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What is your child's target range?

Discussion in 'Parents of Children with Type 1' started by Shopgirl2091, Aug 27, 2014.

  1. rgcainmd

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    Our target range is 100 to 110. Is my daughter's BG always between 100 and 110? Not by a longshot! But we keep on aiming for this range anyway. And we've been achieving BGs between 100 and 110 a whole lot more often with a great deal less effort since we switched to pumping (along with Dexcom, of course!). Pumping is definitely not easy, but it has gotten us quite a bit closer to tighter control.
     
  2. sszyszkiewicz

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    I have been hesitant to respond to this thread because I thought it was a pump question (I got the feeling there was a number you could set inside the pump and it would calculate various things for you). But since other MDI'ers have answered, our target range is between 70 and 180 based on the advice we left the hospital with last November. At night I like to see him between 90 and 110 when he is asleep. Like others feel we can trust the Dex with alarms if we check at bedtime and then again at 1AM to make sure Dex is dialed in OK. The Dex makes it *almost* a fair fight.

    During the day, if 3 hours after a meal he is above 180 we correct (and inwardly ask ourselves...why), and we correct to about 100.

    He is 12, entering puberty (he just blew through another pair of sneakers) and we are still honeymooning to a certain extent, although these last few weeks have been getting significantly nuttier (bring it!).
     
  3. rgcainmd

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    We also just moved to crazy town! Puberty has reared its ugly head. My daughter now wears shoes 1/2 size larger than my own and her TDD went from around 12-14 units/day to 25-28 units/day overnight, I kid you not! I'm just happy we had 2+ months on the pump under our belts before puberty hit. About 50% of the time these days, I feel like nothing we do matters regarding my daughter's BG. (But I'm sure it would be even uglier if we didn't keep on trying...)
     
  4. mmgirls

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    123 no range, for after breakfast and rest of day.

    breakfast is 100. I have changed to 100 or 110 with no range and the endo did not like so much.

    but honestly I do like 123, up 60pts and still OK, down 60 pts and still ok, not ideal but ok.
     
  5. nebby3

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    My dd is 12 too and gets 44u just of Levemir a day. TDD is probably close to 100u.
     
  6. suej

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    My ideal would be 5-6 (90 -108) but as sugars move fast during the day so alarms set for 4(72) - 9 (162) otherwise so much correcting and roller-coasting. At night sugars move more slowly so alarms set a bit tighter 4(92) - 8 (144) but I really aim for 5 (100) at night - a good 8-12 hours near 5 can help HbA1C settle. Do we achieve this? Well sometimes. Maybe once a month during the day(a miracle) and 5 nights a month at night. I am comfortable with DS in the 4's at night ( >72) when sensor OK, also Enlite tends to under-read my son a little, hardly ever over-estimates sugars.
     
  7. msschiel

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    Our target (MDI) is 100 during the day and 120 at night. His range is 80-160. During school I try to keep him a bit closer to 120 due to concentration problems. We have been all over the place lately. We are coming up on our 1 year anniversary on October 18th. He is 11 1/2, so I am assuming puberty may have something to do with it, too. Just never know what those meters are going to show. I have Dexcom getting in touch with insurance to see if they will cover a CGM.
     
  8. Theo's dad Joe

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    Is that normal for 2 year olds? I had a pediatric nutrition PhD tell me that non diabetic kids under 5 could basically be "caught" anywhere from 60 to 225 throughout the day depending on when they had last eaten.
     
  9. Theo's dad Joe

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    By target, are people talking about where their child is supposed to be at meal time and bed time? My doctor says that the current recommendations are to check 7 times, 3 meals, bedtime and 3 times at 2 hours after finishing meals. Again, I am surprised if the target is 120 for 2 hours post prandial, because again I have talked to a top childhood nutritional researcher whom I knew from my grad school work who says that if non diabetic kids under 12 eat a low GI meal they can be 140 2-3 hours after eating all the time, so if 120 is a 2 hour PP target I am having trouble comprehending that.

    Are targets specifically for mealtime?

    If so, then my son's official target started at 70-180 and moved to 70-150 before meals. Above 150 we compensate. Also it is 70-150 at bedtime, but the doctor insists on a snack if it is under 130.

    I have also been told that non-diabetic kids tend to rise 10-15 points around bedtime and I even found a source that non D kids may get a snack before bed if they are under 100. I don't know if I trust it. At least two sources say that non-D kids under 12 normally go 170-200 postprandial.

    are we trying to control the 2 hour postprandial number or just the mealtime and bedtime numbers?
     
  10. Michelle'sMom

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    Your son's range is 70-180. A target is usually a single number, or at least a more narrow range. Targets may vary based on time of day, activity, illness etc.

    Your goal is to try to control 'all' the numbers, however postprandial BG contributes heavily to the A1c.

    My dd no longer uses a range, but her endo recommends 80-180. We program the targets into her pump. Our goal is 70-95 premeal, because along with prebolusing, it helps to control the spike. We wouldnt want to see a 120 2 hrs post meal, because she would go low before the meal bolus finished working. Currently, her overnight target is 120, daytime is 80. She may be at target at bedtime, but we then consider insulin on board (IOB), any daytime activity etc.

    I wouldn't advise comparing a non-D child to a child with T1. The non-D's body adjusts on its own. We are amateur substitutes even on the best days.
     
