Insulin after meals and thinking about pumping

[Amy Walker]

Hi Everyone,

My 11 year old (MDI NPH/humalog) has recently asked if we could do his humalog after the meal, so that he could eat the amount he likes rather than calculate first. I'm fine with this (his appetite seems hugely variable these days), but I wondered if those of you that do this make any changes in the amount of insulin because the timing is different.

We had been doing fine with the NPH/Humalog, but our A1Cs are creeping from the 7s to the low 8s. If we are not back in the 7s at the next endo appointment in May, I plan to advocate for a change (the kid will need convincing, not the endo). He doesn't want lantus/humalog because of the injection at lunch, and because he thinks lantus stings. The pump worries him about having something attached to his body, but I think he would appreciate the flexibility once he got used to it. He's doing the all the right things for his age with his diabetes care, so I don't want to overrule him if its not necessary, but the A1C may force a change. I was thinking to seriously bribe him to do a saline trial with a pump. Is this possible try out the pumps like this?

Thanks,

Amy

Mom to Ken (11) dx 3/06 MDI NPH/Humalog

[kirish]

Hi! Yes a trial run is possible (or it was at our endo office), in fact I did the trial with him! My son started with NPH/novolog as well, transitioned to Lantus, while pump was on order, then to the pump. It was a great transition.

As far as injections after eating goes - this causes the insulin to have to work a bit harder, as the blood sugar begins to go up within 10-15 minutes into eating , and the insulin does not begin to work until 15 minutes after injection. So you end up with about 30 minutes of his blood sugar rising (time it takes to eat) before even giving the shot. I think it is ok to do when he is unsure what he'll be eating (at a party lets say), but not a great thing to do on a regular basis.

I think your son would love the flexibility of lantus - no more set meal schedule and set carbs to eat.

Good luck.
Kris

[TracieandJim]

I don't know if our situation will help much but here goes... My child isn't even 2 years old yet. We give him his injections after every meal and adjust according to what he eats. We pretty much don't have a choice unless someone has a brilliant way to force a toddler to eat :) . We don't adjust his insulin as far as timing goes we only adjust for his food intake and our best on the timing. Yeah.. ya can't time a toddler either. He is on a sliding scale and we are just now getting into ratios so there are times I feel like we are winging it but so far its working, ha. His a1c was 8.9. His 'only' a1c to-date. The endo seems happy with it so for now being so new to this I can't complain to much.

Tracie

[thebestnest5]

At 11 years old, giving an injection after a meal is not something I'd want to do on a regular basis. What worked for us was asking Liv (age 7) what she thought she'd eat and then adding insulin for extras. So, it she thought she'd eat 70 carbs, then I'd bolus her for 100 carbs or so. On the extremely rare occasion that she'd start to get too full; then she could have juice or chocolate milk to finish off the remainder of the carbs that were injected for.

I basically bribed my DD to start pumping and she has thanked me over and over again.

The Omnipod is another option that may seem less intimidating to a new pumper.

[jcanolson]

I'd definitely bribe him to give it a try, but if he doesn't love it, don't push too hard. You'll end up with a $6,000 paperweight. My friend's 16 year old son
hated his pump. Never remembered to bolus, a1c's were horrible. They went back to shots and he immmediately improved his control. To each their own!

[hrermgr]

This is why we went to a pump! It's so much easier for us to pre-bolus T for some of what we think she will eat then the rest afterwards. I really didn't like giving 2 shots so close together and waiting until after she would eat caused big spikes. So the pump really makes this easier.

[liasmommy2000]

Giving Novolog after a meal is great with younger kids. But the older they are the less it should be done. Lia is almost eight and still not much at eating consistent amounts. So what we do on the pump is to bolus for some before and some after. I ask her how hungry she is and look at what the meal is and pre-dose according to that. I usually end up bolusing for between 15-30 grams of carbs before and then again after for the rest. I did the same on shots, though not as much. But for meals that lasted a long time (say dinner out with appetizers and desserts) I would.

[miss_behave]

I say definitely get him to try the pump. Its makes life so much easier and flexible for a pre teen/teen. Bribes are good. It'll only take a short time on the pump to win him over, when he sees the freedom it gives him!

[thebestnest5]

Liv enjoyed reading some of this at age 7. It switches the beginning page every other time
a person clicks on the link to the site. I am referring to the "children and insulin pumps" page.

It's totally biased in favor of pumping. :D

Children on the Pump? Of Course.

