- advertisement -

How can you tell how carbs will affect BS?

Discussion in 'Parents of Children with Type 1' started by steph, Jul 27, 2012.

  1. steph

    steph Approved members

    Joined:
    May 1, 2012
    Messages:
    177
    I hope this isn't a completely ignorant question, but how do you tell how many points on average a certain number of carbs will raise blood sugar? It seems like depending on the time of day, the activity level and which way the blood sugar is trending would affect how much the BS went up. This morning we were running late, DD's BS was 95, and I gave her a small 10 carb uncovered breakfast bc lunch was only in 2 hrs. but by lunch time she was at 390. but then at snack time she can have a BS of 150 or more and have 10 carbs, and then by dinner she's low. So is there a way to figure it out more precisely? Or does it just vary... for example I might treat a low at 7am with 5 carbs and a low at 7pm with 10? the same goes for a corection. sometimes 1/2 unit will drop her 200 pts, sometimes its closer to 50. I feel like it's a total crap shoot sometimes. Is it just because she is still so little, or am i missing something?
     
  2. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    Does your daughter pump, or is she on MDI?
     
  3. steph

    steph Approved members

    Joined:
    May 1, 2012
    Messages:
    177
    mdi, lantus and novolog. ICR 1/20 at breakfast and 1/40 lunch and dinner. 1.5u lantus given in morning. i suppose i should add that to my signature.

    she had a crazy month, but her numbers are back to mostly in range. but i can't seem to get a handle on corrections or how much to allow for uncovered snacks. usually we do 5-10 carbs for uncovered snacks. and 10 carbs to correct a low. mostly that's good, but sometimes it's too much.
     
  4. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    The reason I asked is that on Lantus, your basal is never going to be exactly right. You're supposed to determine the proper Lantus dosage by setting at the dose where your child doesn't rise or fall more than 30 points from the bedtime number. So during the day, you are going to see time periods where your Lantus dosage is either too high or too low, and therefore your child will drift up or down on their own. So carbs given at different times of the day will affect BG differently.

    It's the reason why corrections work different at different times of the day for you too.
     
  5. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    Well, the standard answer is because she's got diabetes! :p:)

    Selah was 17 months, she's almost 6 now (happy, healthy, and loud!) so I can tell you yes, much of it is because she is so small. That's not to say there's nothing else going on. The variation you see will be based on something, but it will be so exaggerated by her size that it makes a lot of smoke to see through! Some folks log diligently and really work hard on the numbers. I found (and I don't know if it was because she was so small or because of my own style or limitations) that I needed to "feel it out", kind of get a gut feeling for things, and then double check my gut with the numbers and logs (and a good CDE when I could find one).

    A few factors.

    Yes, Lantus peaks (and valley's, I think). We always found that Selah needs more Lantus at night during the day, so that with one shot of Lantus per day you usually wind up "feeding" the insulin a little during the day. That's all right, it can work well. When Selah was little, Lantus would peak at three to five hours after the injection (meaning she would go low then), it curves differently now.

    Most folks find their kids have a breakfast spike. I have never seen a satisfactory explanation, I don't know if the kid puts out more basal glucose (my suspicion) or just has more resistance to the insulin. It doesn't help that breakfast food tends to be carby. But mornings will usually need more insulin for the meal (as you see) and often for corrections, too.

    I think for some tiny ones insulin lasts longer than it "should". So for humalog, that stays in the system of some folks here a couple or three hours and is supposed to last 4 or 5 hours, for Selah I think there's still significant action by 6 hours. So the insulin you give at breakfast may be "helping" her at lunch, and lunch at dinner. Have no idea if that's the case for you, but what you see if that is the case is overlapping insulin dosages, called "stacking", and there's really no way to avoid it, just work with it. But it may explain some of what you see.

    Activity can really kick up insulin sensitivity, too, particularly in a small kid. When Selah was that little and went swimming -- the combo of cold, adrenaline, and exercise had an amazing effect on her! Sometimes she went low, sometimes high, often both! Toddlers have such varied routines, they can spend hours sitting still (well, never still, but you know!) and then hours running in circles. Ya just roll with it!

    We tend to run off 1 carb raising Selah's bg by 10 points. Here's the problem, though. Let's take three scenarios in which I "catch" her bg at 70. In the first scenario, her insulin is almost gone or is matching well with food still entering the system (digestion peaks at 2 hours, usually) so her 70 is steady. I give her five grapes. She comes up to 120. In another scenario she is 70, but she is already moving up (and in toddlers, boy they can move up FAST!!). Without carbs, she'd have moved up to 150 in half an hour, so when I give her five grapes she's 200. Scenario three, she's 70 but dropping like a brick. I give her 5 grapes and now she's 60 fifteen minutes later! But what I need to remember is that without those grapes she might have been 10 (not really, her body probably would have kicked in carbs, but in theory).

    I think this last is probably what you are seeing most.

    I strongly suggest you look into a CGM, it's an imperfect tool in a toddler but it can really help. Small bodies react so strongly to the least amount of insulin and the tiniest amount of food, it's just so darned hard to track through bg tests!

    Good luck, and please ignore anything that is unhelpful or that you already know in full!
     
  6. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    And all of what Lisa said too, LOL.
     
  7. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380
    Oh, there are ways to "test" carb sensitivity, correction factors, all that, I think you can find them in "Using Insulin". I may have simply been test challenged, I never found those formulas to consistently apply to us, toddlers are their own animal, but they may work for you.
     
  8. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    The problem with those "tests" is that everything else has to be perfect in order to get an accurate outcome from the tests. I don't know about you, but NOTHING is ever perfect for us, so I treat ISF, I:Cs, carb sensitivity and even basal all as approximations.

    It is (mostly) an art, as opposed to a science.
     
  9. Lisa P.

    Lisa P. Approved members

    Joined:
    May 19, 2008
    Messages:
    5,380

    yes, that's it for us, it's like those equations you try to solve that have too many variables.

    But I think some people have more success than we did, they can get one number and work from there.

    I think it's important to treat them as approximations, also, because the body is not a set factor, it changes all the time, so if you think you know something solidly you are more likely to make a mistake than if you figure things are probable.
     
  10. Joretta

    Joretta Approved members

    Joined:
    Nov 7, 2009
    Messages:
    528
    Also don't forget the factor of the glycemic index for food. How they absorb likes to play havoc.
     
  11. steph

    steph Approved members

    Joined:
    May 1, 2012
    Messages:
    177
    thanks everyone. i've seen people post things about carb and insulin sensitivity factors, and have wondered why it didn't seem to hold true for us. it makes a lot of sense about the peak of the basal. i usually just start conservatively for a correction, and then add more insulin or carbs later if needed. it would be great if there was a one size fits all answer, but it looks like in our case, while she's still growing and changing so much at least, it's better to just feel it out one episode at a time.
     

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