  11. Theo's dad Joe

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    My son's range is currently 70-150, and 130-150 at bedtime according to the doctor.
    What do you like to see at 2 hours?

    What kind of HbA1C have you been able to get with those target numbers?

    You say that the daytime target is 80 to help with spikes, but when I give my son a 20 minute pre-bolus he drops 20 points by the time he eats. And when he drops below 80 before he eats he spikes faster and earlier and longer, at least based on what I've seen. I really can't verify that until I go on CGM (asap) but I do know that he drops 20 points by the time he eats if he pre-boluses 20 minutes.

    Can you tell me when do you usually see the highest blood sugar after eating, given a prebolus? Is it like 30, 60, 90, 120 minutes?

    Also, have you ever felt that humalog works too fast for kids? I almost feel like it hits hard within 40 minutes (I caught my son at 68 right after finishing lunch one day, 40 minutes pst bolus and 20 minutes after starting to eat a peanut butter and jelly sandwich, and milk and carrots, and he was probably lower because he told me that he felt terrible when he was eating). And I've found him with low GI meals hugging the 70s for 2 hours and then coming up to 150.

    Again, I'm going for CGM, but the honeymoon has bought me some time.
     
    Last edited: Jun 13, 2015
  12. Michelle'sMom

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    Again, you're asking for absolutes & they just don't exist. The 2 hr number I look for depends on the food eaten, & it's based on what I've learned about my daughter's D. We're very aggressive & have been practicing the methods now known as Sugar Surfing since shortly after starting CGM. For most meals, if I see she's trending up, with a current reading of 150, I'll have her bolus an additional small amount. But that's a more aggressive & advanced technique that I'm relatively sure is safe. Before CGM I wouldn't have given any additional insulin until 4 hrs, & certainly not on MDI, or even during the honeymoon.

    Highest BG after eating depends on the food, but it's usually 70-90 minutes after the meal.

    Wilf mentioned earlier, possibly in another thread, that prebolusing during the honeymoon shouldn't be done. There were a few foods, oatmeal was the main one, we prebolused for. Mostly we bolused as she sat down to eat. There's just no way to know when the pancreas will decide to throw out a little insulin, & it's far too easy to overdose. If you're that bothered by meal spikes, try starting the meal with protein or fat, or even complex carbs.

    Humalog is much slower to work & also lasts longer in my dd. I would think what you're seeing is your son's own insulin production contributing.

    If your son recognizes the symptoms of lows, or of dropping BG, I would find some 1 or 2 gram quick carbs & experiment a little with slowing the drop. Dex4 used to make Glucobits, a 1g glucose tab. I'm not sure they're available now, but Walgreens make their own version. Others here can advise on candies that can help. We've never used them so I wouldn't have a guess.
     
  13. Theo's dad Joe

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    Thank you. I am not asking for answers, just experiences. I am not pre-bolusing now. I am not worried about spikes right now either. I am just considering that the humalog may be too fast even taken after eating.
     
  14. wilf

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    You nut - stop with the prebolusing already! :cwds:
     
  15. Michelle'sMom

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    I think he's got it Wilf. Lol

    Mertdawg, for what it's worth, I can vouch for Wilf's insulin expertise. My dd was on NPH at dx, & having lots of dangerous lows. We were between endo's & I was new, green & scared of adjusting. Wilf walked me through the adjustments. Since then I've sent a few people his way for advice. If you want to learn about insulin, ask him.
     
  16. Theo's dad Joe

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    I am not prebolusing. I mentioned that when I prebolused my son he went down 20 points in 20 minutes. That is not about the honeymoon, it is about insulin sensitivity and speed. Why is a honeymoon going to contribute to someone at 100 dropping 20 points in 20 minutes before eating anything? The 68 I mentioned by the way was in the first week back in January. He started going low-ish while eating right away in the first week.

    What I found odd was that at school when he got his insulin right before eating, he never went above 120, but when he got his breakfast or dinner dose at +20 minutes he peaked earlier, higher (150-170) and longer.
     
  17. Michelle'sMom

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    Because the pancreas starts secreting insulin long before the first bite of food is swallowed. Injected insulin takes a while to reach the blood stream. Onset is usually 15-20 minutes. Once your son's honeymoon has ended, you'll see the difference.
     
  18. Theo's dad Joe

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    But he dropped 20 points in 20 minutes after the injection waiting to eat, before he took a bite. How does the honeymoon affect that?
     
  19. Michelle'sMom

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    Have you read up on glucagon secretion prior to & during meals in T1s?
     
  20. wilf

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    It would be helpful if you would either stick to what is happening now, or (if you are trying to figure out why something happened some time back) sticking to the past - and if you were clear about what time period you're talking about.

    Your prebolusing was causing lows and these were resulting in rebounds. Thus the higher numbers after the prebolused meals.

    Regarding the honeymoon, something that is hard to wrap our heads around is that his body doesn't know it has diabetes. So to the extent it can, his pancreas will always be pulling him down to what it considers the optimum level - around 60 - 70. Not 100, where your stupid endo wants to see him overnight, but 60 - 70. If he came down from 100 to 80 in the 20 minutes before a meal, it's because his pancreas was trying to get him to where it "thinks" he should be - at 60-70.
     

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