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Advice on post-lunch BG's at school

Discussion in 'Parents of Children with Type 1' started by azdrews, Sep 10, 2011.

  1. azdrews

    azdrews Approved members

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    I've been pulling my hair out for the last week trying to figure out what to do...maybe I could get some advice from y'all!

    Adam is in Kindergarten (doing great! totally supportive school/nurse) and his numbers have been really good, except for the last week or so, his BG's have been in the low 60's at his 2 hour post-lunch check. On Friday, after I had changed his lunch I:C ratio from 1:20 to 1:22, he was in the 50's!

    The previous week, I had dialed back his basals in the afternoon to see if that would help, but it obviously didn't.

    Here are a few variables:

    Before lunch at 10:45am, his BG is usually around 115 or so - he then eats lunch, and is bolused for what he eats at around 11:20pm.

    He does go out to recess after lunch for about 20 minutes. **I'm thinking this may be the culprit** but it wasn't an issue the first few weeks of school.

    By 1pm, he's been low. Should I forget changing his lunch I:C ratios and perhaps have them bolus for HALF of his lunch carbs? And again...it depends on how active he is at recess, but from what I'm gathering, he's really active! :rolleyes:

    Ideas?
     
  2. SFGingerBeerSoda

    SFGingerBeerSoda Approved members

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    I think you are on to something.... There is definitely a connection to insulin uptake and activity. Having playtime after lunch will certainly have an impact. Every child is different but my DD carb count has gone from 25:1 at lunch this summer to 30:1. I have been slowly adjusting it over the past week :)
     
  3. Tricia22

    Tricia22 Approved members

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    I think so that less math and thinking is involved for the school staff, the easiest would probably be to do one or both of these: keep chaging the lunchtime I:C and / or lower the lunch-time-ish basal - until things start working for that time period.
    Many, if not all pumps let you do different basal profiles for weekdays vs. weekends, etc.
    I was just thinking so that there's as little chance for error as possible, rather than having the staff count all carbs, cut that number in half, input number into pump which does the calculation - why not have them just count all carbs and input THAT one counted number into the pump, let the pump do the ONLY calculation and you'll be good.
    He's in kindergarten, and waiting for this to be done to be able to go to recess, yes? In my experiences - kids aren't very patient when waiting to go play... lol I would think there would be the potential for distractions at that time,and the fewer steps / calculations, the less chance of user error...
     
  4. manda81

    manda81 Approved members

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    We had the same problem. We ended up changing his lunch bolus (on school days only) to 1:26 (we also started where you are, and we worked up to this number).

    We have pe & recess both after lunch, so first we changed that, and then to combat the lows later from all the activity we had to drop one 2 hour segment of basal to .05 (from like 10am-12noon) ... and *knock on wood* for one week now, this has worked, and he's stayed relatively flat through the pre-lunch check to the dismissal check.

    Good luck!
     
  5. ashleesmommy

    ashleesmommy Approved members

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    We've been having a similar issue. My DD has PE first thing in the morning. They have a snack an hour before lunch, which kinda complicated things! She also has recess after lunch. By the time school gets out she had been trending low. We've bumped up her ICR for lunch several times, and Friday was finally a really good day! Im betting its from the recess and activity thats bringing them down. I would have changed her basal rate 2 hours before the time she was dropping, but hers was already at 0.05. The increase in ICR seemed to work. Hope you can get it worked out!
     
  6. hawkeyegirl

    hawkeyegirl Approved members

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    I've found that when we require a different lunch ratio at school because of recess or PE or whatever that it's actually easier to just tell the nurse to not count X number of carbs for that meal and dose him for the rest. Otherwise I've got a different lunch ratio at school than at home, and invariably I forget to change it back for the weekend or a holiday and then I wonder why I'm looking at a 350 mid-afternoon.

    Just a thought....
     
  7. azdrews

    azdrews Approved members

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    Thanks for the advice! I'm glad to know we're not the only ones dealing with the same thing. I think I may change his I:C ratios for lunch again so that the pump does the work - our nurse is awesome, but the health assistant has a little more trouble calculating everything and I want to make it easier for her.
     
  8. danielsmom

    danielsmom Approved members

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    Daniel hasn't been at school long enough...yet to see if we will have to adjust.. He is 1:30 round the board....but this week he will start P. E. On Mondays after school starts and Fridays after lunch...If I see he drops after that I will reduce his insulin those two days for lunch and breakfast.....
     
  9. cm4kelly

    cm4kelly Approved members

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    My four year old

    In my four-year-old at school, I have found that active recess can often be the culprit.

    Here is what my nurse does. The snack (or lunch) BEFORE he goes to recess - she subtracts 5 carbs from his carbs eaten. For instance, if his lunch is 45 carbs, she boluses for only 40. The extra 5 totally helps him stay in range while he is running and playing.

    However, on days when it is raining and no recess is planned, the nurse will NOT give the free five carbs. See if something like this would help on recess days.
     

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