- advertisement -

after breakfast numbers

Discussion in 'Parents of Children with Type 1' started by wvchinacat, Sep 30, 2008.

  1. wvchinacat

    wvchinacat Approved members

    Joined:
    Jul 23, 2008
    Messages:
    957
    Ok - this is one for those of you who like all the number calculations . . .For the last 4 weeks we have been on the following schedule - 1 u humalog at Break)7:30a), .5 unit at lunch, dinnner and 3 lantus at bed. With a correction factor of 1/2 u for every 50>150 BS. In the past 2 weeks about an 2hrs after breakfast she is running in the high 200 and 300's (296, 314, 321) anyhow - way to high for my comfort. A couple of the days the teacher called and I told her to recheck in 1/2 hour and if not down under 250 to call me and I would come and administer some insulin. The one day is was 399 (9:30a)- I came immed. and gave 1/2 unit and at 11:00 280 she was by lunch (11:30)she was 250 and the nurse gave her 1 unit. By gym 1.5 hrs later she was 105 and they gave her 4 oz juice before ggoing to gym. She was 78 when she got off the bus at 3:30.

    So for all you pattern watchers and calculators out there (wilf) - what do you make of this. This is typical of most days at school. My insulin is new - (actually the schools needs to be changed) - I realize I could have corrected with more than .5 unit but am so afraid of her having lows at school.

    I did change her morning insulin at breakfast to 1.5 units - we are NOT currently counting carbs - only using the sliding scale and correction for high BS. But we started this yesterday and her 9:30 am numbers were still in the 200s. (not as high)

    Thanks
     
  2. cassie

    cassie Approved members

    Joined:
    Sep 12, 2008
    Messages:
    51
    Is she getting protein with breakfast? If we don't add peanut butter, eggs, etc then Megan's numbers do about the same thing.
     
  3. wvchinacat

    wvchinacat Approved members

    Joined:
    Jul 23, 2008
    Messages:
    957
    I try to add protein to her daily diet. But she is not a protein eater much at all. She will sometimes eat bacon - but no PB in the morning. There are PB allergies at school - so she has to be really careful about what snacks she can bring. Usually our breakfast consists of oatmeal with 1/2 and 1/2 and 1/2 tbsp of syrup. I know - I konw. I do add cinnamon and milled flax seed to the oatmeal. If we do not do oatmeal - she has a bowl of cereal - fiber one or cheerios. Those are about the only ones she will eat. She always has an additional cup of milk. She refuses eggs - unless in french toast form . . .LOL

    It is so hard to get her to eat anything. Then for lunch she will eat ham or turk lunch meat (no bread - go figure), and a slice of cheese. Then usually a granola bar or something.

    Ok - so add some protein. I'll try tomorrow . . . hmmm maybe I can get her to do PB toast before a bowl of cereal . . .It will take some coaxing! BF is really our easiest meal . . .she is such a picky eater - ugghhh

    Vicki
     
  4. MontereyMama

    MontereyMama New Member

    Joined:
    Aug 22, 2007
    Messages:
    3
    I deal with the same thing with my daughter because of the 'dawn effect' something about those growth hormones that kick in around 5-6am compacted with those highly processed cereals/fruit and an empty stomach. She's on a pump, but you could easily do something with the injections.

    I test her at 6am and I give her her insulin for breakfast then (as long as she's above 80). She doesn't start eating for 30-40 or so minutes. So she gets dressed, torments her brother, etc...then sits down to eat. Her insulin is good and working for that first spoonful of cereal and those grapes.

    If I don't do this, she's in the high 200s low 300s during the mid-morning.

    Another idea is to try a food that's a little slower to digest - ie steel cut oatmeal - not the instant stuff, that should level her off. I asked the endo. about changing to whole milk/adding protein to slow down the digestion process. She suggested that our kids have enough health problems as it is and why switch out the fat and cholesterol for the blood sugars. One good suggestion was to sprinkle some nuts (almonds, walnuts) on top of the cereal for added protein and good healthy fats.

