Adjusting diabetes care due to more activity

[JBattles]

Hi!
My 2 1/2 year old son, who is pumping with omnipod, started daycare yesterday, and today I got a call right before lunch to tell me his BG was at 22! I freaked. He's never had a low BG lower than in the 40's before, WHICH, ironically enough, when I tested him before dinner this evening, he was 47. Clearly, the new activity at daycare is really messing with his BG.

So, in order to adjust to this new level of activity, what would you do?

Should I add a low carb morning snack that isn't covered? (5 carbs or so - I know most of you were probably told 5 carbs and under are "free", but my son was diagnosed at 11 months old, and is now only 28 pounds - ALL carbs count for my son)

OR

Should I adjust his carb to insulin ratio for breakfast and lunch?

OR

Should I lower the basal rate for his morning activity?

I'm really confused. Usually his BG is super high in the morning after breakfast, and then sharply declines right before lunch.

Any advice is much appreciated.

Thanks!

[MomofSweetOne]

I would have freaked with a 27, too! The lowest number recorded to day on my daughter's meter is a 38. She decided it was a good thing I wasn't there when it happened because the other mom didn't know enough to panic, and I would have.(eyeroll)

I never dealt with a toddler with D, but this summer, I saw my daughter's BG drop like crazy the night before camp from excitement. I called another D-mom in a panic because I wasn't sure what was happening. She told me excitement could cause it. I ended up feeding my daughter over 70 carbs that night by 2 a.m. (more than double her supper bolus), but she went off to camp just fine.

I would run a temp basal and have him tested frequently if you don't CGM. Give snacks as needed I wouldn't reprogram anything permanently until you see him settle into a temp basal level.

[Sarah Maddie's Mom]

Originally Posted by JBattles

Hi!
My 2 1/2 year old son, who is pumping with omnipod, started daycare yesterday, and today I got a call right before lunch to tell me his BG was at 22! I freaked. He's never had a low BG lower than in the 40's before, WHICH, ironically enough, when I tested him before dinner this evening, he was 47. Clearly, the new activity at daycare is really messing with his BG.

So, in order to adjust to this new level of activity, what would you do?

Should I add a low carb morning snack that isn't covered? (5 carbs or so - I know most of you were probably told 5 carbs and under are "free", but my son was diagnosed at 11 months old, and is now only 28 pounds - ALL carbs count for my son)

OR

Should I adjust his carb to insulin ratio for breakfast and lunch?

OR

Should I lower the basal rate for his morning activity?

I'm really confused. Usually his BG is super high in the morning after breakfast, and then sharply declines right before lunch.

Any advice is much appreciated.

Thanks!

I don't know enough about your child to make a smart suggestion - but if you are seeing a spike after breakfast, then a tank, it could well be that your 9-10 is AM basal is too high and/or your breakfast bolus too little or too late.

You know your rates best - I prefer to avoid feeding the insulin with snacks, but sometimes in preschool and in little kids in general that's the best you can do.

Good luck!

[hawkeyegirl]

Personally, I'd lower basal and have them test more frequently so you can see exactly when the drop is occurring. I wouldn't fuss with a temp basal in this situation. It's not like a basal change is in any way permanent. Also, with a child that small, he may be on a basal dose that is too small for temp basals to be terribly effective.

[MomofSweetOne]

Originally Posted by hawkeyegirl

Personally, I'd lower basal and have them test more frequently so you can see exactly when the drop is occurring. I wouldn't fuss with a temp basal in this situation. It's not like a basal change is in any way permanent. Also, with a child that small, he may be on a basal dose that is too small for temp basals to be terribly effective.

I tend to use temp basals almost all the time because it leaves her basal profile intact while adjusting needs up and done; that's why I suggested it. Most of our temp basals are set for 24 hours at a time. Puberty girl survival technique. We've used different basals almost daily for the last few months. If I had to basal test all the time, I'd be extremely frustrated because two days are rarely the same, but her profile doesn't shift often.

[Lee]

Originally Posted by hawkeyegirl

Personally, I'd lower basal and have them test more frequently so you can see exactly when the drop is occurring. I wouldn't fuss with a temp basal in this situation. It's not like a basal change is in any way permanent. Also, with a child that small, he may be on a basal dose that is too small for temp basals to be terribly effective.

This...but above all else - I would rely on your endo and CDE for help with dosing - that is what you pay them for . But since you are pumping, I wouldn't give free carbs, I would try and figure out if it is a basal issue, And I would test every hour or two until you get a good idea of what is happening.

[steph]

ugh. what a way to start daycare. we do MDI, so I can't really give advice from experience, but reducing morning basal seems most logical to me. for my DD who is 2yo and in daycare, the activity definitely changes things up. She was having frequent lows at dinner time. She has to have uncovered carbs to tide her over from lunch to dinner. But on the weekends, she gets a free snack at that time. We do this bc we cant really have variable basal rates on MDI, but on a pump, there is no need to do that. i worried about DD being in daycare all the time after she was diagnosed, but now her teachers are so good about keeping an eye on her and checking if she seems the least little bit wobbly or out of sorts. i totally trust them now.

[natallia]

my 1.5 yo toddler would spike upto 400s after breakfast and then tank before lunch to 60-80 even with uncovered midmorning snack. after playing around with insulin dosages for weeks we found the only thing that really worked well for us was to switch around breakfast (35-40 carbs with some protein like yogurt or egg) with midmorning snack (20 carbs of fruit and crackers) while leaving his morning insulin unchanged.

[maciasfamily]

Originally Posted by JBattles

Hi!
My 2 1/2 year old son, who is pumping with omnipod, started daycare yesterday, and today I got a call right before lunch to tell me his BG was at 22! I freaked. He's never had a low BG lower than in the 40's before, WHICH, ironically enough, when I tested him before dinner this evening, he was 47. Clearly, the new activity at daycare is really messing with his BG.

So, in order to adjust to this new level of activity, what would you do?

Should I add a low carb morning snack that isn't covered? (5 carbs or so - I know most of you were probably told 5 carbs and under are "free", but my son was diagnosed at 11 months old, and is now only 28 pounds - ALL carbs count for my son)

OR

Should I adjust his carb to insulin ratio for breakfast and lunch?

OR

Should I lower the basal rate for his morning activity?

I'm really confused. Usually his BG is super high in the morning after breakfast, and then sharply declines right before lunch.

Any advice is much appreciated.

Thanks!

We've been in the same boat a week ago. We too are pumping with the pod. Previously he would run high after breakfast. But now he's been going low. We've decreased his basal little by little so that he now only gets .05.

We also notice on the weekend when we're busy doing stuff he starts to tank. I've started using the temp basal since its not everyday.

If his ratios were fine before my suggestion would be to start lowering basal. For sure have them check BG more often.

[JBattles]

Thanks so much for your suggestions!
I think I will experiment with a lower basal for mornings at daycare to see if that helps. I will also check in with my Endo team, but over the weekends I can't get in touch with them, and so your insight is invaluable.
Adjusting anything with a toddler is so tricky, they change so fast. I'm thinking that perhaps nerves/excitement also affected his low reading, and so perhaps once he gets used to the routine, I'll probably have to adjust again.
No one can accuse diabetes of being predictable, huh?
Again, much thanks for the support.
Best,
Joanna