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How do you bolus for a meal when you're low?

Discussion in 'Parents of Children with Type 1' started by calebsmom1113, Jan 4, 2011.

  1. calebsmom1113

    calebsmom1113 Approved members

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    I've heard conflicting things. It's tricky because we're so scared to bolus him if he's already low,, but if we don't he skyrockets! Today at school he went down to 48 and then ate lunch with no bolus (big mistake) and ended up over 300. Any suggestions? Do you give partial boluses? Only bolus after the meal? Help!
     
  2. sugarmonkey

    sugarmonkey Approved members

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    If Phillip is low before a meal we treat the low normally, and wait till he comes back up before eating. If it's not too low (about 3.5 (63) and up) we'll treat and eat. We still bolus for the meal as normal.

    With a low of 48 (in your post) I'd treat, wait until in range, then have meal and bolus as normal.
     
  3. BrendaK

    BrendaK Neonatal Diabetes Registry

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    If he's very low (under 70), we'll treat with glucotabs (1 to 3 depending on how low) and then bolus as normal.

    If he's in a lower range (70-100 ish), we'll subtract 10 grams from the meal bolus. This is easy for him to do for a morning snack since he does his own bolus in the classroom.
     
  4. Nancy in VA

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    We treat the low, and then bolus for the meal based on the I:C and don't factor the reading into the equation.

    We are confident that our treatment carbs are the right amount, so we are comfortable going ahead and treating and moving on before a meal
     
  5. Flutterby

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    For a 48, I'd treat the low, give lunch and then sometimes I bolus light for the meal, depending on what activity she'll be doing, what she WAS doing, if she had any active insulin at the time.. for something in the 60s/70s I'd give the meal/snack and take 10c off the carb count..
     
  6. Heather(CA)

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    Treat the 48 until he comes up, then eat. If he can't wait, give enough juice for the low and eat/bolus. Don't just eat without giving fastacting. Food takes too long to work on the low, that high could have been from not bolusing and/or a rebound. :cwds:
     
  7. Amy C.

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    If my son were 48, he would drink a juice, eat his meal and then we would bolus for all the carbs consumed (including the juice), usin the 48 as the blood sugar. The pump calculates a lower amont of insulin for the food because of the low.
     
  8. mmgirls

    mmgirls Approved members

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    Your pumping right?

    I would treat the low with fast acting carbs, usually a juice box 15g, which is more than enough carbs. At school she will test again in 15 minuyes, at home she will not.

    Once we verify that she is up and above 90, she can eat have a snack or whatever and we bolus for ALL carbs and including the 15 grams carbs for treatment and enter the FIRST lowest BG, allowing the pump to reverse correct for the low by minusing out the appropriate amount insulin for the low BG AND any IOB still going.

    So far this has worked the best for at school situations.

    I would never treat a low and have her eat and not give insulin unless there seemed to be a stomach absorbtion issue.

    If I was unsure of why the low happened and was hesitant, then I may give less than recomended insulin or do a combo bolus and test early to either give more carbs or more insulin .
     
  9. Mary Lou

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    Like most of the other posters, we would treat a low with fast-acting carbs (juice doesn't work fast enough for my boys, we use tabs, skittles, gluc-shot, things like that), wait 15 - 20 minutes, test, and then eat as normal.

    Once in range, and eating a normal meal, it might help you to know that it takes at least 15 minutes for the insulin to begin working, so even if you bolus for the meal right away (once in range), the food and fast-acting carbs will be continuing to work to bring BG up before the insulin kicks in to bring it back down.

    It has been my experience that we need to bolus for the entire meal and not take into account any negative correction factor for a lowish number that followed the 48. The fast-acting carbs acted as the correction (I think Nancy said it better :)) This should help prevent a high later on...
     
  10. BrendaK

    BrendaK Neonatal Diabetes Registry

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    I just wanted to ask why people treat a low and then wait 15 minutes to eat a meal? I get waiting 15 minutes to retest to make sure you come up, but why wait to eat a meal? When you are low you are SO HUNGRY that you could eat an entire house! It's not just a starving hungry, it's a desperate hungry that you HAVE to eat or you will collapse! It would be pretty rough for my son to make him wait to eat a meal when 1) he's low and crazy hungry and 2) it's time for a meal anyways. Just can't imagine having food ready on his plate and making him wait to eat it.
     
  11. Tuff

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    It's so that you can bolus accurately for the meal according to what the BG is once they come up.
     
  12. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Maybe it's different with other brands of pumps -- but on the Cozmo, we don't enter the blood sugar in with meals (the calculations for IOB don't work well at all) so we just enter carbs in for meals. So a 20 or 30 point rise in blood sugar after a low and a 15 minute wait wouldn't affect at all how we bolus for it. Plus after 15 minutes he would still be rising from treating the low.
     
  13. Nancy in VA

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    But if you know the number of points the carbs brings up your child, you should be giving him enough to get in range, and then you would be dosing just based on a reading in range, which adds or subtracts nothing from your reading. You shouldn't be overtreating so that you have to dose for some of the treatment carbs, and you shouldn't be undertreating and reducing insulin from your dose (otherwise, you might as well just not treat and negative correct anyway). That's why we don't bother to wait
     
  14. Tuff

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    Thats true - I have to admit I do it both ways. I don't always wait however if he has had numbers are wacky I do try to wait and start with the bolus when the BG is up as far as it should be. Also if he is very low then I wait for sure. I wouldn't want to add insulin before his body has caught up.
     
  15. Heather(CA)

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    The reason is that say for example their low number is 58. You don't know if that's a steady 58 or whether they are actually dropping more. By waiting, you make sure the low is treated correctly. If you give 1 juice when in actuality they needed two for example, you are creating ANOTHER low in the near future because the last one was not treated fully. If you don't treat the first low correctly, your not starting with a clean slate and that can confuse adjustments. Does that make sense? :cwds:
     
    Last edited: Jan 5, 2011
  16. Tuff

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    An example of needing to feed a low twice would be this morning for us. My son was 52 and I checked 10 mins later and he was still 52 so I gave a second juice and 10 mins later he was only at 57. You just never know when the lows are still on their way down while you are correcting.
     
    Last edited: Jan 4, 2011
  17. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Maybe it's also in how people are treating lows. We treat lows exclusively with glucotabs -- they have brought numbers up within 15 minutes 100% of the time. We use them because they work super fast. Juice doesn't work nearly as fast for us. We also use the Dexcom which will tell us if it's steady or a fast drop. But even with a hard fast drop, the tabs have always brought him up in 15 minutes. YDMV as always!
     
  18. Phyllis

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    Bolusing when low

    This is where a bolus wizard or other similar programs come in handy. Some pumps are equipped with these programs and they correct the recommended dose when the blood glucose entered is low. If you do not have a program like this in your pump ask your diabetes team how much to reduce the dose when you are low. Also remember insulin action is not immediate. If you feel safer,you can eat first when you are low and then administer a reduced insulin dose (based on software or provider recommendations).
     
  19. Nancy in VA

    Nancy in VA Approved members

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    Our pump has that. But, we choose to treat and then bolus without dosing the reading rather than "negative correcting". I think most in this thread have said they do the same. I think all of the main pumps on the market do negative corrections - we don't do it unless we are between 70-80. Otherwise, we treat and dose with no reading.
     
  20. emm142

    emm142 Approved members

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    That starving feeling is the worst. Mostly I don't feel lows now, but when I do.. it's just the most intense hunger I've ever felt. I do try to wait 15 minutes after treating a low below 50 before I eat, because eating normal food will slow digestion of the fast carbs. Also, I'm incredibly terrible at carb counting when low (I drastically underestimate how much I'm eating), so I mis-bolus.
     

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