    I'm also always concerned about early morning severe lows with a seizure that could cause her to shoot way up by mid-morning if I didn't catch it. Hasn't happened yet to my knowledge, but you never know.

    There's also something called the superbolus, you can google that - where you basically front load the breakfast insulin combined with the basal/background insulin all at breakfast time and then cut the background insulin for the few hours after breakfast. I haven't tried that, though. I want to wait for a vacation day. And that's probably not an option for you right now.

    Well, good luck! I hate mid-morning highs. It's taken some experimentation to get to a place where I'm satisfied with it...Until she hits another growth spurt.

    :cwds:
     
  5. wvchinacat

    wvchinacat Approved members

    Joined:
    Jul 23, 2008
    Messages:
    957
    I sent her to school on eggs and toast and I give her insulin usually 1/2 hr before she eats. She woke up at 85 - that was at 7:30 when we checked - but I had not heard about the earlier morning lows (seizure thing you spoke of). Hmmm . . . I sure hope that is not happening . . .

    I also sent a note to the teacher to let her know that I changed up her meal this morning and to check her frequently.

    I'll update this afternoon
    Vicki
     
  6. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Ok, so her TDD is probably around 6 units. She's been getting 5, but it sounds like she needs a little more.

    With a TDD of around 5-6, her Correction Factor would be 1800/5 or 1800/6, that is one unit of insulin should bring her down between 300 and 350 mg/dl. I would have your endo check her sliding scale, as it seems to me that she is at risk of going low on that scale.

    Certainly if you're giving corrections, do NOT give more than 1 correction every 4 hours or you risk insulin stacking. That is what happened on the day she needed juice to treat her low and still came home at 78 - you corrected with 1/2 unit and then the nurse corrected too (even though she had a good deal of your correction still working).

    Overall, what it looks like is that she is spiking after breakfast. Key question - is she back in range by lunch? If she is, then it is just the timing of the breakfast bolus that you need to adjust, by prebolusing. If she is still high at lunch she needs more breakfast bolus.

    Finally, do you measure at night? If not, I'd look at doing a night's worth of testing (at her bedtime, your bedtime, 3 am and 5 am) just to make sure she's not having night lows. There is an outside chance that night lows followed by rebounds are what is causing the high morning numbers.

    Lots to chew on here.. Good luck! :)
     
  7. wvchinacat

    wvchinacat Approved members

    Joined:
    Jul 23, 2008
    Messages:
    957
    I did move her morning bolus to 1/2 hour earlier - but maybe you are right - I need to move it even further - like at 7:00 am. HOnestly - I do not really check thru out the night - but I will for the next few nights to see if I notice any patterns. Since we are not in the real initial phases - I have not emailed the endo all this - but I will prob. this week. About the insulin stacking - exactly how does that work? And why does it sometimes seem like the insulin at lunch works right away but the morning insulin takes longer. And to your morning dose suggestion - are you suggesting that possibly she is having early morning lows and then her body is shooting out some glucose to recover that? I am trying to understand. I did not think she still had that function. Oh - so that is why I would test early morn - like 3 am and 5 am - wow - I'm gonna be tired the next few day!! LOL

    Our typical day (school) is wake at 7:15 - bolus at 7:30, breakfast, then off to school at 8:15, morn snack (in class) 9:30, and lunch at 11:30, school out at 2:50 and dinnner at 6:00. Weekends are altogether off that schedule and we let her sleep in - but I usually check her about 7:00ish to make sure she is not low and then let her sleep until and then do her insulin around her BS - that is probably not good - but it lets her have a couple of days of not so strict everything!!

    Thanks wilf - and btw - how did you figure out her #s With a TDD of around 5-6, her Correction Factor would be 1800/5 or 1800/6, that is one unit of insulin should bring her down between 300 and 350 mg/dl. I would have your endo check her sliding scale, as it seems to me that she is at risk of going low on that scale. I need a course in that altogether! LOL
     
  8. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Well, lots of questions to answer and comments to make:

    1) How long before breakfast is she getting her bolus? At our end I measure DD while she is still in bed, and give her her bolus right then. She then has breakfast about 20-30 minutes later, which is what you want to be shooting for..

