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Cereal - how would you do this differently

Discussion in 'Parents of Children with Type 1' started by mandapanda1980, Dec 27, 2011.

  1. mandapanda1980

    mandapanda1980 Approved members

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    Yesterday dd was 89 at wake up. We had 1 bowl of cereal and a slice if toast. I boluses her as follows

    Gave her 55 carbs(40 for the food and upon a suggestion I gave her 15 extra carbs free.)
    Then I did a temp basal of 150% for 1 hr.

    She went as high as 300, then next check she was 216, then at lunch she was 69. So a little low, but 1 starburst brought her up to 112. Was good from then on.

    There was no corrections given at any time

    How can I bolus her and try to get her in range faster? Without the 300 jump.
     
  2. Charliesmom

    Charliesmom Approved members

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    This is probably a silly question but have you tried different kinds of cereal? For example my son can eat regular cheerios but honey nut cheerios is difficult.
     
  3. Brenda

    Brenda Junior Member

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    A couple of questions: did you measure the cereal to make sure you had the suggested serving size or "eyeball it?" Did you give her insulin BEFORE she started eating? Realizing that you consider 89 low (given her age and when dx'd), don't give her 15g carbs "free." I don't know what you have been instructed to do, but maybe if you give her only 5g free for BGs in the 75-90 range (this is part of the "normal" range for people) you will not see such a big jump. I think a cereal breakfast is one of the harder things to get right, i.e., not see a post-meal high. As I recall, a sugary cereal is the worst, a high fiber cereal better. If you try giving insulin earlier, increase the fiber and reduce the "free" carbs, you should see lower BGs. If you really want to see lower post-breakfast BGs, you could provide a low carb, high protein breakfast (eggs, bacon--turkey or reg., etc.). Of course, I know that cooking a breakfast like that is not always feasible!
     
  4. wilf

    wilf Approved members

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    Do you pre-bolus (give the insulin before the meal)? If not then it may be time to start..
     
  5. mandapanda1980

    mandapanda1980 Approved members

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    Yes we pre bolus. Always have.

    I didn't give the 15 carbs free because I thought she was low..it was a suggestion from a friend to give extra carbs just as a way to give extra insulin...like she is eating the extra carbs but not really, basically it gives her 1 extra unit. Sounds weird I know but they swore it worked for them. thought I would give it a try. Probably the reason she went down to 69. Today I did not give extra carbs.

    I have her down to a science on how many carbs raise her bg, if I gave her 15 free carbs out would be disastrous lol

    I could do different meals, that is not the problem, I am just trying to solve the cereal spike. Trying out different ways. So far that was our best, most days need a correction.

    We try all kinds if cereal, most react the same way. Even fiber plus.

    Today I tried just a temp basal increase for 1 hour.

    I hope I am making sense
     
  6. JaxDad

    JaxDad Approved members

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    I was also confused by the "free 15g of carbs" and understood it to be unbolused but now I think I understand what you did. You gave her more total insulin by including the bread, hoping that would help avoid the spike because bread is not something that would spike her.

    I am thinking that a pre super bolus followed by a temp lowered basal would be more likely to keep the spike down and avoid the low. This is just analytical thinking, as we don't have this issue with cereal.
     
  7. mandapanda1980

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    I have tried a super bolus before. One time I gave get 1 hrs worth of basal with her breakfast bolus, then turned basal off for one hour. She went up to 250 ish, and needed a direction to bring her down st lunch. I tried another day, this time she requested two bowls, do the amt of cereal was more, but I gave 2 hrs of basal with her breakfast bolus, and forgot to turn off basal. Oops. She had the same effect, went up to around 270 with a correction needed.

    How would you suggest doing this?
     
  8. danismom79

    danismom79 Approved members

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    How far ahead did you prebolus? I bolus my daughter upon waking, which is at least 30 minutes before breakfast, and often closer to 45 minutes. I tend to get the same cereals over and over (yes, the sugary ones), so I have an idea of how many carbs she'll get.
     
  9. JaxDad

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    Hmm, in working through this I first have a couple of questions.
    I didn't see the starting BGs for the other attempts. Were they also around the 89? In other words, I usually chart for a food, starting BG, Starting BG correction if any, 2 Hr BG difference, then difference at 3 hrs, 4 hrs, etc. Since I don't have CGM we meter like mad when trying to chart a new or challenging food. Sometimes at 1 hour after eating too, but not much.

