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Need help with dosages due to meal timing in school

Discussion in 'Parents of Children with Type 1' started by missmakaliasmomma, Sep 10, 2013.

  1. missmakaliasmomma

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    My daughter started school yesterday, and since she has the same meals everyday, her sugar has been around the same before lunch and snack on the 2 days she's been at school. Her first pre lunch number was 206, second-201. Snacks are 2 hours after lunch. First snack- 150 something 2nd day- 170 something. I'd like to find a way to bring the first time down a little bit but they barely eat lunch 3 hours after my daughter eats breakfast. Actually this week it will be 2hrs and 40 minutes after breakfast. Next week it will be 3 hours. She will come down into range after 4 hours because that's how long her insulin takes. I don't like her being that high since she doesn't really have a chance to get to her target number. I don't know if I should increase her dose for breakfast, but would that actually keep it lower, or will it just hit her hard at the end? I have apidra but I don't want to start using it in school until she's gotten used to it at home.. just in case it works a lot different than her humalog. I don't really want to wake her up any earlier so she can eat earlier so if there's something else I can do, I'd like to try that first.

    She eats eggs and fruit in the morning, fruit being mostly raisins. I have to keep this pretty low carb because of the spike.

    Lunch is great with her BG, teriyaki grilled chicken with brown rice and broccoli. IT breaks down very well, as you can see with her snack numbers.

    I check her after snack since I pick her up 2 hours after snack. She's good at that point too. In the 100s. She gets a bag of smartfood cheddar popcorn

    Maybe increase basal in the morning?? I dont want to do anything too drastic that could result in bad hypos.

    Had to edit this: 2 hours after her snack she was 298 today. Tested twice. The popcorn has the carbs right on the bag, is popcorn normally an issue for anyone? Its never seemed to be one for us in the past
     
    Last edited: Sep 10, 2013
  2. Sarah Maddie's Mom

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    Raisins are a problem food for us. I'd try some berries instead and see if you don't have less of a post breakfast spike.
     
  3. Amy C.

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    I personally would make no changes until she has settled down in school. She could be running higher due to excitement. Wait a couple of weeks for her to get into the routine.
     
  4. missmakaliasmomma

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    I know she will come down after 4 hours though. The amount of insulin is right, I just don't want her to eat on top of her insulin not fully working yet AND being high.
     
  5. susanlindstrom16

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    Raisins are the devil for us too. I actually stopped buying them since my daughter seemed to not miss them that much. Maybe try a different fruit?
     
  6. momof2marchboys

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    we were having highs the first 2 weeks of school in the mornings too and now this week we are right where we need to be after the initial excitement and nervousness of being at school has worn off. I would wait a week or so before making any adjustments - also maybe get your hands a daily schedule - are they sitting in the classroom more in the mornings that what she did during the summer and not as active?
     
  7. shannong

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    Raisins are a problem for us too. They really spike his bg and I could never give them in the morning. Actually, I have to avoid all fruit in the morning or a see a big spike. Mostly just low carb and protein breakfast for us.

    My son also does morning snack, lunch and afternoon snack. Sure, insulin from previous boluses are still at work, but I think in order to not have high numbers all day, I actually dose so that hopefully my son will go into his next snack/meal on the low end (in the 100's), otherwise with the frequency of snacks, he would probably run high all day. In fact if he is running on the higher end (gets above 180), it is very difficult to get his numbers down, and sometimes I ask him not to eat snack (but he really hates to miss out on snack so I don't do this often). I think it is a balance of I:C ratio and basal that needs to be worked out to keep them in range. Good luck.
     
  8. mmgirls

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    I learned that I needed to have her bg be as close to 100 as possible and tp Prebolus Apidra by at least 10 minutes. If above 100 she needed to have a good prebolus of 20-30 minutes.

    Also we did allot of "Super bolusing" in kinder to deal with the early breakfast and schedualed snacks.
     
