Discussion in 'Parents of Children with Type 1' started by danielsmom, Feb 2, 2012.
I'd take less insulin for my lunch and eat, wouldn't bother with the juicebox
Have you considered that his uncovered snack may be effecting his dinner numbers??
Also, it sounds like you have some serious communication issues with your Endo. I would work on getting those straightened out. And as I said before, I believe that the order of communication should be from the Endo to you and from you to the school.
I would have a serious problem if the school was making changes (even based on what the endo told them) without my knowledge or consent. You are being cut out of the decision making loop.
I agree with this. Danielsmom, don't let the school nurse bully you! We had a very agressive nurse once and I was quick to put her in her place. As Christopher said, it should be Endo to you and you to school. :cwds:
I'm sorry if I made the nurse sound like a bully.. she is the nicest person ever..The deal is that the CDE had faxed over orders just yesterday, nurse called me and told me if I concurred with the orders I needed to come over and sign them also...I was under assumption that it was only an insulin change being made....she just called to tell me when Daniel went in for lunch check he checked in at 65...so she juiced him as per her orders..waited 10 minutes(my son told me after) and then he got his shot and lunch...When I went in to sign orders I noticed the changes that were made to the correction factors...I do not recall the endo reviewed that with me...so I wasn't willing to sign them....It was an extreme change from where Daniel was at, so I called CDE right away and expressed my concern. She is talking to endo today so we can clarify why this change came about.. I can ask her about the snack.. But here is the deal...although many don't agree...They want Daniel snacking and keeping protein in his system through the day to avoid Low Blood Sugars....at the most he may get 1 every 7-10days and then we see what happened to lead to it..
Does he always get uncovered snacks after school? I see that you are to treat snacks at bedtime now with insulin, but why the uncovered after school? I would suspect that as a dinner high culprit before I'd suspect lunch had anything to do with it.
I'm not a fan of uncovered snacks in general, unless treating a low or going into a known sport that drops reliably. I'm not a fan of snacks actually, bad habit and all that, and not something I'd want to set up in my kid's life as an ongoing thing. Occasional snacks, fun snacks socially, etc, all great, but regular planned scheduled snacks aren't something I want my kids learning.
In general, reliance on snacks means you are feeding the insulin rather than covering food. I'd much rather deal with daily food on an as needed basis than rely on snacks. I'd personally be cutting snacks (covered and uncovered) as a rule and just let him snack when he wants to rather than when they are "scheduled", and I would cover all snacks.
Can't respond to nursing situation as we aren't in school, but it seems odd to me that a nurse would make changes without letting you know. Is that common, for the nurse to communicate with the MD directly at school? I'd rather it be MD to me to nurse, that way I'd always know what decisions were made. This seems a precarious situation to have a nurse making changes without your input/knowledge but perhaps I am misreading things.
We posted at the same time, sorry! Can I ask why an uncovered snack after school? It would be a more likely culprit for pre dinner highs than anything related to lunch would be. Lunch time food and insulin is long gone by dinner...but if he's eating after school and not taking insulin that is a VERY likely reason for the pre dinner highs.
From what I understand he is NOT having lows before dinner, correct? He is having highs before dinner, thus the lunch time change. But if you drop that uncovered snack, won't you solve the problem?
Yes, he needs his snack at am...with activity at school that seems to be the time he would drop if he doesn't have one....The snack after, is 1.niel is hungry after school and just to maintain his BG up till dinner which many times doesn't happen until after practices.....But he doesn't drop during that time as you stated if he went without it and there was no practice, Endo wants him in the habit of eating through the day to maintain BG levels and avoid night lows. But I understand where you are all coming from in that the snack may be
the culprit to a higher dinner BG...he may start to need it getting covered..
Yesterday though with the 3.5 he got at lunch and snack at home, he was 134 at dinner.
His higher dinner numbers were usually after practices, he always shoots up after running around for a few hours...but he does come down on his own..I would record that on the meter.
just a thought...
if you are needing to give uncovered snacks to keep his blood sugar up, then give less insulin. His blood sugar is higher at dinner time because of the uncovered snack he is getting after school.
As I have said several times, it seems like you are feeding his insulin. I also wonder if because you are mixing the fast acting and long acting, if that is part of the issue here.
But everyone has their own management style of dealing with diabetes, and if this is yours then it is what it is. Not judging, just don't really agree with it. But since you posted asking for advice, that is what you are getting.
Agreed. This is the type of regimen where you really shouldn't have to be feeding the insulin.
I've often wondered many times if the mixing of the insulin is causing problems. I wonder if they are working against each other.
But, as you say, to each his own.
My thoughts too. Why not give a snack, but just use a lower insulin to carb ratio? I would think that something is better than nothing.
I agree with the others that the constant snacking is not the healthiest habit to get into. With the insulin regimen that you're using, he should be able to eat when he wants to and not eat when he doesn't want to. If it takes constant snacking to keep his BG up, his basal is set too high.
