Interesting about spikes being worse when kids are younger. Wonder if this is related to their higher metabolism & faster digestive rate that would require taking a bolus earlier before meals.
Non-diabetic children have lower BG than adults, so spikes in diabetic kids are even further from what’s normal.
Think you’ve answered your own question:) It’s near impossible to avoid highs/lows eating that many carbs. There’s no magic formula to address this. Eating to cover insulin isn’t good, going low isn’t good, 4 meals can lead to insulin stacking with more lows, taking large amounts of insulin isn’t good either.
I know from reading a lot of toddlers spike really really high; DN was diagnosed at 8 and much easier to control the spike now. Of course we are no longer using Novolog but Apidra but I had noticed it before switching. Going to really experiment with superbolus. Overbolus does work; but you cannot forget to test and compensate with ex-carbs at the two hour mark. If super does work, it will be safer.
Getting ideas for the next few years, and future. She is 13 and I will be turning it over gradually. It will be entirely up to her as to how many carbs she eats per day. But I had noticed the Type 1s on this board often do use carb restriction to some degree. Contrary to what we were taught. But want to know the truth re how many carbs are optimal, etc. and I’m sure it varies person to person.
My daughter eats fewer than 20 carbs for breakfast, and she always goes 180 - 200 at the one hour mark. I haven’t changed her insulin: carb ratio because 3 hours later, she’s back where she started or lower.
I eat anywhere from 50g to 100g per meal, not including snacks, and anywhere from 150g to 350g per day. I do well keeping my postmeal spikes under 150, but it’s completely a part of the work I’m already putting in in trying to keep my BGs normalized before, during, and after intense activity. The best answer I can give you is that it depends on what I’m doing that day, what I’ve done in previous days, and what I plan to do in the next couple of days.
I’ve gone on extended vacations where I haven’t been able to do any of my usual routines including working out. After a week or so, I have to cut back on the carbs. My insulin sensitivity starts to drop and my control goes out the window. Nothing I do at that point helps if I eat too many carbs beyond dosing more insulin, which I would rather not do. For me, restricting carbs generally means between 100g and 120g a day. It’s been a long time since I’ve gone more than 21 days without a workout so I can’t say what would happen to my requirements beyond that timeframe.
I’m sure your daughter will find her own way with your help. There is so much more open to us these days.
I guess for children what the endo said is then correct; strive for 180 to 200 one hour mark and 150 two hour mark. Or you have to fiddle… When reading these boards, I am inspired by the much better control the adults here seem to have.
I would think if anything the maximums would be stricter for a child because they have a lot longer period of time in which to accumulate complications for highs. I’ve heard this from several people about children being allowed higher blood sugars and I don’t understand it. Course some endos are still spouting the ADA garbage about 180 being ok for adults too!
We can get to 140 two hours postprandial with Apidra (and I will be backfilling with a few carbs at the 2 or 2.5 hour mark). But, you may not realize that if she is 140 or 150 two hours postprandial, she will most likely have been 180 to 200 at the ONE hour postprandial mark. It may be that many/most of the Type 1s on this board were diagnosed as adults? Some of the adult Type 1s realize what I am talking about; this may be because they were diagnosed as children. I can assure you we have seen very competent pediatric endos. Our current pedi endo has said she would like us to get to 150 at the two hour mark, but this is with the use of cgms. Again, if she is 150 at the two hour mark, it is easy to see she is 180 to 200 at the one hour (or it could be 1 hour and fifteen minutes). The spike occurs, probably because we don’t restrict carbs to the great degree a lot of the adults do. And her diet of 40, 40 and 60 or even 70 grams and some days a snack… I may experiment with modifying the carb load at one time, but won’t reduce her carb intake per day. That said, if she is not hungry, there are days she eats less carbs. If hungry, there are days she eats more. Weight has never been an issue; in fact, quite the reverse. She could stand to gain weight.
I think 180 could be okay for adults too, depending on exercise levels. I’m hoping spike will reduce when her body is fully grown. Spike has lessened as she has grown in size; she used to have to be about 180 at the two-hour mark to avoid hypoglycemia after a meal (but that was with Novolog which had a 4.5 DIA). Seems the amount of carbs acceptable in adulthood may vary with the individual; some of the responses indicate there are some that can eat a decent amount of carbs; some that can eat practically none.
