I’m father to a 3 year old T1 also. I’ll let you know what works for us, but as always…YDMV.
First, our first Endo team was worthless. They were OK with our sons BG’s being over 300 all day long…as long as he wasn’t Hypoglycemic (low BG) for liability reasons…so I took things into my own hands and brought his A1C down to 6.9.
However, our new Endo team recommended that I scrap my plan (honestly, I was OCD and spent probably 7 hours a day analyzing, tweeking, comparing data, etc.,). I had about 15 or more “basal programs” during the day…and although what I was doing was working, the logic behind it, and the sanity I was losing to maintain it, just made it impractical long term.
My new Endo team (Top 10 ranked national Endo hospital) emphasized the following things to us on day 1:
- Lose all the insanity that I created and create only a couple “basal” programs. For us, they recommended a .05/hr basal rate all day and dismissing the nighttime basal deliveries due to his dropping low during the night.
- After the basal rates are changed, focus solely on finding out the correct bolus rates for our son.
Keep in mind, a carb isn’t always a carb in that all foods can and probably will react differently in your sons body. I’ve painfully found this out. We found that frozen french fries, heated up in the microwave) caused him to have severe spikes, so we eliminated those from his food choices. We have 4 other sons in our house so going “carb free” wasn’t an option for us. He eats what our other children eat as well as some specific foods that he likes, which don’t wreak havoc in his body. Whatever we do, we just make sure we count the carbs and apply the appropriate bolus for each food.
My recommendation is to test each food individually. We spent multiple days allowing him to eat only a single food so that we could get a feel for how each food ALONE reacts within his body. Once we found this out, we were better able to combine the foods and predict what his BG’s are going to do…but keep in mind, you WILL see high spikes, even “HIGH” pretty often, with toddlers our age because they are growing, their bodies are secreting growth hormones sporadically throughout the day and sickness wreaks havoc on their bodies as far as BG management goes.
The MOST important thing is to find the correct basal rate. This means that his BG should remain LEVEL during fasting…if he’s going up or down, then the Basal rate is wrong. If his BG rises with a basal rate of .05, then he needs his basal rate increased to .10. If it’s dropping, he should have his basal suspended during that time since you can’t go less than .05. (As indicated earlier, we had been suspending our sons basal during the night because he was dropping low.)
After you find the correct basal rate, begin focusing on bolus rates. Bolus rates are what determine the “spikes” we see after our sons eat their meals. Basal rates won’t have any impact.
Here’s what we do to determine if our son needs a bolus rate change:
Let’s assume our son has an I:C of 1:30, and his BG at time of meal was 150
- We annotate our sons BG (150), what he’s eating, when he was bolused, when he actually begin eating, and when the meal completed).
- Then you WAIT 3 hours…during this time you will see some pretty big spikes! Even potentially above 400!! The concern, though, is what the BG is AT THE END of the bolus test…a 3 hour period. So from the END OF THE MEAL, count 3 hours and look at the BG. If it’s > 30 points higher, we DECREASE the I:C to 1:28. If it’s > 30 points lower, we INCREASE his I:C to 1:32.
It’s really that easy. We don’t get “HIGH” that often, and most of the time we are even able to stay under 300 post-meal, now a days, but this isn’t always the case…some foods to cause huge spikes.
Also remember to use the “Extended Bolus” functionality on the Omnipod for any foods that are high in fat / starch. For pizza/pasta, etc., We do a 50/50, or 60/40 ratio most of the time and extend it 2.5 to 3 hours.
If you have any specific questions, please always feel free to send me private messages! My wife and I don’t know it all, but we’re trying to learn more every day to make sure we are making the right decisions for our son. Not sure if your son is used to the “cyborg contraptions” yet, but ours is NOT. He is still screaming bloody murder every time we have to change out his CGM/Pod…can’t wait for that stage to pass because it breaks my heart every time I have to change them out. 
Stay strong! Remember that we have to remain sane if we’re going to help our sons, so do the best you can do every day and if you have bad days…FORGET THEM…and just focus on having a better day tomorrow. This is the single piece of advise that’s helped me most.
At our sons ages, we can expect BG’s to be wild and move like a roller-coaster…it’s just part of having a toddler with T1. All we can do is annotate, analyze and tweak at every turn to avoid CHRONIC HYPERGLYCEMIA WHILE AVOIDING HYPOGLYCEMIA.
One final point. Hypoglycemia is CRITICAL at our sons age. Given all the brain development going on, low BG’s can significantly impact our sons development/growth. So I’ve finally wrapped my mind around that fact and be OK with higher BG’s as a trade off of avoiding hurting his brain development. As long as the BG’s come back down after the 3 hour period following a meal, I just let the BG’s do what they’re going to do. If they don’t come down enough and they’re outside the 30 points, then give a bolus correction, then tweak the I:C up or down based on the test results. And I do multiple tweaks per day sometimes because my sons body fluctuates sometimes from day to day significantly.
One final point. AVOID bolusing your son BEFORE the 3 hours is up. Doing this will most certainly result in a low. Just let the Insulin do it’s work for the entire 3 hours and then apply a bolus correction if you need too. Stacking insulin in toddlers more times than not, results in LOW bg’s.
Hope this helps a bit, but as I said, I’m always here if you need to talk/share or swap information, or just need to find out what another parent with a toddler with T1 is doing.
Stay strong!
Harold
