For 3-4 year olds what is your goal BS

[lisamomtotwins]

Hi everyone, it has been a while since i have been on here. We have our next appt next week with the endo and i want to ask him about median blood sugar levels. Our goal in the past was always 150, but Hailey was diagnosed at 17 months and he didnt want to make it any lower in risks of it going to low and us not knowing. So just curious what other endos are saying for kids in her age group ... I know as they get older the goal BS gets lowered. Hailey is still very unpredictable there are days where she is perfect then days where she goes from 60-490! We are on a pump but most of this started when she started daycare/preschool and her eating habits changed a bit.

Thanks for any advice.

Lisa

[jcanolson]

At age 5 we're down to 120 daytime /140 night as the goal - whether we actually hit it or not is a different story!:) I'm also a stay at home mom, so I'm a little more aggressive since I'm with her pretty much 24/7.
I want to say we were at 150 daytime and 180 night when we started age 3.

[hawkeyegirl]

Our "official" target range is 80-200. I have sort of overruled that, and our pump targets are set to 110-130 for daytime and 140-150 for nighttime. I know that's tighter than a lot of kids his age, but since we're able to do it without experiencing severe lows, our endo has given us his blessing.

[BeckyND]

My daughter was diagnosed when she was 4 and at that time we were told her range should be 70-200. They never really gave me one specific target number. I concentrate more on her A1c and try to keep that at a 7 or less.

[Nancy in VA]

Emma is 3. Her range has been 80-180 with a target of 140. We treat them as follows:
- If she's over 180, correct her using BS-Target/CF with Target of 140
- If she's under 100 during a meal, we factor a negative correction (to target of 140) into her carb dose
- We treat lows under 80 at non-meal times.

[lisamomtotwins]

Thanks everyone ....
do your kids go up to like 400 at times ??? How often?
We have alot of highs in the AM.

[Nancy in VA]

We used to have a lot of highs in the AM, but I found through a basal test that her basal wasn't right during that time. I suggest you do that. Also, we pre-bolus about 20 minutes for breakfast because she is so insulin resistant in the AM. With those two changes we have reduced our AM #s to no higher than upper 200s.

[lisamomtotwins]

Hmmm, maybe i will try the prebolus, except she sometimes doesnt eat everything and we have to rush out of the house and go to daycare so it is hard for me to do it. And we have basal tested in the past and she usually drops lower with that so we havent upped her basals in the AM. She is on a 12 to 1 carb to insulin at breakfast and every other time of the day it is 25 to 1.

[Nancy in VA]

We don't usually pre-bolus the full amount unless we are sure she is going to eat it. Look at your past 2 weeks. What is the average amount she ate? Maybe give 80% of that amount in a pre-bolus. Then give the rest as you head out the door.

If your basal test showed her going lower, then you're right, you don't need more basal - but I think the pre-bolus will help.

Also, what does she have for breakfast? We had to basically stop giving some of the evil breakfast foods - namely pop tarts and cereal. And we ALWAYS give protein with breakfast (pepperoni and cheese, sausage, egg). The protein slows the spike a ton

[lisamomtotwins]

Thanks for the info Nancy. The morning routine is a big struggle with Hailey, she doesnt want to wake up so it is always a fight. Lately she has wanted low fat pancakes with SF syrup. this am she kix with low fat milk, she hates eggs. Maybe i can get her to eat some other kind of protein, even turkey or soemthing like that. Good ideas. Thanks so much!

[Kara]

Carter is 3, he will be 4 in September. His goal is between 100 - 200. He usually is lower in the mornings and goes high at night.

[Emma'sDad]

Ever since she was 3, it's always been 4.0 to 10.0. I assume when she gets older (and past puberty) that it will become more strict.

[twodoor2]

Elizabeth just turned 5, but even when she was 4, I would be happy for her to be under 200 all day (and I still am). Even with postprandial spikes, a toddler and very young child can go up to 220. There is a lot more leeway with small children than with older children and adults.

Right now, Elizabeth has a bg target on her pump of 80 to 140, and I am happy if she has an average BG of 150, although any number under 200 is good. My endo wants to keep her at the low end of the scale (80 to 120), but I feel this can be dangerous and not necessary for such a young child. To me, at this stage, it is more important to have a range of 100 to 200 and a low standard deviation (blood glucose variability).

I know others might disagree with me on this, but that's just my opinion.:) You also have to remember that it's much more difficult to maintain a lower average for a toddler or preschooler because they're much more insulin sensitive and much more senstitive to carbs as well (they have a much higher BCR - blood glucose to carb ratio).

[wendyc]

Our range is 80-180 with a goal of 150.

[jcanolson]

Hmmm, maybe i will try the prebolus, except she sometimes doesnt eat everything and we have to rush out of the house and go to daycare so it is hard for me to do it. And we have basal tested in the past and she usually drops lower with that so we havent upped her basals in the AM. She is on a 12 to 1 carb to insulin at breakfast and every other time of the day it is 25 to 1.

That morning time frame has always been our hardest. It took us forever to figure out how to keep her from shooting up to the high 300's.
You'll get it figured out!

[lisamomtotwins]

Thanks everyone!

[tiffanie1717]

My 4 yr old (almost 5 in one month) was diagnosed 3 weeks ago. her range is 80-180 in the daytime and 80-220 in the night. She only weighs 33 lbs, though, so she's small for her age.

[EmmasMom]

Hey Lisa! Long time no see!;)

We strive for an A1C in the low 7's, and a daily average between 140-180, (I strongly prefer the 140's, but some days it's just not possible!) Our endo is pretty aggressive but HATES to see lows, so if we have any problem with lows we bump up her target a bit.

Breakfast spikes are a common problem for a lot kids. If basals are set correctly and the bolus does eventually correct the high, your best bet in slowing that spike is pre-bolusing, even by 10 minutes. If she's unpredictable you can pre-bolus for 1/2 the carbs, then the other 1/2 when you're sure. It makes a HUGE difference.

I'm very cautious about breakfast foods, most of them are just not a good fit with D. If we're in a hurry Emma eats a South Beach bar, very balanced with protein, fat and carbs, (only 15g) and a cup of milk. With a 10-15 minute pre-bolus her Bg rarely goes over 200. (even on the CGMS where you really see those immediate post meal spikes)
She doesn't care for eggs yet either, but she loves bacon so I'll have her eat a few slices of bacon with her waffles or pancakes to help slow the spike.

I also have her basal set higher than needed from the time she wakes until just after breakfast. This is not a great idea if you have a crazy morning schedule, but if you can watch it closely and adjust as needed it can really help too. I like to see her dropping on the CGMS just before she starts to eat because I know the insulin has kicked in and is ready to process those carbs.

As far as the 400's, I'd like to say never...:rolleyes: but maybe once or twice a week something goes screwy and she has a high in the 350-400 range. We have weeks that it doesn't happen, but with travel, crazy schedules, babysitters, special events involving food, etc., ya know life... it's going to happen sometimes!
The best thing I've found to help prevent major swings in wither direction is her CGM. You can be so proactive when you can see what's happening.

BTW, we'll be starting pre-school in the Fall, so I'm sure I'll be making a lot of changes to our current routine then...