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Minimizing Post Meal Spikes?

Discussion in 'Parents of Children with Type 1' started by wearingtaci, Dec 22, 2013.

  1. wearingtaci

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    Now we are seeing how much Sophie spikes after meals,and it is a lot more then I would like,about 100 points. She comes down and stabilizes around 100-150 after 3 hours.
    Where do I even begin to look for help minimizing these spikes?
     
  2. MomofSweetOne

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    Prebolusing is HUGE. Exercise for about 10 or so minutes post-meal also helps tremendously.
     
  3. nebby3

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    Prebolusing is big. Exercise can help insulin absorb faster. So can a hot shower. I will often bolus my dd, send her to shower, and then give her breakfast. Brain work like math problems also seems to burn a lot of glucose for my dd so I am happy when she does math early in the day. Depending on the flexibility of your schedule you can also give all the insulin for breakfast and a morning snack but then not give the snack for a couple of hours. If you prefer to think of it that way, you could see it as breakfast eaten in two chunks but all the insulin given up front.
     
  4. wearingtaci

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    I have been bolusing her according to the table in Think Like A Pancreas,basing when I prebolus her on her BS and the overall GI of the meal. I was hoping there was some additional magic I could do with the pump to get these numbers u der control.
     
  5. Dave

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    Well - the obvious answer is to reduce carbohydrate. You wont hear it much on this site, but Type 1 Diabetes is fundamentally a disease of carbohydrate intolerance. So just eat more protein and less carbs. Is your child consuming empty carbs like sugar or flour? There is no need for these types of foods, so I would start here before I started with hot showers.

    What you will find with this disease is that you will never have tight blood sugar control with a high carbohydrate diet. By the way, as a parent WITHOUT type 1, feel free to steal the meter sometimes and see what a 40g carb snack will do to you!

    I suggest you read Bernstein, Taubes (why we are fat)...there is a new book called Grain Brain...something like that. Here you will learn what the modern carbohydrate diet really does to both non diabetics and diabetics alike.

    Now if you encounter some parents absolutely committed to the ADA high carb diet, I suggest you review the scene in The Poseidon Adventure where Gene Hackman has it right and is going to the bottom of the ship because it has capsized and turned over and all the other folks are going the wrong way!: Its pretty clear what high carbs do: you get a high A1c, your blood sugars are out of control, cognitive function decreases (type 1's dont do well academically), growth deviates from growth curve, kidneys, CVD, etc.

    Its just not worth the cookies, pizzas...sugar flour...sugar flour.

    Figure out at way...up the protein...drop the carbs...try it for 90 days...watch your a1c drop into the 5% club.
     
  6. mmgirls

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    Personally, I would not want my younge child to be in the 5% club. If is we're just about carbs then it would be easy of course, but there is so much more to take into account.

    You amaze me on how flip you can be to other parents/ caregivers.

    If you want others to take you seriously why not try to be nice. Then maybe just maybe, you could help parents that are wanting to lower their families carb loading.
     
  7. nebby3

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    We are not low carb overall but I do try to keep dd's breakfast and dinner low carb because those give us the most problems. Are you familiar with the super bolus concept? On a pump you can give the next couple of hours basal up front along with the insulin for carbs and then reduce the basal to 0 so they get the same amount of insulin overall but more up front.
     
  8. StacyMM

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    My son had huge spikes after breakfast. He would start out at 90 and be 250-300 afterwards. Lunch was also a spike issue on school days because he simply would not pre-bolus when he's at school. What we did was create a school basal program and a no-school basal program. On school days, his breakfast and lunch times are set and his carbs are fairly consistent (80-100 carbs at breakfast and 100-130 at lunch) so I adjust the basals to have extra insulin in place when he eats, then drop it down afterwards. With this in place, he rarely goes over 140 after meals. It takes care of the breakfast spike and the lack of pre-dosing at lunch. We switch basals Friday and Sunday nights. If I did it right, there are two pictures attached that show how different the patterns are.
     
  9. Pemb

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    My son eats a very carb heavy breakfast every day and was experiencing the huge spike (getting up to 250-300) With a little experimentation, we discovered that what works for him is bolusing for the meal about 20 minutes before he eats. He spikes up a bit still, but doesn't go out of his goal range (over 150).

    SO, my advise is to play around with the timing of the prebolus until you hit on what works for your child.
     
  10. shannong

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    I find that pre-bolusing really helps. If my son gets even a little bit high, before he eats, then the spikes are that much more significant. So, I usually will try and correct and do a pre-bolus. That however is in a perfect world and really sometimes we just can't wait because he wants to eat. At school, I almost never see spikes and I believe this is because the kids eat and then go out to play, so that definitely helps.

    I would definitely never limit carbs for my growing 7 year old son. However, I do find that whole grains, lower glycemic carbs, do make a huge difference in terms of less spiking.

    I also keep basal rates set pretty high. My son is a frequent snacker, so having high basal rates helps offset some of the spikes that may come with eating often. My son can pretty much eat around the clock, so this works for us.
     
