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Thread: bolusing for oatmeal..

  1. #1

    Default bolusing for oatmeal..

    Ashleigh likes oatmeal, but due to bolusing problems she doesn't eat it a lot. What normally happens is she eats breakfast at 7:00AM. between 8:30-9:00AM she spikes close to 300. Then without fail around 10AM she drops below 70. She's gone as low as 35 after oatmeal. We are using the same ratio (1:7) that has worked for every other breakfast meal, but it does not seem to work for oatmeal. Here are suggestions other parents of type 1s have given me and the results.

    Suggestion #1 Prebolus. This works well for the spike. We have tried different prebolus times. Everywhere from 10min-40min ahead of time. It pretty much eliminates the spike but she still drops low 3 hours later.

    Suggestion #2 give less insulin (change I:C ratio): we did try a 1:8 and she still dropped low, so perhaps even less than 1:8 the difference would be 10 units vs 8.5 units

    Suggestion #3 subtract fiber. We were taught to only subtract 1/2 fiber if there is 5g or more per serving. This oatmeal has 3g per serving

    suggestion #4 have protein with it. She does drink a glass of milk every morning with breakfast. So that includes 9g protein. but perhaps more is needed.

    Today she had oatmeal. We subtracted the fiber and added in 3 sausage links. Which gave her a total of 20g protein (9 with her milk + 11 with sausage). Hoping it works out, but she had to correct a high, so i'm afraid that's going to be our downfall.

    Any other suggestions on what to try? It's mainly the low that's driving us crazy.
    Chris mom to 4 daughters
    Ashleigh diagnosed Type 1 diabetes 3/23/10
    MDI-Tresiba and Novolog
    Dexcom g4 CGM
    Most recent A1C 6.0%



  2. #2

    Default

    We subtract all fiber. We weren't taught to at dx; we learned it from the T1U classes. Our endo said most Americans eat so little fiber it doesn't typically matter, but for us, it was a huge difference. We did have to adjust her carb ratios when we switched.

    Adding in the sausage without doing an extended bolus for the fat and protein would create highs here, too.

    My daughter has sworn off oatmeal/granola as she doesn't like the spike and doesn't consider it worth bothering with.
    Last edited by MomofSweetOne; 03-14-2017 at 08:51 AM.
    8/2010 - 9/2011 MDI, Lantus & Humalog
    9/2011- Medtronic Revel 723 & CGM
    11/2012 - Dexcom G4
    2013 - Cut-The-Cord for water times after multiple Aquapac failures
    10/2015 - T-slim

    "Life is not waiting for the storms to pass, but learning to DANCE in the rain."

  3. #3

    Default

    yes i forgot that someone did suggest an extended or combo bolus, but since she's MDI kind of hard to do.

    Ha Ha i should make her hook up to her pump on oatmeal days. I'm sure she'd love that suggestion.
    Chris mom to 4 daughters
    Ashleigh diagnosed Type 1 diabetes 3/23/10
    MDI-Tresiba and Novolog
    Dexcom g4 CGM
    Most recent A1C 6.0%



  4. #4

    Default

    That would be tough. Correction doses proactively? I'd missed she was on MDI. What if you try the sausage combo without subtracting for fiber? You might still need to increase the dose would be my guess.
    8/2010 - 9/2011 MDI, Lantus & Humalog
    9/2011- Medtronic Revel 723 & CGM
    11/2012 - Dexcom G4
    2013 - Cut-The-Cord for water times after multiple Aquapac failures
    10/2015 - T-slim

    "Life is not waiting for the storms to pass, but learning to DANCE in the rain."

  5. #5

    Default

    it didn't work she dropped to 58. My next idea is to pre bolus 1/2 the amount by 20-30 minutes then post bolus the remaining 1/2. I had an adult Type 1 suggest i try bolusing 1/2 the amount and then just have her correct the spike.
    Chris mom to 4 daughters
    Ashleigh diagnosed Type 1 diabetes 3/23/10
    MDI-Tresiba and Novolog
    Dexcom g4 CGM
    Most recent A1C 6.0%



  6. #6

    Default

    oh her correction factor is correct for this time of day. We seem to only have issues with oatmeal. She can even eat cereal with no problems!
    Chris mom to 4 daughters
    Ashleigh diagnosed Type 1 diabetes 3/23/10
    MDI-Tresiba and Novolog
    Dexcom g4 CGM
    Most recent A1C 6.0%



  7. #7

    Default

    Since she has a cgm, can she just keep an eye on it during outmeal days and have a snack to ward off lows? Lots less work....Set the low alarm up to 100 and snack when it hits that if the IOB isn't worn off.
    8/2010 - 9/2011 MDI, Lantus & Humalog
    9/2011- Medtronic Revel 723 & CGM
    11/2012 - Dexcom G4
    2013 - Cut-The-Cord for water times after multiple Aquapac failures
    10/2015 - T-slim

    "Life is not waiting for the storms to pass, but learning to DANCE in the rain."

  8. #8
    Join Date
    Aug 2007
    Location
    Hamilton, Canada
    Posts
    9,621

    Default

    What about using a faster insulin (ie. Apridra)?
    ________________________________________
    Wilf

    Proud Dad of Amy (19), diagnosed Aug. 2006 and getting MDI of Apidra, Regular and Lantus..
    and Sylvie (15); very happy husband of Shirla!

  9. #9

    Default

    we may have to do the snacking. But i know she likes to avoid snacking in class if at all possible. Our insurance doesn't cover apidra. I actually went and looked at all the insulins they covered a month ago, because we were switching from Lantus to Tresiba and i wanted to see what all insulins were covered.
    Chris mom to 4 daughters
    Ashleigh diagnosed Type 1 diabetes 3/23/10
    MDI-Tresiba and Novolog
    Dexcom g4 CGM
    Most recent A1C 6.0%



  10. #10

    Default

    Have you tried just subtracting all fiber and dosing? The spike might be a bit higher, but it might avoid the low without adding in the complication of the sausage.
    8/2010 - 9/2011 MDI, Lantus & Humalog
    9/2011- Medtronic Revel 723 & CGM
    11/2012 - Dexcom G4
    2013 - Cut-The-Cord for water times after multiple Aquapac failures
    10/2015 - T-slim

    "Life is not waiting for the storms to pass, but learning to DANCE in the rain."

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