At endo appt today her educator said...huh?

I was mentioning that I have been working hard on preventing fat spikes with dual boluses and temp basals lately. Her response was that they don't normally see those kind of issues in kids her age...what? I was a little thrown off by this. I see fat spikes in probably close to half the meals I prepare. Is this more uncommon than I realize? I know ydmv but fat is fat I would think. Anyways, I was just surprised is all. A1C 7.6 Id like to see it under 7, but maybe next time if I keep cracking these meals

 

I think fat spikes are pretty timeles ;-) idk... only do combos for ice cream, pizza, and chicken nuggets

 

She's either lying or she doesn't know the stats...
Do you pre-bolus? Is the I:C ratio correct? 7.6 is very acceptable... especially if the there's not a very big SD. Our initial goal was to eliminate all low lows -- which we achieved (the of course, she'd had a couple this past week alone!) Now to get rid of the high highs.

 

I think you should have been.. honestly it may be that most of the time medpro's just don't care to fine-tune insulin doses to that degree, but it doesn't mean that the fat spikes don't happen, or that they couldn't achieve better control if they were managed better.

The best CDE I've ever seen looked at me once when I was explaining that I combo bolus for nearly everything I eat because Apidra works so fast, and she said "You know more about this than I do, and I'm not even going to try to argue" - I wish all of them could be so flexible rather than insisting things can be done a "simpler" way.

I also have another theory about Apidra that if I bolus more than about 3u at once, it's not as effective if I drag it out over an hour or so. That goes for food *and* corrections. My correction factor is higher (so less insulin is required) with an extended bolus than if I just gave it all at once... it works for me, and I've documented it many times.

 

I have to do extended boluses for almost any food with fat for Hana. Chocolate, pizza, fries, red meat (the absolute worst! She will be in the 400s about 5 hours after eating beef if we don't do some sort of extended bolus) - not to mention pasta and bagels! Yeah, we pretty much do extended boluses for everything!

 

The 2 CDE's in our endo's office are clueless. There, I said it!

 

I have found that foods have affected BG's much more as Rachel gets older. When she was smaller we only had to combo bolus for pasta/noodles. Now at 10 we are finding many more problem foods including fatty foods.
Very few of our meals need anything but a normal bolus though. :cwds:

 

Caroline is just 2 months older (and still honeymooning), and she has so many 11pm fat spikes I've been wondering if it's a basal problem. On low fat nights she consistently has fine numbers so I think it's the fat. I've just resolved to have more low fat dinners until we get her pumping end of May because I can't get good numbers lately.

 

Fat spikes are more obvious when you eat a variety of different meals. For people who eat consistently low fat food, they don't see fat spikes. For people who eat consistently high fat food at a particular time, they might not realise that they are even having a fat spike and simply adjust basal, thinking there is a higher basal need at that time. And then there are many people outside of CWD who just don't do that kind of 'advanced' D management. And then I'm sure there are a few people whose bodies actually metabolise fat differently and who don't have fat spikes.

 

When my daughter has cheese, I never know what to expect. Sometimes it requires a 175% basal for hours; other times no adjustment. I don't get it. She's trying to figure it out.