you and how do you use them to make adjustments?:confused:

[Nancy in VA]

Never 1 hour. Insulin has just started working and is still chasing the food.

2 hours if you think the insulin is about done working in your child's system; otherwise
3 hours is probably pretty standard - insulin should be done working. You can identify a high or low and correct
4 hours - only if you really believe insulin is not done in 3.

[payam7777777]

the 1hr pp is usually the highest bg of them all. after one hour (according to john walsh) 85% of food is converted to glucose while at the same time only 15% of insulin has become active. so apparently it's the highest bg. of course with foods containing more and more fat this may change. we're happy if the 1hr pp is < 180 because it'll settle down automatically because of the IOB. if the 1hr pp is > 180 it's almost always a sign to us that for some un-freakin-known reason the bolus has been small and has not matched the food. in this case (whenever the 1hr pp is > 180) we give another .1 to .5 extra bolus (dependin on the bg) even though we know that we have IOB. we do this because otherwise we'll hit 200+'s at the 2 hr mark and we dont like that. we no longer use the boluswizard or the IOB feature of our pump. we use our own instinct and experience. we dont like the mathematical/logical approach of the boluswizard or the IOB concept. it's cool but not always working as mathematically and loically as expected. it'll cost you just an extra calculation if you choose to bypass boluswizard and we do it. one other benefit of testing at 1hr point is that we can prevent a hypo. is for example we're 130 at 1hr pp we give Ali some honey or something because after 1 hour 2/3 of the bbolus is still active and it means a drop of ~80 point or more which we cant afford with a bg of 130. so a bg < ~130 1 hr pp is considered danerousely low in our book.

the 2hr pp in our book should ideally be anything below 160ish and above 130ish. if the 2hr pp is less than ~130 we give Ali some honey or something because we know that after 2 hours roughly 40 percent of the insulin is still active and it means another ~60 point drop in bgs hence we cant afford to be anything less than ~140.

again i should say that testing 1hr pp has worked for us we like it and it gives us a lot of information. i personally think it'll be helpfull for others too but since it;s very addictive and may affect the quality of life i cant recommend it very strongly.

[momofphoenix]

We really only test

Before meals
Snack time
bedtime
symptoms of High/low
he complains of feeling funny or he looks funny.
1 time at night unless he was lower then I want then I will do 2 tests.

Other then that we dont do a 1 hour test, to me that would be an extra unnessasary fingerstick. That is just how we work it. I also dont correct a high bs if it has only been 1-2 hours, he still has insulin working and I feel that the more ups and downs he has will cause more complications later on.

[payam7777777]

We really only test
Before meals
Snack time
bedtime
symptoms of High/low
he complains of feeling funny or he looks funny.
1 time at night unless he was lower then I want then I will do 2 tests.


momofphoenix,

the 1hr pp is not necessary but the 2hr pp is necessary. please consider testing at 2hr post meal. it helps adjust boluses and ...

[momofphoenix]

We dont do the 2 hour test since his insulin is still not done working, he drops way to fast and hard for me to try and give an extra 1/2 unit when he is higher then I would like at that time. I will test him at the 3 hour, but normaly I only test at meals, snacks, bedtime, 1 time during the night unless there are issues and if he thinks he is low or is acting strange.
We test between 6-10 times a day now I think that is alot on his little fingers, his #'s are pritty good, lately we are having tons of lows with the crazy high rebound later. So I have been testing about 12 times a day.

[payam7777777]

We test between 6-10 times a day now I think that is alot on his little fingers
you might want to consider Alternate Site Testing.
http://www.childrenwithdiabetes.com/ast/
we only use Ali's thumb base for testin. no more finger tragedies.

http://i6.tinypic.com/81ix9j4.jpg

[mph]

the 1hr pp is usually the highest bg of them all. after one hour (according to john walsh) 85% of food is converted to glucose while at the same time only 15% of insulin has become active. so apparently it's the highest bg. of course with foods containing more and more fat this may change. we're happy if the 1hr pp is < 180 because it'll settle down automatically because of the IOB. if the 1hr pp is > 180 it's almost always a sign to us that for some un-freakin-known reason the bolus has been small and has not matched the food. in this case (whenever the 1hr pp is > 180) we give another .1 to .5 extra bolus (dependin on the bg) even though we know that we have IOB. we do this because otherwise we'll hit 200+'s at the 2 hr mark and we dont like that. we no longer use the boluswizard or the IOB feature of our pump. we use our own instinct and experience. we dont like the mathematical/logical approach of the boluswizard or the IOB concept. it's cool but not always working as mathematically and loically as expected. it'll cost you just an extra calculation if you choose to bypass boluswizard and we do it. one other benefit of testing at 1hr point is that we can prevent a hypo. is for example we're 130 at 1hr pp we give Ali some honey or something because after 1 hour 2/3 of the bbolus is still active and it means a drop of ~80 point or more which we cant afford with a bg of 130. so a bg < ~130 1 hr pp is considered danerousely low in our book.

the 2hr pp in our book should ideally be anything below 160ish and above 130ish. if the 2hr pp is less than ~130 we give Ali some honey or something because we know that after 2 hours roughly 40 percent of the insulin is still active and it means another ~60 point drop in bgs hence we cant afford to be anything less than ~140.

again i should say that testing 1hr pp has worked for us we like it and it gives us a lot of information. i personally think it'll be helpfull for others too but since it;s very addictive and may affect the quality of life i cant recommend it very strongly.

