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bolusing for oatmeal..

Discussion in 'Parents of Children with Type 1' started by mom24grlz, Mar 14, 2017.

  1. mom24grlz

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    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.
     
  2. MomofSweetOne

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    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: Mar 14, 2017
  3. mom24grlz

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    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.
     
  4. MomofSweetOne

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    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.
     
  5. mom24grlz

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    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.
     
  6. mom24grlz

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    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!
     
  7. MomofSweetOne

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    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. wilf

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    What about using a faster insulin (ie. Apridra)?
     
  9. mom24grlz

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    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.
     
  10. MomofSweetOne

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    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.
     
  11. mom24grlz

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    Yes, yesterday i subtracted all fiber. She dropped to 58. I think im going to try splitting the bolus next time.
     
  12. wilf

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    Other possibility is splitting the breakfast - have her eat half, and the other half about 30 minutes later..
     
  13. Ali

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    You dropped the ratio once, try reducing more along with the fiber subtraction and no pre bolus. Ideally try one change at a time:) The split dose will probably give you the best spike coverage and reduce the low later but it is tricky. Did you check with your diabetes team? They might have some ideas after viewing your cgms data. Good luck.
     
  14. MomofSweetOne

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    Could the given carb counts be off for the oatmeal? Could you start decreasing the carb count given until you find what works?

    Isn't it insane the things we do just to make life semi-normal that most people have no idea of? That if we do our work well, it looks so easy to outsiders, but behind the scenes, we're wracking our brains to solve things to make life better for our kids as we try to help them imitate the function of an organ that is impacted by so, so many factors?!?!
     
  15. mom24grlz

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    Wilf=Other possibility is splitting the breakfast - have her eat half, and the other half about 30 minutes later..


    You mean splitting the actual food or splitting the insulin? I did think about splitting the insulin (though not sure how percentage wise it should be split) but i thought part before she eats and the other after. We really don't have time (unless it's a weekend) to split the food. She eats at 7:00AM and has to leave by 7:15AM for school. She normally gets up around 6:00AM to get a shower and get dressed.

    Ali-
    You dropped the ratio once, try reducing more along with the fiber subtraction and no pre bolus.

    I'll try. The last time i did the no prebolus, subtracted fiber but kept the 1:7 ratio. I think i need to try this on a day where she does not need a corrective bolus. The last time her BG was 181 so she did a correction in addition to the bolus for the oatmeal.


    Ali-The split dose will probably give you the best spike coverage and reduce the low later but it is trick

    Yes. Not sure what kind of split would work? 50/50, 60/40, 30/70?? I did get the suggestion to bolus 1/2 the amount and then just have her correct the spike. Or to replace 1/2 the oatmeal with almond flour or ground flaxseed so it's not as carby.

    Ali-
    Did you check with your diabetes team?

    No we haven't. We're pretty independent in diabetes care, and mainly use them just to get prescriptions. Plus with Ashleigh being 18, not sure if they can still give me advice or she has to actually contact them. We recently switched to a new office (in Oct) and still haven't met the endocrinologist. The last 2 appointments were with the CNP. She's supposed to have her first appointment with the endo in May.

    momofsweetone-
    Could the given carb counts be off for the oatmeal

    This actually did cross my mind, that the carb count was off on the box. It says 1 packet is 32 carbs (she normally eats 2 packets) Dietary fiber 3g, Soluble fiber 1g

    momofsweetone-
    Isn't it insane the things we do just to make life semi-normal that most people have no idea of? That if we do our work well, it looks so easy to outsiders, but behind the scenes, we're wracking our brains to solve things to make life better for our kids as we try to help them imitate the function of an organ that is impacted by so, so many factors?!?!

    Amen! you said it!
     
  16. Ali

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    Mom24grlz
    I never use my team for details like this:) but I was hoping your daughter might have one of those super great teams. I have used a pump for a long time and so can not offer any advice on splitting the dose, sorry. Hopping Wilf chimes in as he has always been really knowledgeable about MDI. Yes trying these ideas without a correction bolus or a major low in the 12 hours prior can really help clarify what is going on. Of course there are always all the other unknowns, hormones, exercise, stress etc:):). I used to always have to eat a snack on any of the insulins at the 2 1/2 to 3 hour mark no matter what I ate if I wanted a reasonable spike without going low, I switched to Apidra to get the spike coverage without the low.
     
  17. mom24grlz

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    oh yeah and i forgot to mention that on the day we did the oatmeal, she started her period a couple hours later! And she does tend to have lows for at least 24-48 hours after she first starts.
     
  18. wilf

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    I did mean splitting the food - have half before and half after her shower.. :cwds:
     
  19. mom24grlz

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    yeah i don't think she'd go for that LOL! i'd have to wake her up at 5 something to eat before her shower. I don't even want to be up that early!
     
  20. Ali

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    If she only dislikes snacking during class have her snack when she has a chance before, i.e. on her way to the class to bump her numbers up before the tail hits. She might not be dropping yet but looking at her data you should be able to figure out when it happens and what type of snack will carry her through the 60 to 90 minutes of dropping. Sorry, I think your choices may be figuring out a split dose or snacking.
     

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