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morning spikes

Discussion in 'Parents of Children with Type 1' started by susanlindstrom16, Jan 6, 2015.

  1. susanlindstrom16

    susanlindstrom16 Approved members

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    For the past several school days, my daughter has been high at her lunchtime check (220-250). She gets her insulin for lunch around 11:30am, and then when the nurse checks her at 2:30ish, she has been typically getting another little correction, which brings her back into the low 100s or even lower by the end of the day. She typically wakes up 100-120.

    I know she needs more insulin in the morning, but I'm not sure if I should adjust basals or I:C ratio first. I lowered the I:C slightly for this morning (1:18 from 1:20). That seemed to do nothing. Should i lower a little more for tomorrow?

    Thanks for advice you could give me!!
     
  2. wilf

    wilf Approved members

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    What about more detailed monitoring on the weekend when she is at home? If you take readings hourly after breakfast you should know what you need to do.. :)
     
  3. susanlindstrom16

    susanlindstrom16 Approved members

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    We haven't really been noticing this same pattern on the weekends, I don't know if maybe because she is more active then? Or maybe because she will typically want to eat something or another soon after breakfast, and so she has a few more boluses working in her system.
     
  4. missmakaliasmomma

    missmakaliasmomma Approved members

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    I find the only thing that helps is increasing basal. When my daughter doesn't spike crazy from a donut, I consider that job well done lol
     
  5. quiltinmom

    quiltinmom Approved members

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    I would give it at least 3 days before changing it again.


    Without doing basal testing it can be hard to know what to change. One guideline I try to look at is if the bg is higher when more carbs are eaten. If ratio is off, it will often be more exaggerated with higher carb amounts.

    Another guideline I sometimes use (although it's not as clear cut with pumping as with mdi) is that if a highs tend to be at a certain time of day I lean toward ratio tweaking, if it's random throughout day I think basal. Not hard and fast by any means, but it's at least a starting point.

    Third, if she's out of honeymoon, look at ratio of basal vs. meal insulin. It ought to be in the ballpark of 50/50, in honeymoon we ran about 25 basal/75 bolus. If one is a but lower than the other, maybe change that one first.

    Maybe try a low carb breakfast to see if it helps, or wait until the weekend and do some basal testing.


    Honestly, fwiw, my first inclination would be to change meal ratio, because it's always after breakfast, and lots of type 1s need more for breakfast than other meals. Not knowing exactly where she's at already makes it more of a wild guess though.

    Sorry if all my suggestions are things you already know. I forgot to check how long ago you were dx'ed.

    Good luck. :)
     
  6. susanlindstrom16

    susanlindstrom16 Approved members

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    Thanks! It never bothers me to be reminded of things I already know- its easy for me to forget when certain things should be applied. This morning I kept the 1:18 carb ratio and added a 10% temp basal for 4 hours. She was 169 when she left for school at 9:45, and I figured she was coming down, but nope, nurse's text said 294 at 11:30. However now I also have to add the fact that we are almost 2.5 days into the site so maybe we are nearing the end of it's use. UGH this stuff is so frustrating sometimes!!

    She really likes these fiber one protein bars and usually has one with breakfast. I find them really filling so I'm wondering if they are really slow to digest and maybe the carbs are hitting later than i think they should?
     
  7. susanlindstrom16

    susanlindstrom16 Approved members

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    That sounds like success to me!
     

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