Spikes..How concerned should I be?

[Mom2Deacon]

I hear many on here trying to keep spikes lower. I know how to keep spikes lower but I know that it is difficult in a toddler because I do not always know how much he will eat. Do I really need to be heavily concerned about spikes just yet or can it wait to be incorporated when Deacon is older?

--Sara

[Nancy in VA]

We lowered our A1C significantly by lowering the spikes.

[twodoor2]

I forget how old Deacon is, but for children 5 and under, it is recommended to keep spikes under 220. There's a little bit more leeway with children, but even so, they do overal affect your A1C.

[Aidan'sMom]

I was wondering the same thing not too long ago. I think for long term damage it is worse to be high for a long period of time. I have been trying to avoid the breakfast spike (our biggest one of the day). I have a toddler who has unpredictable eating habits. What I have been doing for every meal is pre bolusing the amount of carbs that I am for sure he will eat. Most of the time I do 15 carbs up front and then add the rest after he is done. It makes for more injections, but really does help with that spike. Aidan was spiking into the 300's after breakfast, now he rarely goes over 190.

[Mary Lou]

I think that, in part thanks to CGMS technology, that the diabetes world is waking up to the fact that our kids (and adults) spike a lot after eating. This spike is significant and often unnoticed as the pre-meal and then 3-hour post-meal check can both be in range.

Our endo has said that reducing the post-meal spike is the single biggest thing we can do to improve our children's A1Cs and long-term health.

I think that with toddlers you have a higher "allowance" for spiking than for older kids, but the significance is the same.

Like the PP, we pre-bolus for part of the meal (20 carbs) and then finish the bolus as the meal progresses.

[twodoor2]

I think for long term damage it is worse to be high for a long period of time.

Definitely, The most important to take care of the spike right away to make sure it comes down right away and not let it sit there. :)

[danismom79]

When do you check for spikes? My daughter eats around 6:30 after her waking check, then again at school at 8:15, but she doesn't get checked again until about 10:15. Am I not being diligent enough? She's on regular and NPH in the morning, if that makes any difference.

[Mary Lou]

When do you check for spikes? My daughter eats around 6:30 after her waking check, then again at school at 8:15, but she doesn't get checked again until about 10:15. Am I not being diligent enough? She's on regular and NPH in the morning, if that makes any difference.

I think you would need to check with your endo. I'm not sure if there is much you can do about it while on NPH, since you are meeting a specific number of carbs per meal (right? I remember having a "meal plan" on NPH). Do you give a fast-acting insulin for meals like Humalog or Novalog?

I am assuming that your child is newly diagnosed?

This might be something you would want to look into at a later time if you switch to using a regime of lantus/MDI (multiple daily injections) or pumping.

If you want to determine the meal spike, you would need to check in half-hour or hourly incriments after eating.

You sound like a very diligent parent :)

[danismom79]

I think you would need to check with your endo. I'm not sure if there is much you can do about it while on NPH, since you are meeting a specific number of carbs per meal (right? I remember having a "meal plan" on NPH). Do you give a fast-acting insulin for meals like Humalog or Novalog?

I am assuming that your child is newly diagnosed?

This might be something you would want to look into at a later time if you switch to using a regime of lantus/MDI (multiple daily injections) or pumping.

If you want to determine the meal spike, you would need to check in half-hour or hourly incriments after eating.

You sound like a very diligent parent :)

Yes, she is newly diagnosed and eating a certain amount of carbs per meal. She gets the regular in the morning because she eats 3 times in the morning (long commute to school), then the NPH usually peaks around lunch. Then she gets Humalog for dinner and NPH again at bedtime. So I think trying to correct any spikes might bring her too low since the NPH is going to peak anyway, right? I'm still trying to wrap my head around the way insulin works.

[Mary Lou]

Yes, she is newly diagnosed and eating a certain amount of carbs per meal. She gets the regular in the morning because she eats 3 times in the morning (long commute to school), then the NPH usually peaks around lunch. Then she gets Humalog for dinner and NPH again at bedtime. So I think trying to correct any spikes might bring her too low since the NPH is going to peak anyway, right? I'm still trying to wrap my head around the way insulin works.

If I were you, I wouldn't worry about post-meal spikes at this point. We use Regular when Brian is unhooked for sports, and if you're feeding the "peak", like with NPH, then it would be really tricky to figure out what to do to prevent spikes in the am, or at lunch with NPH. The only opportunity you have is with the Humalog at dinner, but even then....

File this info for a time when you're ready to fine-tune things or take them to the next level :D And always be sure to check with your endo before trying new techniques or methods.

[WestinsMom]

If I were you, I wouldn't worry about post-meal spikes at this point. We use Regular when Brian is unhooked for sports, and if you're feeding the "peak", like with NPH, then it would be really tricky to figure out what to do to prevent spikes in the am, or at lunch with NPH. The only opportunity you have is with the Humalog at dinner, but even then....

File this info for a time when you're ready to fine-tune things or take them to the next level :D And always be sure to check with your endo before trying new techniques or methods.


AGREED!!! :D You need to take some time before tweaking. Just deal with the idea of having diabetes for now. You have time to get to that "obsessed" stage :o

[danismom79]

AGREED!!! :D You need to take some time before tweaking. Just deal with the idea of having diabetes for now. You have time to get to that "obsessed" stage :o

Definitely. I wasn't really thinking of tweaking anything, just worried that I might not be obsessed enough! She gets checked 4-6 times a day, and I usually don't check any more often unless a previous number gave me some concern. I rarely check in the middle of the night unless she was particularly active that day (plus, she's sleeping in my bed for now...).