    I just noticed Amanda is 5 (sorry for not noticing or knowing) so I'm assuming that her basal rates are pretty small and the amount of insulin in a super bolus may not make that much difference. Maybe a different IC ratio is required?

    If Amanda were Jack, I would approach this normal bolus challenge in this way: shoot for a 2 hour Bg of around 160-180 using more total insulin and/or a longer delay before eating. Delayed eating is hard at my house and we try to avoid it if possible. So I would start with adding about 1/2 the amount of whatever a correction would be for a 100 pt drop and add more insulin from there trying to get the 270 to about 170.

    I'd look to see also whether he goes low later and do a temp lowered basal or no basal, starting at the time of initial bolus (we don't do any, "planned corrections" after meals - my memory isn't that good) to try and avoid the late low. If we can't avoid the late low, then you have no choice but to shoot for a higher 2 hr number, and work from there.

    Good luck.
     
  10. StillMamamia

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    How about splitting the bolus - one prebolus and one after she finishes eating? Hopefully the second bolus peak will coincide with the cereal spike and curb it somewhat. Perhaps a bigger prebolus compared to the second bolus, which will be acting as a buffer only. Have to see what pre-meal BG is though, so don't prebolus too much ahead of time if at the lower end of your range.
     
  11. mandapanda1980

    mandapanda1980 Approved members

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    I may try this tomorrow. Thanks!

    And thanks to the other responses as well. Today I attempted just a temp basal of 175% and it was way worse. Ask the way up to 390, then I corrected and prebolused for lunch to help bring it down. Took an hour to get into range even with the lunch bolus.

    Try again tomorrow :rolleyes:
     
  12. Lovemyboys

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    Sometimes if I want a "good" prebolus and my sons bg is in the lower range I'll go ahead a prebolus and then give 2 or 3 grapes (he's only 2), then wait the 10-15 minutes. Something else we do is to add sausage or other protein and fat to the breakfast meal. Cereal is a hard one, in fact we've stopped eating it for the most part.
     
  13. virgo39

    virgo39 Approved members

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    Do you use the same I:C ratio for breakfast and lunch?

    Our DD was dx'd at age 5 (also in November) and we wound up using a much more aggressive I:C ratio for breakfast (1:25, when other meals were 1:50).

    We also prebolus at least 30 g. for breakfast by 20-30 minutes.
     
  14. emm142

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    I prebolus by 20 minutes and superbolus with 2 hours of basal and it's working well right now.
     
  15. mandapanda1980

    mandapanda1980 Approved members

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    So today was an epic fail. 143 wake up bg. Pre bolus 25 min.
    At 2 hr check 292. 3 hr 415. Correction needed.

    I did a super bolus, gave her all of her carbs up front plus 2 hrs basal. After she was done eating I turned off the basal for 2 hrs.

    Boo
     
  16. emm142

    emm142 Approved members

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    I wouldn't actually look at this as a failure. It looks to me like you've stopped the spike, just ended up with a flat high instead. If I saw this kind of pattern, I'd consider giving 2 hours of basal along with the bolus, but then only turning basal down to 50%. So she ends up getting more insulin overall, but should still stay flatter. Make any sense?
     
  17. StacyMM

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    We have never found a good insulin plan for cereal. What we do is pair it with a higher fat protein and do as much of a pre-bolus as we can. With a 15 minute lead and enough pepperoni, the spike is lessened and we are still okay until lunch. Oh, and my daughter loves pepperoni before cereal - didn't want anyone to think I force her to sprinkle pepperoni on her bowl of cereal :p My preference is no cereal, of course, but it does happen just because it's so convenient.
     
  18. danismom79

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    I've never gotten a superbolus to work.
     
  19. Style mom

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    Ditto. They're disasterous for us.
     
    Last edited: Dec 30, 2011
  20. Gwyn

    Gwyn Approved members

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    Does your extra 15 carbs have to be toast? We find adding fruit or protein to be a better mix. Toast is not that much different than cereal really--most grain.

    10 carbs of apple slices and a handfull of nuts or extra milk could be your answer.
     

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