    Do NOT wake her earlier just to give her the bolus, better would be to give bolus at waking at 7:15, and breakfast at 7:45.

    2) Her body will always have some ability to counteract lows by producing various hormones to raise BG levels and reduce insulin sensitivity - so if you see stubborn highs, always try to rule out the possibility that they're being caused by an earlier low and then rebound.

    3) Insulin stacking occurs if you give a second correction before the first has finished working. The Humalog you are using takes around 4 hours before it is done working. So on the day in question you corrected the 399 with 1/2 unit at 9:30 am, and then 2 hours later at lunch (11:30 am) the nurse gave 1 unit (1/2 unit bolus and 1/2 unit correction, if I understand your original post correctly). So the nurse's correction was given based on BG 2 hours after you corrected, even though BG would have kept going down from your correction all by itself (likely to under 200).

    4) No need to measure a bunch of nights - just 1 night to make sure there are no low issues.

    5) Now that you've had a chance to catch your breath after the initial diagnosis, there are some equations you can learn to make managing the D easier. They are all clearly presented in a book called Using Insulin by John Walsh. You want to get that.. :)

    6) The equation I used to calculate the Correction Factor is the Rule of 1800, an empirical equation developed by observing the BG response of thousands of D patients to corrections.

    The equation is as follows:

    Correction Factor = 1800/TDD, where TDD is the total daily dose of insulin, in your case 5 to 6 units.

    So for my daughter (who has a TDD of around 30), her Correction factor is 1800/30 = 60. One unit brings her BG down by 60 units. In your case, with a much lower TDD the Correction Factor is much higher.
     
  9. wvchinacat

    wvchinacat Approved members

    Joined:
    Jul 23, 2008
    Messages:
    957
    Thanks - that was really helpful - we are going to do the night watch tonight - I'll update tomorrow. This morning (not the one I originally posted about) I gave a high protein /lower carb - she was not all that happy - but ate it anyway. - and her numbers were all over the place - according to teachers log book. and she tested 5 times while at school today - the lowest being 68 and the highest being 235.

    I was telling my DH about this 1800 rule and the testing at night to see if she is having lows that is causing her body to shoot out some of its own glucose. Being diabetic himself - he said he had never heard of this. Is this more common in children - or does this dawn phenom. happen in adults too? Just wondering. He also wondered if taking her lantus in the morning might be more beneficial than taking at night . . .

    Oh and one more thing - when she is having before bed lows - do you continue to give her lantus as scheduled. Tonight for instance she is just now coming up from a 54 and I am getting ready to test again before giving lantus. I am alwasy tooo afraid to give when her BS is lower than 130

    Vicki
     
  10. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Some responses:

    1) From experimenting at this end, we found our preferred time for Lantus is mid-afternoon when DD gets home from school. That way any peak (with resulting low BG levels) happens while we're awake to deal with it.

    2) I really think it's time to think about starting to count carbs, and then learning about giving the insulin she needs to cover them. It is a more accurate way of doing things, and you'll need to be doing this once she's done honeymooning anyways. Might as well get started before then..

    3) The body's defence to lows (producing various hormones to drive up BG levels and reduce insulin sensitity) is strongest in those most recently diagnosed, but my understanding is that it present to some degree in all people with Type 1 D. But if the person is having frequent lows, that can temporarily exhaust the body's capacity to do this.

    4) Note that the body's defence against lows (which is triggered by a low at any time of day) is not the same as the Dawn Phenomenon. The Dawn Phenomenon is the tendency seen in many people with D for their BG levels to start rising by themselves as dawn approaches.

    5) You always want to give her her Lantus at the scheduled time. If she is low before bed, you want to treat the low by giving carbs to get her up to your bed-time range (which should probably be at least 120-130 or so).

    I really think it's worth you doing some reading. I can recommend Type 1 Diabetes by Ragnar Hanas, as well as Using Insulin by John Walsh. The concepts I am trying to explain with these brief posts are covered in excellent detail in these books. :)
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice