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2 hour post meal BG.

Discussion in 'Parents of Children with Type 1' started by Rusty, Feb 19, 2009.

  1. Rusty

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    I was just wondering what everyone thinks a good 2 hr. post meal Bg is. For us it seems like if he is around 280 2 hrs. in he will be at a nice number by next meal. I know i could get this down if i change his ratios and give a snack between meals to keep from droping to low. Just wondering how everyone else handles this ?
     
  2. betty6333

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    we are pumping, so that is pretty different, but we like our 2 hr post meal to be under 180. if he is over 180, we either gave a wrong dose for carbs or is basal is WAY off.

    I see you are using a different insulin setup and so that makes a BIG difference and it is hard to compare apples to oranges. 280 would be a red flag at any time of day, but like I said, we are using a pump and have never used the particular insulin set up that you are using, so as long as the endo knows, what the BG level is, I would assume that they are fine with it.
     
  3. Barbzzz

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    I'm sure someone has a good answer for this (it's certainly got to be better than this one :eek:).

    We do a lot of guess work over here, and know practically nothing about ratios. I would imagine that the 2 hour post meal bg is probably not going to be a fixed figure because it depends on what the consumed meal was (high fat, GI number, etc.) and the amount of insulin on board plus other YDMV variables.
     
  4. Rusty

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    I would really appriciate some input from the parents doing MDI. Does the 280 sound way off. If i would see a 180 2 hrs post meal i am sure he would drop way low by next meal but like i said i could counteract this with a little carbs. Thats why i ask do most accept the spikes or risk the lows ?????

    PS, The 280 is just a general number and does vary, ballpark number.
     
    Last edited: Feb 19, 2009
  5. Barbzzz

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    That 280 didn't really strike a bell with me until I converted it to our reading, which is 15.6. (Alex's range is 4.0 to 8.0 (or about 70 to 140)). That 280 is a really high starting (pre-meal) number. I'd have to consider extra Humalog to factor that in, then whatever I thought she needed for the food she was going to consume.

    180 post meal (or a 10.0) would make me think I didn't give enough Humalog, since it peaks before 2 hours and there's very little of it left on board.

    You might want to run this question past Wilf, one of the MDI experts.
     
  6. Rusty

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    The 280 is not a starting number it is a ball park 2 hr post meal number. The 280 post meal number is asuming was in good range pre meal. 130 or so. Then it seems about 4 hrs out he is back around 130.
     
  7. coni

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    When DD was MDI she was on Novolog and was a year older than your son, but we did see fairly regular higher numbers post meal. Breakfast, of course, was the worst. (Is any one meal clearly an issue for your son?) DD's a1cs were in the mid 7's, and like your son, she'd be in range at meal time.

    This pattern did not seem to bother the endo but it certainly bothered me. If we gave DD more insulin for meals, we'd have to check for lows and give small snacks between meals. We're pumping now, and what I can tell you is that we were facing a situation where DD needed different basals. It wasn't the I:C ratio. It's one of the struggles we faced on MDI that's easier to deal with pumping.

    I'm not saying not to seek a solution. I just wanted you to know that I'm not surprised because we encountered it ourselves.
     
  8. betty6333

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    I think that your child is very young, and so if they start the meal at 200 then an 80 point difference 2 hrs after, might be reasonable.

    Often with young children the range is 100 -200 and so a starting # is important to take into consideration. On the CGM and pump, we target 100, I correct anything over 120, SO a 280 would make me very nervous.

    When we did MDI, we could never see numbers under 150 without worrying about low, so i think it is just different and you can't really compare, esp since your child is so young.

    If they start at 180, (in range) and they go to 280, that is a 100 point rise, and on MDI most endo's would say that is ok, ESPECIALLY if you do not want to prebolus because they are picky eaters. I remember many days post - bolusing after eating, because you can't guarantee they will eat every thing they pick out.
    IMO little kids are different and unless you had a CGM and pump, I wouldn't want you to try to get those numbers too low for safety reasons since your little guy may not be able to tell you he is low yet!! and even then developing hypo-unawareness would be a concern.

    I would send the #'s to the endo and ask what they recommend, and remember that as he get's older and will eat more predictably, that you can target lower #'s
     
  9. coni

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    I forgot to add that another factor may be the type of meal. If you haven't already, you might want to track what he eats and compare it to the post meal spike to see if there are particular foods that affect him. Some foods are clearly evil on BGs and it differs from person to person. Including protein helps, but in our case DD will still spike with certain foods even with protein.
     
