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Breakfast Spike Help Needed

Discussion in 'Parents of Children with Type 1' started by andiej, Nov 17, 2014.

  1. andiej

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    Hi. We are in the UK. My son is still honeymooning so the last 3 hba1c's have been very good, 6.2. A new product came on the market here a couple of weeks ago, the Freestyle Libre i'm not sure if any of you are familiar, any way it's not a CGM but gives us the same data pretty much, each time we scan the sensor it gives us a reading, the arrows and also a graph of the last 8 hours. Any way we knew there was a small spike after breakfast but this has shown us it's much bigger than we first thought. I'd really like to get it leveled out more. We have tried bolusing 20 minutes before breakfast but with no improvement. Does anyone have any further suggestions?
     
  2. Sarah Maddie's Mom

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    What's a typical breakfast?
     
  3. sszyszkiewicz

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    Andiej,

    We have/had same issue. It was this "aha" moment when we saw the trace on the CGM and we have been battling that spike ever since.

    For morning our carb ratio drops to 7 to 1. It normally is 10 to 1. Between that and 20-30 minute prebolus we can keep it less than 200 most days. Breakfast is typically betwen 70 and 90 carbs. Oatmeal and eggs is a typical breakfast.

    How do you like the Freestyle Libre?
     
  4. Nancy in VA

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    The breakfast spike is a problem for us too. I'm actually doing a basal test today to confirm that AM basal is correct.

    The other thing we did in the past is super-bolus. Emma would always come back into range eventually, which would tell us that the I:C is correct, but there would be a huge spike in the middle, which tell us the timing of the food and insulin was off. We started taking the amount of basal for 2 hours past breakfast (so if she ate at 8, we took the amount in the 8am and 9am basal program) and add it to the bolus for breakfast. We'd then turn off the basal for 2 hours. This allowed us to front load a bit more insulin to help with the spike. We haven't been doing it for a while but once I confirm the basal is right with a basal test, I intend to go back to superbolusing. Emma has protein every day for breakfast and can still spike to almost 300 easily. Evil breakfast and insulin resistance!
     
  5. andiej

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    We are loving the Libre, and it is eye opening to see what is really happening.

    Breakfast is usually a bowl of cereal, can be any one of a variety, or like this morning a croissant with butter. We still get the spike with the croissant but it's later than with the cereal, i tried using full fat milk yesterday and that did seem to help...might try the super bolus.
     
  6. Cheetah-cub

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    We too battled breakfast spikes for a long time, until someone mentioned that my daughter's bowl of cereal is like eating a bowl of fast acting sugar, and that is why her BG spike to 300's after the breakfast, but comes back down nicely to 100's by lunch time.

    Then we realized that my daughter's breakfast does not have enough fat and protein to slow down the sugar. So now, in addition to pre-bolus, she would also eat a stick of string cheese before her regular breakfast, and we found those spikes have flatten out quite a bit for us mostly, most of her spikes are in the 150-180 range now.

    She only eats cheese or nuts before low fat sugary breakfast, if she were to eat bagel with cream cheese, then there is no need for her to eat the cheese before the meal.

    Maybe try to feed your child a bit of fat and protein and see if that helps you guys too.
     
  7. GChick

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    First time hearing of the Libre.

    So, just a quick question, the sensor thingie, it is not "inserted" into the skin like a CGM, just is basically like a thick sticker on the skin (or am I misunderstanding?)? If so, I'd be into that. I appreciate the useful info that a CGM could give, but am not ready to make that step and do not like the idea of losing real estate to something other than my infusion sets and like the low profile of these sensors compared to what it looks like a CGM's sensor is (never seen one in real life).

    If it is something that is mearly "applied" I could prolly go for something like that, as alarms (something that it apparently doesn't do) and such are not something that would be overly important for me... the information however (arrows, past BG through the day, not having to do finger sticks quite as often), is.

    Hope they eventually bring it to the US (where I'd be able to get it... if they haven't already) or my country.
     
  8. andiej

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    The sensor is inserted under the skin, it's very small though. The main reason we have it is because CGM's need to be self funded in the UK and the libre is wayyyy cheaper...around £30 for the reader and £50 for a sensor that lasts 2 weeks instead of 1. My plan was to see if the alarms were important to us...and so far they are not but if we find more fluctuations over night then we will consider funding something like the Freestyle navigator or dexcom.

    I will try the adding protein and fat tomorrow!! thanks.
     
  9. GChick

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    Ah... I see. The words "non-invasive tech" and "The system consists of a little round sensor worn on the skin" that were one a site that I googled about it confused me I suppose.

    Truth be told though I did only skim the article, so it very well may have elaborated further down (http://www.diabetesmine.com/2014/09...ybrid-glucose-monitor-approved-in-europe.html)

    Thanks.

    <edit>
    Ok found this... seems a more accurate description than what I found before, and yeah, the "needle" bit does seem rather small. A little shorter than your average set cannula at +/-5mm.

