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Low hours and unbolused snacks

Discussion in 'Parents of Children with Type 1' started by Portabella, Sep 23, 2014.

  1. Portabella

    Portabella Approved members

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    DS is always low at noon, before his lunch.
    His basal rate is zero 10.30am-12.00pm
    Endo told us to give him a snack between breakfast and lunch, ho hold him over. But he still gets low by noon or earlier. We tried a smaller bolus (with I:C 1:75), but still BG drops at this hour.
    Recently I tried giving him a small UNbolused snack, about 6 g carbs, but his BG still drops by noon. What is this?
    Does anybody have "low hours" and give snacks without bolus to prevent lows?
    Endo said decrease his 9am basal. But then he gets very high at 10am (has been a lot), so I don't wanna do that again.
    10.30am to 12pm has always been his "dropping hour", even before the pump, when he was on MDI
     
  2. Sarah Maddie's Mom

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    "This" sounds like a strong honeymoon. Can you define "low" and "very high" just so we have some idea if you mean 70 or 50 for low or 180 or 350 for high? Also what is he doing between 9-noon?

    You might try increasing carbs and fat at breakfast, increasing the breakfast bolus ratio, lowering basal at 9:30 or 10:00, or trying a 10g uncovered snack (or 8) midmorning.

    It's a beast sometimes, especially in one so young. :blue:
     
  3. Portabella

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    Thank you
    By low, I mean 50s before lunch (average of course, it can be 40, can be 60s)
    His 10am high's used to be above 250, but we fixed it by changing breakfast carb ratio and basals, and it's good now
    We are usually home in the AM
     
  4. Portabella

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    So far, uncovered snack works best. I was wondering if anybody else does that.
     
  5. LauraC

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    We give an uncovered mid-morning snack everyday. We have breakfast around 7:30am , snack around 10am and lunch between 11:45 and 12. Now that we have the dexcom I am able to see what time she starts dropping from her breakfast. In our case, her morning bolus doesn't start working very fast but then it seems to continue working 3 to 4 hours later. I usually give her about 8g carbs for her mid-morning snack. If her blood sugar is on the low side I give her 10g and that helps her make it to lunch. Mornings are tricky. Good luck!
     
  6. Portabella

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    Thank you LauraC, sounds just like us!
     
  7. Lori_Gaines

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    We have this exact same problem!!! We had her school stop bolusing her for the mid morning snack but keep it to 10g of carbs or under. Made a huge difference!
     
  8. Lori_Gaines

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    Just to add, our daughter was going so low at lunch because she plays so hard during their outside time, which is around 11:00. Hence, the uncovered snack making the difference. :)
     
  9. susanlindstrom16

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    My daughter tends to go low in the afternoon hours. She'll typically have an uncovered snack around 3:30 or so, in aftercare when they have snacktime. But if she wants something more than 10-12 carbs we have to bolus.
     
  10. Portabella

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    Thank you!
    I just came up with this solution the other day. Wonder why Endo never mentioned it. He's been dropping in that hour since day one.
     
  11. dpr

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    Drop the basal back to zero half an hour sooner. Keep moving it back a half hour at a time until the low stops. You will eventually find the time slot where his own basal and the pump basal merge. A snack is a nice easy fix but learning how to adjust basal is in my opinion the most important thing there is to know about having a pump. Although sometimes in diabetes the easy way wins, and that's o/k too :)

    A cgm makes the pump a lot easier to set up and you will find it life changing when you can see the lows and highs coming on and start treating before they become an issue.
     
    Last edited: Sep 24, 2014
  12. rgcainmd

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    Word. We started using the Dexcom G4 shortly before my daughter began pumping, and I can't even begin to describe how much easier this made transitioning to the pump (after the first 3 weeks of crap numbers while we let our endo and CDE make useless mini-micro change after micro change until I began making effective adjustments without their input.)
     
  13. Portabella

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    We had the zero basal starting earlier. But then he was in 200s at 10 am
     
  14. Mish

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    We're 9 years into this and my son still gets an unbolused (or half bolused) snack in the afternoon. It's the only thing that consistently works well. No snack, he's low by dinner, even with his basal at the lowest rate of the day. Full bolus and he's low by dinner. No basal and he's high. So...it's what works.

    My motto is now this; if it works for YOUR child, it doesn't matter if it works for anyone else. What matters is that it works for you.
     
  15. kail

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    We are not on the pump so its quite a bit different but morning and afternoon uncovered snacks were essential for us initially (a little less so now). This was largely because we couldn't realistically dose her any lower at a meal than 0.5units (for 30 grams) and she would be in the 50s if she didn't eat again within 2-3 hours. This problem was also honeymoon related I am sure since she would frequently drop low even if she didn't have any humalog at breakfast or lunch due to lower intake or lower carb meal. We give roughly 15 gram uncovered snacks morning and afternoon. She is a little less sensitive now after 9 months and so we sometimes can skip a snack or give a little less. At the start we were only on 1 unit of lantus and doctor did not want us to give less so we had to do the snacks.
     
  16. Portabella

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    So, this has been working for a while, but now it doesn't. I mean the mid-morning snack. At 10 am DS is still to high to have an uncovered snack. 11am-11.30 he starts going down, then I give him an uncovered snack, but then he doesn't want his lunch shortly after. And still low before lunch sometimes.
     
  17. kim5798

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    idk. he is still so small...even if you figure out what to do, it is going to change again in a very short time. It is the nature of the beast! For now, I would just give lunch at the earlier hour to head off the low.
     
  18. Phyllis

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    Phyllis

    It sounds like you have tried many reasonable approaches. It would be safe to try an unbolused 15 gram mid-morning snack that also has some protein and fat. Peanut butter or cheese and crackers would work if he likes either. You will figure this out. Keep up the good work problem solving.
     
  19. nebby3

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    Is he home with you or at daycare? Could you just feed him lunch at 11ish?
     

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