  11. hawkeyegirl

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    It is definitely possible to achieve good control without significantly limiting carbs. Dave's son is still strongly honeymooning. Basically, Dave was born on 3rd base, and thinks he hit a triple when it comes to BG control. ;)

    Play around with predosing. Gary's suggestions are good, but they're a starting point. You may need to predose more aggressively to avoid spikes. I find that in the morning especially, Jack simply can't eat carbs without a massive spike unless he is below 130 or so, and the closer to 80, the better. Stacy's system with the increased temp basal is a good one too, and one that we sometimes use with temp basals if he is a bit high.
     
  12. swellman

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    We have the same problem ... we've been adding and adding insulin and doing a super bolus with almost no reduction of breakfast spike. We've nervous about adding even more insulin.
     
  13. 3kidlets

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    Prebolusing helps. But I found it wasn't enough for breakfast spikes. We switched to Apidra from novolog and have pretty much cut out the spike completely. We do not limit Hana's carbs or food at all. With Apidra, we prebolus by about 15 min and her blood sugar rarely reaches 180 now. Back to 150 or under in 2 hours. Now, I realize not everyone can just switch insulins, but it did work wonders. Her a1c went from 7.2 to 6.7. That's with being In hr throes of puberty and growing 3 inches in 3 months.
     
  14. 3kidlets

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    Your son has had D since March. There is a huge difference in managing type 1 in someone with D for 9 months versus 4 years or beyond. I thought we had this and didn't see what the big deal was when Hana's a1c was consistently 6.0. Then reality set in. The honeymoon came to a screeching halt. Then she started puberty and growing like a weed. All heck breaks loose.
    I also think your setting your child up for major issues if you are micro managing everything they put in their mouth. We eat a very healthy, unconventional diet. I'm vegan and my kids are primarily vegetarian. But I do not micro manage the food. I know our day to day diet is healthy but hana is a 12 year old tween. She wants to go to sleepovers and have pizza, cake, ice cream. Wants to go to the mall with her friends and eat in the food court. Sometimes she chooses a salad,sometimes not. We work with it.
     
  15. mamattorney

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    We've had good luck with both extra basal and with exercise after breakfast. Prebolusing isn't practical with her morning routine, but it works really well at lunch when it is practical, so I'll bet it would work at breakfast as well.

    On school mornings she walks to school immediately after breakfast and there's very little spike unless she eats muffins, but even those don't send her sky high. If it's raining and I drive her to school the spike appears in full force - and it's there mostly on weekends, too even though we change the I:C ratio on weekends. Her walk is only 10 minutes, so it's pretty amazing to me to see the difference.

    However, within the past two weeks, we upped basal significantly (doubled it) and it's kind of an aggressive basal - but like a previous poster mentioned; it's great for snacking and for breakfast. If she doesn't eat for hours, her BG will drop, but that's pretty rare around here! I think having that extra insulin running helps with the timing of the insulin just enough to curb the spike a bit. Weekend breakfasts are looking much better these days.
     
  16. missmakaliasmomma

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    this is to Dave as well.

    I agree with kidlets. there's a big difference between 9 months and 4 years (which is where we are actually at right now) for a little while, I became a food nazi ( I was going wayy too crazy with D) and let me tell you, no one was happy. My daughter having a cookie gave me anxiety. I have since then learned to loosen up and she has everything any other kid can have but in moderation- and that moderation is both for D and for the fact that she doesn't need to have 15 cookies in one sitting. Obesity is definitely a problem with kids these days, i see it everyday at my daughter's school.

    We cut out white flour, yes, but she still eats pancakes. She still eats pizza- do we eat it everyday? most definitely not. There's no need to completely cut cookies out, I do believe you are asking for some issues when your child is older.
    With the right insulin and prebolus, you can definitely experience minimal spikes, but it's really all a trial and error until you get it right for your child.
     
  17. mmgirls

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    You have me curious, how many carbs do you allow a day? How much protein are you advocating?The all sweeping comment to just reduce carbs and increase protein bothers me.
     
  18. Michelle'sMom

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    Hmmm...my dd eats few carbs, & has always eaten that way. The last time we saw an A1c in the 5s was just over 4 yrs ago. It was 5.3 in Oct 2009, about 3 months after dx, & in the midst of a very strong honeymoon.
     
  19. Phyllis

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    Post meal spikes

    Unless she tests low, try increasing the time between the pre meal bolus and the meal. This only works when you can accurately predict CHO grams. I wouldn't go any more than 15 minutes to start with.
    Another big help is looking at the glycemic index of foods..this is not an exact science but for sure potatoes, white bread, pasta and other refined carbohydrates will be rapidly turned into glucose in contrast to whole grains.
     
  20. mmgirls

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    Super blousing the basal may help you allot. Basically you are taking the basal and frontloading it to help minimize the spike. then the larger tail of insulin is acting as the basal.

    But with the G4 you should be able to determine if the pre-bolus time is really working or not. Many kids have insulin resistance in the AM and need a longer pre-bolus time just for the first meal of the day.
     

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