    "The Abbott system includes a tiny glucose sensor (0.2 inches in length, about the thickness of a hair) worn under the skin connected to a water resistant on-body patch the size of a one-dollar coin. The sensor remains inserted for 14 days and does not require fingerstick calibrations (“factory calibrated”); after putting it on the upper arm and waiting one hour, it begins reading glucose and trend information."
     
    Last edited: Nov 17, 2014
  10. 321

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    For us it is impossible to halt the spike when having cereal of any kind.
    What we have been successful with is splitting breakfast carbs.
    If 1to 10 ratio then 4 units for 40 carbs, but only giving 30 carbs, then 10 carbs 3 hours later (snack)
    Please advise how you got freestyle libre, we were told it is not for under 18s yet
     
  11. wilf

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    The more lower glycemic index items you add to the breakfast, the smaller and later the spike.

    Fresh fruit, yoghurt, nuts, and whole milk are all great to add to cereal. Also, take a look at the kind of cereal and see if there's something your son will go for that has less and/or slower carbs. Additional breakfast items, like your croissant with butter (or brown toast) , can also help. If you're getting jams, look for the ones with maximum fruit and minimum sugar - they cost more but are worth every penny. :)
     
  12. Melissata

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    My daughter uses soy milk on cereal and it helps immensely to avoid spikes.
     
  13. dpr

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    My daughter is a chronic cereal eater. We spike into the mid to high 200's every day but comes back down in range. Her A1C is almost always below 7% so I just quit worrying about it. Bacon and eggs or protein and fat of some kind just aren't going to happen any time soon. The battle is just not worth it.
     
  14. rgcainmd

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    Same here!
     
  15. natallia

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    the only way we can REALLY eliminate the spike after breakfast, meaning keeping it in single digit and not compromising on food choices is to do the super bolus of 7-8 units of Apidra flat, at least 20 minutes before mealtime followed by mandatory uncovered "carby" snack 2-3 hours later to halt the drop. His breakfast consists of large bowl of hot cereal, sweetened with real (omg!) sugar, glass of juice and ALWAYS greek yogurt. To compare: Sam is 3 y.o, thin and and quite small for his age, requires 0.5 unit at lunch and 0.8 unit at supper to cover the same amount of carbs as for breakfast.

    We just ordered our Libre thru my family in Denmark, very exciting...It is sad and annoying that even their official website with Libre information and online shop is blocked from viewing in North America. If anyone is interested in checking it out, there is a way around the blocking by launching your browser thru that country proxy. Just google the instructions :)
     
  16. Phyllis

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    Breakfast Spike prevention

    We had a good response to changing from skim milk to 2% or whole milk on our grandson's cereal. We also have selected low sugar whole grain cereals such as Cheerios and give him free access to Splenda or generic sucralose on his cereal. The fat in the milk slows down the digestion. Other options are eggs and whole grain toast with 2%milk and a serving of juice or fruit. We limit OJ to 4oz. You are smart to look at these spikes and try to respond. If these dietary changes do not do the trick, you may want to talk to your provider about his insulin to carb ratio at breakfast.
     
  17. Lakeman

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    You could check to see if there is an increase in BG when she eats nothing at all. If so then more insulin is needed but not to cover the carbs but to cover the expected rise which may be dawn phenomena.

    For us things that helped: prebolus 20 minutes, switch to full fat milk, do the largest bolus we can get away with without causing lows within three hours, include a correction in the breakfast bolus, make that correction even larger if she is high going into breakfast. I also find that if she goes high before breakfast begins and has had a correction in the last few hours the spike after breakfast is lower or non-existent.
     
  18. GChick

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    A bit of a "kid at heart" food-wise myself when it comes to breakfast and I loves me some cereal every now and again.... and though I try to be more adult these days, I still cant help but have a nice bowl of super-sweet cereal sometimes.

    I never fussed too much about the spike after cereal before the pump and just let it happen... but with the pump have lately been experimenting with a new technique that has so far appeared to work (have only tried it about two or three times). While you might try some of the ideas, I'd be MUCH more conservative if I were you with the numbers/quantity extra etc. until you get it figured out as I went a bit low the first time I tried it with different numbers and different lengths of time.

    My "technique":
    Double the amount of insulin for the serving size of carbs listed on box/milk etc. and pre-bolus a minimum of 20 minutes (assuming you are above 80 at the time).
    Depending on what the bg is at time of pre-bolus (don't wanna go too low too fast) either start a temp basal of 15% higher than normal then or wait till right before the first bite of food is in mouth. Set temp basal from anywhere of 30 min to 1 hour (I personally landed at 45 min looking like a good time frame for me)

    Doubling the amount of insulin for listed carbs may be too drastic for you. 15% extra basal may be too much/too little. An increased extended bolus may accomplish the same thing as my new technique, however I find the math to be too involved for my morning brain (double carbs, plus 15% of basal), and think this is simpler.
     

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