  9. missmakaliasmomma

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    I do have her schedule. I don't find that she will be more or less active than what she was during summer really. She's not really a crazy kid so she doesn't just run circles around the playground at recess lol. Maybe the real issue is, is that in the summer, she was sleeping very late and now she's up and about. When she sleeps she needs less insulin, which is why I thought the basal might need to be upped for school days. I hate to let her run high for a couple of weeks you know?
     
  10. missmakaliasmomma

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    I actually thought this might be the perfect situation to start the apidra I got and haven't used yet, since technically it's supposed to work fast and has a shorter dia.

    I think i need to start prebolusing her breakfast. I never have to at home. I don't really think her lunch needs to be since she's in the 100s and obviously I don't want her much lower because the nurses don't test her as much as I do at home. I'm personally not comfortable yet with the nurses prebolusing her though since it seems to be a bit of a balancing act, and she doesn't have dex so it's just kinda... scary? I don't know if that's the right word
     
  11. Sarah Maddie's Mom

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    What about ditching the raisins, as a number of folks have suggested?
     
  12. missmakaliasmomma

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    Thanks everyone. You all had really good ideas. I will see how this week goes since it's a hectic week for everyone and they need to settle into a routine. Then I will start making adjustments slowly. Don't wanna go nuts! lol
     
  13. Sarah Maddie's Mom

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    Honestly, the very last thing I'd do given your difficult pump start is to change insulin. Yes, I'd pre bolus breakfast and yes, I'd ditch the raisins but no, I'd not change insulin at this time.
     
  14. Heather(CA)

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    Can you start Apidra Friday after school? It will most likely get her to a good number before those times without the tail I have heard Humalog has..
     
  15. Heather(CA)

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    Why not? Everything is going to get messed up anyway? Why not figure it out on the insulin she is going to be using once instead of throwing everything off again?
     
  16. missmakaliasmomma

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    This is actually what I planned haha, to do it on the weekend. I'm not sure about this weekend because it seems like many kids are thrown off their first week of school. I definitely feel more comfortable trying to see how apidra might work if she's home with me and I can test her frequently.

    I was also not sure about using it in the pump. I know people have had some issues that I've read -with occlusions. I do change sites every 2 days though so I'm not sure if I'd even have a problem with it in the pump at all. I emailed her endo last night asking for orders for mdi so at least if we go back to that, I have the orders on hand I can give them to the nurses.
     
  17. missmakaliasmomma

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    What else would you give instead of them? I can't do any kind of bread in the morning. That spike is ridiculous. I'd be welcome to more ideas of what I can give her for breakfast also :)
     
  18. shannong

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    I would try whole fruit then, rather than raisins or other dried fruit. Or stick with veggies and protein, like a veggie omelet. I do give bread, but I keep the carbs to less than 20g. in the morning.

    Last year, on MDI, I used to super-bolus for breakfast, which required my son to have an uncovered snack mid-morning at school. He would go low if he did not have this snack. But it was a bit of a nightmare- sometimes the teachers would forget snack, or give it to him late, or the timing was just off and he would go low before the snack got into him. It was the only way to get his breakfast spike down, but I found it resulted in too many lows.

    On the pump, he does cover his snack in the morning. He has not had a single low at school yet so far, which I am happy about because this was a problem last year. Morning snack time can vary, but this no longer stresses me out, because I know he probably won't go low if he misses snack. I attribute this to the fact that I no longer super bolus, I keep his breakfast low carb, and the fact that he is on the pump and I can adjust basals. Anyway, I share this because I know you are worried about upping the insulin and having lows at school. I tend to have a fairly high basal rate going for the frequent snacking, but go easy on the amount of Insulin to carbs ratio while at school (other than breakfast which gets a bigger bolus). Everyone does it differently, but this tends to work for us.
     
  19. cdninct

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    We have a pretty bad breakfast spike no matter what I do, so I can't offer any overall brilliant suggestions, but I will say that most berries, and blueberries in particular, are pretty gentle on K's BGs.
     
  20. Sarah Maddie's Mom

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