Post breakfast spike

I'm sure this has been discussed, but I can't seem to find any old threads on this topic. My son has pretty big post breakfast spikes. We prebolus about 20 minutes prior to eating. Breakfast tends to be his heaviest carb meal of the day (cereal or waffles). He eats around 7:30 am, then has snack at school around 9:30-10 at which time he is always 200-250, sometimes up to 285. By lunch time at school (1 pm) he is always between 90-140.

On weekends, when he doesn't always have that snack he is within range 3-4 hours after breakfast so I tend to think increasing his breakfast bolus isn't the answer. Am I wrong? Are their other ways to decrease that spike or is this just one of those things I need to learn I can't control?

Thanks for any suggestions.

 

There's a fantastic Type1University class called "Strike the Spike" that I would highly recommend.

 

I haven't seen that one, and I think I still have a credit for a class, thanks!

 

I find with certain foods, such as cereal and waffles/pancakes I always have to do a temp basal increase for a couple hours to counter the spike from those foods. I'm not sure if you are on a pump or mdi, didn't check the signature. And to be honest when on mdi I never attempted to fix those problems...never thought to...maybe somebody on mdi has some advice if needed

 

We have a similar problem. We've noticed it doesn't matter what the food, he still spikes from low 100's at breakfast, to 200-300 2 hours past, to 80-150 at lunch. We've brought down his bolus ratio to 1:8.8, and lowered his 6am to 11am basal. He has an uncovered 5 carb snack at 2 hours past. However he's started to drop low an hour before lunch, so I think we're going to make it 10 carbs uncovered. He can't be that high during the school day, he just has too much trouble concentrating and getting his work done.

 

You could have just written my post. We just started an uncovered snack cause Taylor would actually drop into the 60's.

 

We still struggle with breakfasts, but the two things we did to improve the situation were to prebolus by 30-40 minutes (if he was running on the lower side, I would include a few more carbs in the bolus and give him a very little bit of fruit or juice at around the 15-minute mark to keep the early action of the Novolog from sending him too low), and ultimately to switch from Novolog to Apidra. Waffles are still killers for us, but we have solved the cereal problem!

 

We crank up early morning bolus

We also fight after breakfast highs. For my 5 year old we pre-bolus - but I also crank up his basal rate around 4:30 in the morning (we eat breakfast around 6:15 AM). This gets more basal in his system to help counteract the spike.

I decrease basal later.

Just an idea -

 

Thanks so much everyone.

To try to minimize the spike today, I did a temp basal increase this am (our first one, we've only done temp basal decreases for sports in the month since we started pumping) and Im hoping I got the timing right, if not the percentage. I did 120% for 1.5 hours starting when he ate (7:30 am) thinking it would effect the BG from 8:30-10 am when the spike seems the biggest.

The nurse emailed that he was 202 at 10 am, so its better but I can probably increase a bit higher. He is "taking a break" from his CGM unfortunately, that data would have been helpful. Anyway, thanks again.

 

Since the total dose is okay, as evidenced by the lunchtime numbers, I have two suggestions:

1. Have him eat less for breakfast and more at snack. That way he will be a little lower at snacktime but still getting in the carbs.

2. Reduce the basal for the mornings and add it to the pre-breakfast bolus.

Both of these things would be intended to help with the problem, which is that the insulin being used and sugar being used are overall balanced for the morning, but are not balanced over the parts of the morning.

 

FOr my son, if I increased the basal at 7:30, I would not really see the effects until 11-11:30 on Novolog and 10:30-11:00 on Apidra. Every child is very different in this regard, but if you discover that he is still spiking then dropping rapidly, you might want to consider starting the basal increase even earlier!

 

This sounds like my daughter. She will be in range at breakfast (7 -7:30), eat, get her shot and then go to school. She usually checks at least once if not twice at school in the AM and she always goes up to 250-300, but then is back down in range before lunch at 11:40. She doesn't get a morning snack.

I've been worried about this ( we are less than 2 months from dx) so it helps to know others are in the same situation.

 

Thank you for the suggestion. Are you saying to bolus for the breakfast and snack at breakfast time? This is what our CDE just suggested to me, but Im not clear on why that wouldn't produce a post snack spike and I'd be so nervous to give him insulin for a portion of food he isn't eating for 2 hours.

This feels a little more comfortable to me. Our CDE just offered this as an alternative too. He said to add 3 hours of basal to the bolus and thenr educe the basal by 90% for those 3 hours.

Thank you also. When we did basal testing we would change basal rates approx. 1 1/2 to 2 hours prior to the time we needed tweaking. Is this the best way to ascertain when effects from changing basal rates occur? I am having a hard time wrapping my head around all of this for some reason.

 

We do a super bolus of setting temp basal to 0% for 2 hours and adding that basal to the bolus and it seems to help with the spike.

 

The issue is the timing of the insulin and the food. At breakfast, the food kicks in way before the insulin does resulting in a high when you don't want it. If you give the insulin for the snack with breakfast, it has a head start on the food. The timing would actually be better with this as food raises the blood sugar rather quickly.

 

After more than a year of high numbers at morning snack we are finally at the point where we do not have high numbers about fifty percent of the time - this is a great improvement.

After trying numerous strategies this is what works best for us:

Eating earlier so more time elapses between breakfast and snack.
Treating highs at breakfast aggresively: (we divide by 95 instead of 200)

Using a high ratio: (we use 1:8 at breakfast and 1:27 at other times)

I believe that numerous things are causing the highs: some insulin resistance, a sluggish metabolism in the morning, less insulin on board from meals before breakfast (since there are no meals before breakfast), and perhaps some growth hormone.

Exercise would work too but she just does not like to exercise in the morning and it is also hard to fit into the schedule.

For many people pre-bolusing works great. For us we were pre-bolusing a long time before breakfast and it just did not help.

Lastly, I should add that we do not always get to eat at 6:30 am because sometimes we are running late. I have figured that when we eat after 7 the ratio for us is 1:6 and the closer to 6:30 it is the closer to 1:8 - it is a bit of an art.

Good luck

 

We always assumed that DS had about a 2-hour active insulin time, and when we tweaked basals, we did so accordingly. Then, one night, I underbolused for dinner, purposely running DS a bit too high. I waited until BG had levelled out, then I corrected. I then checked on him at 30-45 minute periods until the insulin had done its work. It turned out to be about 4 hours, so that is the time-frame we use now. I also noticed that the last time I did a basal test, his BG perfectly mirrored his the changes in his basal rates (inversely) at the 4-hour mark.

As with everything else diabetes related, experimentation seems to be the key!

 

Well, I wasn't, because I thought you already were effectively bolusing for the snack at breakfast and giving the snack uncovered.
But since you aren't already doing that, then YES, I am suggesting that. Try it in increments of increasing the breakfast time bolus and reducing the snacktime one if doing it all at once feels funny.

 

You have a great CDE looks like ...
Some people call that "super bolus"... to avoid the spike after meals, especially breakfast.

...
I need to figure out our dinner/ post-dinner issues but I've been too lazy to make any adjustments and just wing it everyday...

 

We struggle with this with our six year old. I see your child has a revel. We have had alot of success by using the dual wave feature if he is eating a carby breakfast, granola, etc. We do 60% 15 or 20 min. before he eats and set it to give the other 40% in a half an hour. It has worked great!