So would you say that any meal should raise the bg by no more than 80-100pts and then the insulin brings it back to the starting point (or lower when correction is used)????

I REALLY REALLY want to keep Nick from shooting up and plunging down. Just not sure what I am doing wrong. When I only check at meals, all usually looks great. But the inbetween meal checks are disturbing. By 2hrs post meal, he often reaches 250 (over 300 for breakfast even with LOW carbs that are complex and 10-15 min prebolus):(. By 3hrs he will drop about 50pts (say to 200). But by the next meal, he will be 80 or so (dropped another 120 in an hour). Not sure why:confused:. Basal works well at night, so I don't "think" it is that. I think the Humalog does stay working for the 4 if not 5 hrs. Seems to do the most by 2hrs if he has not eaten (correction at night while sleeping) and during the day it is closer to hrs 3-4 where we see the big drop.

Do you find a difference btw reading using alternative sites????? I get differences of 50 btw thumb and fingers at times or btw fingers and toes (only use them at night when he is sleeping on his arms....;)).

[payam7777777]

So would you say that any meal should raise the bg by no more than 80-100pts and then the insulin brings it back to the starting point (or lower when correction is used)????
well honestly i believe this should and can be the case at least 50 percent of the time. i really believe so and believe that if this doesnt happen there are some things we can do to help it.

By 2hrs post meal, he often reaches 250 (over 300 for breakfast even with LOW carbs that are complex and 10-15 min prebolus):(. By 3hrs he will drop about 50pts (say to 200). But by the next meal, he will be 80 or so (dropped another 120 in an hour). Not sure why:confused:. Basal works well at night, so I don't "think" it is that.
although you clearly said that basal is fine because you have checked it at night i want to suggest you to reduce the basal a little. the pattern you described here (and you did it very well) tells me that it's the basal who is responcible for the drops after the 3rd hour. it's unlikely IMO that after reducing the basals you'll still have these drops. i'd reduce the basals and see what happens. i know reducing the basals seems odd but you know the body will kinda adjust itself to the new reduced basal. it may not, but i'd test it.

Do you find a difference btw reading using alternative sites????? I get differences of 50 btw thumb and fingers at times or btw fingers and toes (only use them at night when he is sleeping on his arms....;)).
i read the Alternate Site Testing part of the cwd carefully and concluded that arm or leg sites are way off, so is the palm, but the thumb base is quite correct. we confirmed this by comparing Ali's meter bg average with his a1c. alternate sites are not accurate but the thumb base is.

[mph]

although you clearly said that basal is fine because you have checked it at night i want to suggest you to reduce the basal a little. the pattern you described here (and you did it very well) tells me that it's the basal who is responcible for the drops after the 3rd hour. it's unlikely IMO that after reducing the basals you'll still have these drops. i'd reduce the basals and see what happens. i know reducing the basals seems odd but you know the body will kinda adjust itself to the new reduced basal. it may not, but i'd test it..

Thank you!!!!!!! I will consider the basal adjustment and see what happens. Anything is worth a try at this point.

I may have to sit on him to do a thumb base test.....:D He is sooooo resistant to change sometimes, but finds he likes it AFTER the fact. I have found his thumbs to be the most reliable, so I imagine the thumb base will be as well. It's worth a try to give his fingers a rest. Thanks!

Ideally, I would LOVE to get his "patterns" figured out and match insulin to carbs and basal to background needs..............and test less!!!!! But what's the likelihood of D being "predictable" :rolleyes:?

[payam7777777]

you do use multiclix dont you.

[mph]

you do use multiclix dont you.

Actually, no. I have read great things about it here so I asked the endo and they will be giving me a FREE one with an AccuCheck meter (I think that was the brand) next month at our clinic appointment! They are also giving me an extra bottle of Lantus, Lantus pen and Humalog pen to try. So I can NOT complain too loudly about the endo team for other reasons...........;)

We have the One Touch Ultra 2 meter and lancing device that was given to us at dx. I "assumed" they were all "similar" enough until finding this site. So we will see how much better testing can be, right?:) Should I hold off on thumb base testing until then??????? I don't know how he stands the checks because they HURT. I've tried it a few times. Even on the lowest setting.:(

[payam7777777]

Should I hold off on thumb base testing until then?
with multiclix they dont hurt. really. at least this is the case for us.
one option is to wait until you receive your multiclix and THEN start using the thumb base thus the 'no pain' or 'very little pain' factor will automatically/uncinsiousely will be assosiated with 'thumb base'... it'd be easier this way to convince the child that it's better to use thumb base.

[mph]

with multiclix they dont hurt. really. at least this is the case for us.
one option is to wait until you receive your multiclix and THEN start using the thumb base thus the 'no pain' or 'very little pain' factor will automatically/uncinsiousely will be assosiated with 'thumb base'... it'd be easier this way to convince the child that it's better to use thumb base.

Great idea........ hey, I'm the "psychologist" and didn't think of that...YET.....but I would have, right;)!

Thanks again for your help.:)

[payam7777777]

oh i'm glad i could be useful.