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Question about post meal numbers

Discussion in 'Parents of Children with Type 1' started by angelhair45, Sep 30, 2008.

  1. angelhair45

    angelhair45 Approved members

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    Our endo never told us, and I can't seem to find it in any of the literature we have on diabetes. What should post meal numbers look like for a 4.5 year old? My son tends to be low most of the time, but he goes pretty high sometimes around an hour or two after he eats. I'm not sure what normal is.
     
  2. cassie

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    After meals you should not be testing until 2 hours after you give insulin. That's how long it takes the fast acting insulin to work. If he is low, or you suspect he is low you should test and correct.

    After the 2 hours he should be in the normal range that your endo gave you. For us it's anywhere from 70-180.

    Do you give insulin before he eats or after? We have to give it right away after she eats for most things because we never know how much she will eat. For ice cream and such things I do give it before.
     
  3. angelhair45

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    I understand that part, but I'm wondering what is normal before the two hours. He usually drops low after two to three hours, but he goes pretty high before that and I'd like to know what is normal for a diabetic. I've read that post meal highs can contribute to negative long term affects, but nowhere can I find out what is considered high for post meals. 200? 300? 400?
     
  4. cassie

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    Megan is normally high before the two hour mark.
     
  5. wilf

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    Ragnar Hanas (in Type 1 Diabetes) suggests that 2 hours after a meal, a range of 145-180 is acceptable and 90-140 is ideal. You need to be aware that this ideal level is based on what we call "overbolusing" (giving more insulin than is needed to cover just the meal), and if your child is in the 90-140 range 2 hours after a meal then they will likely be going low unless they get a snack.

    At this end our goal is about 100 to 130 by 2 hours post meal, on the understanding that DD can graze a little in the next 2 hours to keep BG steady.
     
  6. Abby-Dabby-Doo

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    When we were dxd we were told
    Post meal for our child's age was 180

    We tested at 2 1/2 hours after eating due to us not giving insulin to our daughter until she was finished eating. If you give insulin before your child eats, most check at 2 hours. We still don't test at 2 hours (even after giving her insulin before she eats) because she'll drop 90 points in 30 minutes, so we continue to test at 2 1/2 hours.
     
  7. andeefig

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    If you mean post-meal as in 30 minutes to 1.5 hrs after eating (before the 2 hour mark) than my first thought is that would depend on the food. We know pizza is the perfect example of this with that o-so-fun delayed spike. But I could be way off. ?
     
  8. angelhair45

    angelhair45 Approved members

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    Really? When you say snack, do you mean a carb snack? Our endo send us home from the hospital saying no carb snacks,( which was tough because he is a grazer) but we have found lately he goes too low without them. He is usually in the 90-140 range 2 hours after a meal, sometimes lower.
     
  9. wilf

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    Every child is different, but at our end if DD is in the 90-140 range at 2 hours then I know she'll be low by about 3.5 hours.

    We have tested how long her insulin lasts, and found that the Novolog is used up as follows:
    - 25% after 1 hour;
    - 60% after 2 hours;
    - 85% after 3 hours;
    - 95% after 4 hours;
    - 100% after 5 hours.

    If she is back in range at 2 hours, I know that she's still got 40% of her insulin to come - and so she needs a modest carb snack to keep from going low.
     
  10. Lee

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    Two hours is the test time - there is little you can do to prevent a spike before two hrs. At 2 hrs, with a 4.5 yr old, 180 is a great #. Wilf has an older kid, like me, so it is alot easier for us to be more aggressive in dosing becuase our kids are a)less insulin sensitive, and b) more sensitive to when they go low - so we can shoot for 140 - which in 4 hrs would leave my DD at 80. I do not think I would be that aggressive with such a little kid.

    One of the MAJOR things that you could do, which helps control the spike and helps improve the A1C is to prebolus. That means - give the shot for the meal beforehand based on the blood sugar reading. Here is what our CDE recommends for the prebolus:
    View attachment 938
     
  11. Lisa P.

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    I think finding a system is a matter of mastering one step and then moving on to another. When we started, our endo had us correcting every four hours and fasting from carbs in between -- nothing else. Now we correct, count carbs, prebolus, and sometimes overbolus, and we watch the mix of what kind of food she eats (protein, fat and carbs) and what kind of carbs. The step I'm on now is activity. Can't wait to see what fun stuff is still to come!:p

    Our endo, though, was very cautious about taking us up steps. We came here to learn, and then went to the cde and endo and told them what we wanted to do. Everyone was more comfortable that way.

    The first six months Selah was always high at 2 hours. It is a bad place to be. But looking back, until I understood the whole system I would not have been able to use the tactics I use now to keep her in range -- she's 2, very sensitive, and would have gone low. Of course, you may catch on to stuff a lot faster than I did!

    I'm assuming you are using a MDI, Lantus/Novolog sort of scheme. I'd suggest one step at a time, maybe see if you are comfortable prebolusing and figure out what food combos do what, then look at overbolusing, etc. Good luck!
     
  12. hawkeyegirl

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    Two hours after breakfast, I'm happy to see anything under 200. Two hours after lunch or supper, I aim for below 180, and below 160 is better.

    We don't hit those targets all the time, of course, but it's what we strive for.
     
  13. dqmomof3

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    Gary Scheiner, in one of his talks at FFL, actually said the one hour number is what you want to pay attention to, not so much the two hour. From what I gathered, it is because that is when the spike is happening. In other words, if your numbers are good at two hours, that doesn't mean you didn't have a spike, and you want to figure out how not to have the spike in the first place. Our endo, though, said to test two hours post meal to see where you are in terms of making any adjustments in insulin dosing.

    I guess it all depends on when the bolus is happening. If we can't prebolus, then obviously there will be a spike :). And if we don't time it right, even if we prebolus there may still be a spike!

    Dratted disease!!
     
  14. saxmaniac

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    Well, that's the "strike the spike" theory. But IMO that comes after you've narrowed in on a decent basal and I:C, in that order.

    For example, if you have 275 at 1 hour and 255 at 2 hours, 250 at 3 hours, then prebolusing isn't going to really help. The 2-hour is more important.

    Actually, when I read "two hour", I really think of it as "when most of the insulin is used up". You take your DIA and shoot for a bit after halfway though it. Alex's DIA is 4 hours and I know it's strongest at the 2.5 mark. Wilf posted a 5-hour DIA and his is around 3 hours.

    Now if your 2-3 hours tests are mostly good, THEN it's time to do some 1-hour tests and witness Ye Olde Spike and see if you can work on that.
     

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