  10. Reese'sMom

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    We're on MDI and we shoot for under 180 2 hours post-meal. He doesn't go too low before the next meal, and usually only really needs a snack before the next meal if he is very active (most days).

    If you are having a problem going low between meals by keeping the post-meal bg at 180 or below, then I would guess that your Lantus may be too much and you may be able to slowly back off with that.
     
  11. Rusty

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    Yes breakfast is the worst for us also. I usually pre bolus for breakfast about 10 minutes before. Breakfast is the meal i can ALWAYS count on him eating. The other post meal numbers may be a little lower but always seem to exceed our 200 goal range.
     
  12. Rusty

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    Example of our morning so far.
    He was 132 before breakfast gave insulin at 7:30
    Checked at 9:30--280 That darn spike.
    Its 10:30 just did a check---184

    We have about 1.5 hrs till lunch and i am sure he be be back around 130. Maybe even a little lower than that.
     
  13. betty6333

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    Hi again, yeah, at 2 things are very tricky, I have a 2 year old and he talks but, not well enough to trust he would be safe with out constant monitoring in the lower ranges.

    a1c's are higher for young children because it is a totally different rule book, to keep them safe. AND while I wouldn't want my 2 year old over 200- 300 for a long period of time, I would understand that until a cgm was running 24/7 or he was older, a higher range was necessary for safety.

    I think you'll want to go with how you feel is best for your child, because if you have a lower target, and he ends up low, that can be very very scary for both you and the 2 year old.
     
  14. Adinsmom

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    Yes, that is exactly what we do. Adin likes to eat and he has a long duration of insulin. I overbolus to cover a snack. That is the only way I can get his waking numbers in some sort of acceptable range. Or we just have one big rolling spike through the day where the insulin doesn't have a chance to catch up. I target below 200 at about 2.5-3 hours(thinking about dropping the target number). His insulin sensitivity is 500-525 for a unit of novolog.

    If your child doesn't like to snack I wouldn't recomend it though. Besides the extra fear of missing the snack and causing a huge low there is the fact that instead of one peak you have a coouple bounces in insulin action.
     
    Last edited: Feb 19, 2009
  15. samheis

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    I usually avoid these posts, cause I'm better at doing than explaining lol.
    So say he has breakfast, gets his shot to cover it, then 2 hours later he's around 280? Does he then get a snack before the next meal?

    I'm able to set our ratios lower (more fast insulin) then usually 2 hours post he is in the 100-150 range (sometimes it goes higher, not much.) He then gets a snack -morning 10-15 carbs works well, some fruit or crackers. By lunch (if everything lines out that day) he's back in range.

    With your son being younger, I imagine your Target is higher than 100?
     
  16. BozziesMom

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    If we're at 280 2 hours after breakfast, we'll be in range by 3.5 to 4 hours. I don't love it, but with a toddler post bolusing, it's what you get I think. We see the same pattern as you. Sometimes at 4 hours he's even below 100 after a spike to 300+ at the two hour mark. Heck, I'm happy if we're under 300 at 2 hours. If we're in range at 2 hours, I end up having to give a snack by 3 hours or he's going low.
     
  17. fossmommy

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    I'm not sure what the norm is there either... it's something we struggle with, mainly at breakfast. Andrew's 2 hour post meal numbers have been anywhere between 70 and 400! And we can't find anything that would clue us in to if it's the foods or what... I'm interested to hear what others have to say.

    (oh, and yes, we are MDI too)
     
  18. fossmommy

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    Alyce, you crack me up! I think we are pretty much in the same boat... but we don't post-bolus...
     
  19. BozziesMom

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    I was prebolusing, but we get the same results. So I figured if all's the same, why not be more accurate with the bolus? Not that it helps. :rolleyes:
     
  20. 2ladybugs

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    I agree with Alyce on this. We were MDI for 3 years starting at dx age 23 months, so I know where you are coming from. The endo was happy if we were under the 300 post breakfast because breakfast is the most difficult part of the day. She let us run a little high due to the age and the risk of lows. Isabella was and still is very sensitive to everything. With a little one, even 1 gram of carb over or under will send their bs's through the roof or dropped on the floor!

    I think if you are seeing those numbers post breakfast, then you are doing fine. Yes, they are aggravating but if he does not always want a snack, then I would not change anything for now as long as he continues to be back within range by 3 hours post or lunch time. You are doing a great job! We know it's not easy juggling this disease and it's even more difficult with a toddler!! There are too many variables that come in to play. ;)
     

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