I understand that your endo wants to avoid low BGs. We all want to avoid low BGs. But I think the logical thing to do is to reduce insulin, as opposed to feeding him constantly.
Also, most kids get to the point where they need a shot for every bite of food - snacks included. Sometimes on MDI it might not be the same amount as a full dose that you'd do based on I:C, but most of the time they simply cannot go without some bit of insulin for the food.
If he can eat immediately I'd say go ahead and bolus for lunch and have him eat the fast carbs of lunch first, subtracting a touch for the low like has been said here if you think it's appropriate. I. e., drink down a milk carton before anything else.
As for the rest, you seem to have a very different way of managing diabetes than many here have, with quite a bit of complicated snacking and a process where the endo directs the school in dosage and timing and food and you adjust for that? That all seems extremely complicated to me, particularly given the sports activities and food issues and his feeling lows (long time ago?) that you have described, in my view simplifying would be helpful. But you have to do what works best for your family, everyone's style is different, and you seem to be overall happy with the way you are doing things. I would just interject again that as complicated as this all is, I hope you are testing very frequently and maybe logging. You're call, of course, but with as complex a regimen as you use, if I were using it for my daughter I would never be able to keep track without testing frequently and probably writing it all down.
Do the endo and CDE know this? I'm wondering why they would have you increase the lunch dose if he's having adrenaline highs that come down on their own. Is it to try to reduce the spike in the first place? What time is practice?
No technical advice to give...just confused why the endo is faxing orders to the school and not to you?? My son's school nurses are excellent...but have NOTHING to do with receiving or making management decisions for my son. Why make you make the trip to the school to look over and confirm orders...why can't the endo simply call you and discuss changes and then you inform the school? This does seem unnecessarily complicated and stressful. I would take the school out of that loop completely. Communicate with your endo, inform the school of any changes, and have the school call with any questions as they arise.
I agree. We also never have to sign anything when changes are made. Our medical plan states that changes can be made at any time.
I personally would feel very uncomfortable with the interaction between the Endo's office and the school. But that's just my opinion. :cwds:
The correction factors were corrected, and refaxed. I will be in there Monday to sign and approve. As I knew the endo had it wrong. As for the snacking their theory is he is a growing boy and needs his carbs. Remember I only mix the insulin at snacktime at night. Not the rest of the meals. I don't believe from his numbers that is messing his numbers up.. I record on the meter when he has exercised. Typically he would practice in the evening before dinner and his games on Saturday he would have lunch right after and he would be high, which I record on the meter. I would need to ask if they are taking this into consideration.... Daniel does not have a problem with the snack..Eating 3 small meals a day and having two snacks at least a day is ideal for maintaining a good weight for us adults, I dont' see why it should be a problem for a child. He is getting now his night snack covered. But I am going to discuss with CDE about the increase in insulin at lunch since Daniel just had a low today after his meal.
I am aware of the changes sent to school, but I was unaware of the correction factors made on the medical form I got when I left my appointment two weeks ago.. Yes next time I will have it faxed to me first then I will deliver to school.
I think for most of us, the issue with the snacks is that we prefer our kids eat much as they did before diagnosis. So if they want a snack, fine. If they don't, fine. If they want a 40 carb snack, fine. If they want a 3 carb snack, fine. But it's not "normal" to have two snacks at the same time every day of between x and y carbs. And it's not necessary on MDI.
We started on NPH and Humalog, so we HAD to do three meals and three snacks every day, at the same time, of prescribed carb counts. It's a pain, and the flexibility of MDI is so much better. I hope in time your endo endorses that flexibility or you explore it on your own.
As for him being a growing boy, well, he was before diagnosis too. He got enough carbs then without required snacks, and he would now too.
I agree with this, absolutely.
That's just it though, if we trust the body, it will choose to snack some of the time and skip some of the time. UNLESS we train it to NEED that snack, which is what scheduled snacks do. Our bodies are pretty amazing actually, and when it needs carbs, it will go in search of them. At different times of year, different times of day, varying be activity and weather and all manner of things our bodies need different amounts and types of nutrients. I'd much rather my child ask for a snack and treat. If his body needs carbs, it will let him know.
I don't believe it is healthy to expect and require a child of any age to snack at given/set times with a given/set carb amount. That is actually unhealthy in many ways. Trust his body to ask for the snack, instead of training his brain to expect the snack. Trust his body to know what it needs, 10 carbs or 40, not train his brain to expect a certain type snack at a certain time.
Most healthy adults don't snack regularly. It is healthy to eat small meals throughout the day, rather than 3 large, so I agree that small healthy snacks are preferred, but that's not what is being done in most cases, instead most are doing 3 regular sized meals and 2 required snacks.
This is of course your choice and everyone has their own way of raising their children, but I do think that you might consider that you are feeding the insulin with snacks, and you are setting your child up to expect regular and scheduled snacks, which as an adult won't be a healthy option unless he also learns to make those snacks healthy ones like fruit or veggies.
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