(keep clicking on the link, eventually the children page will be recycled to the
beginning).

http://www.2betr.com/

[Kaylee's Mommy]

It would require more shots, but you could pre-bolus, the amount you KNOW he's going to eat, let him eat whatever he wants and then give another injection when he's done eating with the rest of the carbs.. the problem with giving the injection after the meal is that the food is starting to absorb and the insulin takes a while to get working, so he'll start having huge post meal spikes... this would be a good way to convince him to go on the pump because the he can really eat whatever amounts he wants.. he can pre-bolus, give more in the middle and then some at the end... and 20minutes down the line, if he wants more, he can have it.. thats one of the biggest advantages of the pump..

[thebestnest5]

... this would be a good way to convince him to go on the pump because the he can really eat whatever amounts he wants.. he can pre-bolus, give more in the middle and then some at the end... and 20minutes down the line, if he wants more, he can have it.. thats one of the biggest advantages of the pump..

This was life changing for Liv, really. The pump allows eating more like a person would be eating if they didn't have diabetes. If Liv only wants a handful of grapes, she boluses for 6 carbs. Then, she gets discovers that she more hungry then she realized and she boluses for some more grapes, some crackers, some milk. It just frees the person's mind to have to 'think' less about how much will they eat all the time. Liv can eat until she's satisfied...even if it takes 5 small boluses within 20 minutes.

Diabetes takes so much planning and thinking...the pump really gives a freedom that is different from the common mindset of "just less pokes".

[Jacob'sDad]

Here's the beauty of the pump:
If I'm not sure how much Jacob is going to eat I can bolus him before the meal for what I KNOW he's going to eat, meaning that I know he will eat AT LEAST that much. If he eats more than that I just give him the rest of the insulin after he eats. That also works if he decides he wants dessert. He doesn't need extra shots if he wants a snack between meals either. He just gets the insulin for it from the pump.

Jacob felt better physically immediately after starting on the pump. His numbers are still far from perfect, but if I had to pick the healthiest of my three kids it would be him. He just eats better than the other two.:)

[linda]

:cool:we have always done the bolus after eat since in the beginning em wouldnt eat what we thought and had some near issues with this. No problem or anything related to timing here, maybe at school because the time to get to nurse after eat, but if em is hi befor lunch she corrects then comes back and does carbs, in your case now would be 2 shots(frown) but our experince has changed em's life adding much more flexibility to her care, as im sure you have heard the pump is a personal decision, and your son should drive the car...em wanted to pump after 1st year camp...and saw all kids with more flexibility, after and b4 eat, no waiting to get the shot, go to meetings and educate your son and urself as much as possible, handle them, ask questions, meet kids with pump, camp??

[Amy Walker]

Thanks everyone for the replies. I'll show him the kids and pumps link, and reinforce that maybe it's the way best for his eating to be more flexible rather than mucking with the post-meal insulin.

Amy

Mom to Ken (11) dx 3/06

[wilf]

Hi Everyone,

My 11 year old (MDI NPH/humalog) has recently asked if we could do his humalog after the meal, so that he could eat the amount he likes rather than calculate first. I'm fine with this (his appetite seems hugely variable these days), but I wondered if those of you that do this make any changes in the amount of insulin because the timing is different.

We had been doing fine with the NPH/Humalog, but our A1Cs are creeping from the 7s to the low 8s. If we are not back in the 7s at the next endo appointment in May, I plan to advocate for a change (the kid will need convincing, not the endo). He doesn't want lantus/humalog because of the injection at lunch, and because he thinks lantus stings. The pump worries him about having something attached to his body, but I think he would appreciate the flexibility once he got used to it. He's doing the all the right things for his age with his diabetes care, so I don't want to overrule him if its not necessary, but the A1C may force a change. I was thinking to seriously bribe him to do a saline trial with a pump. Is this possible try out the pumps like this?

Thanks,

Amy

Mom to Ken (11) dx 3/06 MDI NPH/Humalog

You should bolus at the start of a meal, better yet 5-10 minutes before. The climbing A1Cs will be reflecting the late bolusing.

I'm not sure why you would worry about giving more insulin than he needs at meal-time. The insulin takes 2 hours to be about 2/3 used up, so there's lots of time after the meal for a snack if you find he eats less at meal-time. We do this on purpose with my DD - that is, I give MORE than she needs to cover a meal, so that there's some insulin working a couple of hours later when she comes with the inevitable request for a snack..

As for the fear of Lantus stinging (it often DOES sting..), why not switch to Levemir (which doesn't have that effect)?