I can’t comment definitively about children, I was only wondering about it. But for adults, no, 180 is NOT ok. Since studies show that complications start accumulating at 140, why would we want to let ourselves hit 180? I’m not saying that never happens, but it is what we all attempt to avoid as much as possible by reducing carbs, calculating I:C ratios, setting doses of both basal and bolus and changing it all whenever necessary!
That is 180 grams of carbohydrate per day, not a 180 blood sugar, LOL. Unless you wear cgms, there is no way to tell how high you spike or how long the spike is. Also high blood sugars happen regardless of what you eat. I have certainly not observed a perfect and steady basal without blood sugar spikes in the past five years. It is good to know that you can keep blood sugars 140 and under postprandially though on a routine basis. Even now, if her BS was 140 at the one hour mark, she would need extra fill in carbs in the next hour just because of the way insulin works in her body. They are working on faster insulins which should help. Yes, I already know children are at greater risk for complications than those who get Type 1 as adults. The years of puberty alone with the growth spurts that accompany it wreak havoc on basal blood sugars even if food is not eaten. I do know that any blood sugar over 140 is dangerous. I don’t know how dangerous one or two hour excursions are. High blood sugars for a certain period of time after eating (smaller body mass, making each gram of carb effect blood sugar more strongly, yet the need to eat X amount of carbohydrate per day just to grow normally) and high blood sugars because of the influences of strong growth hormones (adults are grown), insulin resistance because of the growth hormones make it impossible keep blood sugars in the same range as the adults. Control should improve once she stops growing.
Oops, sorry, Jan.I was responding to the posts above where we were all talking about blood sugar levels and assumed that was what you were referring to as well. I WAS wondering why you would say a “blood sugar of 180 was ok depending on exercise levels”. LOL.
Thanks for all the answers. Lowering the carb load at each meal seems to be worth a try. I am going to give 40 carb dinners, followed by a 40 carb evening snack three hours later and see what happens with that.
Maybe on non-school days the extra meal could be earlier in the day.
I’d hate to see those spikes into the night and not getting treated right away.
On with the CGMS!
Jan you are doing a formidable job with asking questions and getting answers, and caring for about your niece. The adults in this forum. have been quite helpful to you. I have heard that a site called CWD (children with diabetes) has many parent forums and suggestions. I do not know if Tudiabetes has a group specifically for parents and caregivers. Such forums may provide a bit more beneficial info for you.
As you well know;Children are smaller, they are quite active, can be more insulin sensitive, and they can have growth spurts…All these factors can make ithe action of insulins far less predictable and consisitent than in adults…The posters here,again, have been quite helpful to you; but you may want to hear more info from those who are dealing directly with type One Children and their unique needs.
I am familiar with CWD. I would much prefer to get information from this board. On their boards, I have seen mention of prebolusing and overbolusing; carb restriction not used much there. I can now see from reading the entries that modifying the carb load at each meal to 40 grams, while allowing necessary carbs per day for growth, could be a possible solution. Four meals or five. I will try this.
Update on reducing carb load, but extra meal. After reading through the responses, i decided to break down dinner into two mini-meals of 45 grams apiece. I gave 45 grams of quinoa pasta (we can always give an extra free 20 grams of this as it digests too well). So technically 60 grams of quinoa pasta and cucumber tomato onion and mozzerella salad (and we always underbolus for veggies). Her blood sugar rose to 147 then went back to normal. Later on that night she had steak, broccoli, one cup mashed potatoes and 3/4 cup milk (40 grams). This time she spiked to 212 at one hour (obviously the mashed potatoes). I gave an extra unit of insulin at the one hour mark and she came back into range nicely. Restricting the carb load with her known foods is going to prove useful. This way I can see the foods and food combinations that truly spike, knowing spike not due to giving too many carbs at once and adjust insulin accordingly. I will now always give more inulin upfront for the mashed potatoes. Tonight I am going to try the Uncle Ben’s converted rice. She is still getting the amount of carbs per day dictated by her endo team for growth, but I think we may get lower spikes in general. If she is hungry and wants more carbs upfront, I will use the overbolusing technique but reducing the carb load works well.
