Help with highs

My 5 year old son is having significant highs 2 hours after breakfast. I’m talking highs in the 300s. They come down just fine with insulin, but I don’t like that he goes high every single day at this time. (2 hours after other meals he’s usually in range)

I’ve tried switching up what he eats. That doesn’t work. I’m a little wary to increase his basal because the rest of his sugars are pretty good. Also, he already has pretty hefty carb coverage in the morning (it’s 1:28g carbs in the morning compared to 1:35g carbs the rest of the day)

Any ideas or tips on what to do?

A lot of people have to take more insulin in the morning because of dawn phenomenon. I take twice as much insulin to carb in the morning than at other times. I wouldn’t worry about his carb coverage being “hefty”. Everyone has a different sensitivity to insulin, and there’s no “right” amount of insulin.

Breakfast is the most difficult meal for most people. Others have given you good advice already.

But another trick is to save some of the carbs for a snack 1 1/2 - 2 hours later. I often bolus for an apple, yogurt, and cereal for breakfast, but I save 1/2 the apple for a snack 2 hours later. Depending on his age and/or your ability to remember the snack (you don’t want any hypo’s), this might be helpful.

of course, any changes you do should be under physician supervision, but i would be especially cautious about increasing your basal rates. If you increase basal rates when under-bolusing is the problem, you could be stuck with a pretty bad low blood sugar if you miss breakfast.

You could confirm that the basal rate is correct by waiting to eat breakfast for 2 hours and see if your son’s BG is high without having eaten. (You would also want to check his BG at the time he would normally eat to see what change there is, if any). This might be nearly impossible to do with a 5 year old…

I wouldn’t worry too much about the big difference in carb coverage between morning and the rest of the day…the difference between them now is relatively small.

Ken, Amber,mollyjade, and Chris have all given you good advice. The only other thing I can think of is drinking alot of water after he gets through eating and drinking breakfast. Milk will cause you to go high sometimes I will drink whole milk instead of eating anything when I have a really bad low to bring it up fast! That’s for my really bad ones though anything below 35 for me for others it maybe different though. Around here it’s always 2% milk for everybody but we do keep like a pint of whole milk for me though. Just in case!

Depending on the pump model you may consider a dual wave bolus if it is a Minimed. Basically it gives you part of the bolus insulin up font and then you can have it deliver the rest over a 2 hour period (or however long you need it). I use this feature when I eat pizza. The crust = Carbs which breaks down fast and raises your blood sugar but the cheese = Fat which is slow and my BG will spike later on so the dual wave takes care of that.

Breakfast can be tricky. Basically you can adjust two things. You can adjust his insulin, either through basal or bolus. Or you can adjust diet.

On the diet side, I’ve found I just can’t deal with a lot of standard breakfast foods. Cereals don’t work for me. Granola doesn’t work for me. I usually stick with protein heavy foods, like eggs. If I don’t have time for that, I usually just have yogurt and maybe a bit of fruit. Maybe some peanut butter and a banana. Cheese is good as well. These breakfasts, incidentally, are good for non-diabetics as well because the protein provides sustained energy until lunch.

On the insulin side, it’s pretty easy. Increase the insulin. If he’s 300 after 2 hours, then simply give more insulin at breakfast time. It’s also possible that his basal isn’t correct for that time of the day, so you might want to verify that before making any changes.

Good luck… I’m sure you’ll get it worked out.

My morning eating is broken up into small snacks to help combat the dawn phenomenon. Since I don’t take insulin, it lets my Amaryl work better if I break up my food throughout the AM.

Hi. We have the same problem with my niece. All the advice given is good. First, though, I would be sure to check the morning basal to see if it is correct on the weekends. Just feed him a few hours later or you can give eggs, cheese and diet coke and it will give a very good idea if morning basal is off. Then, I would call endo and ask for help with adjusting the insulin to carb ratio for breakfast if I was nervous about how low to go. Her breakfast ICR has varied from 1 to 8 to 1 to 10 even if afternoon and evenings are 1 to 15. You may have to adjust back and forth sometimes. We have been doing this and just adjust by going up or down by 1 point only. I do prebolus if I am home. But I would not prebolus if sending off to school, especially on a school bus. In addition, composition of meals for breakfast had to be changed. Cereal is OUT for her, even Cherios. A&P sells a sugar free low carb oatmeal, Maple and Brown sugar which is 19 grams per serving packet. That one is okay. I usually give slice toast or slice English Muffin, cheese stick and milk or Go-gurt or same with eggs. I keep carbs in 35 to 40 range for breakfast and give a nice lunch. Key is to give protein and fat with the carbs at breakfast, smaller amount of carbs. If your son can eat cereal, I have heard that Frosted Flakes are lower glycemic index than Corn Flakes which are very high. In the past, she has eaten Honeycomb without bad effects but we were never testing before three hours were up. Now we have and I think the cereal spikes high, and comes down by the three hour mark so that’s why we never noticed before. P.S. If you do not want to lower ICR, you could use the plus temp basal feature for an hour and a half, but you would have to be sure how low that will take him. There are many ways.

Thank you for asking. Actually, it’s been pretty wierd. I got a lot of great advice from people, but before I could use any of it, his sugars went down seemingly on their own.

He is now usually around 150-190 2 hours after breakfast. Go figure.

Hi Penny,

I’m with Aaron on this one. Many diabetics can’t or shouldn’t eat too many carb’s for breakfast because of the dawn phenomenon. My personal breakfast is, and has been for at least the last 10 years, 4 eggs and a banana. I rarely if ever have highs like your son after eating. If I do, I take a adjustment shot. (I don’t use a pump. Not interested in having that thing attached to me all day.) Besides, my last a1c was 5.7. That was just 2 weeks ago. I believe my bs’s are more stable without many carbs in my diet. And when they are more stable, my head is clearer and I’m more productive.

Also, I don’t get hungry again until at least 1 pm. (I usually eat around 7am.) So not only do I get great nutrition, I’m able to last a long time between meals. Plenty of energy and strength to battle the diabetes blues, too.

Anyway, that’s my 2-cents for what it’s worth.


this is a adult study but it shows timing is critical… not sure if this helps but… more knowledge… please see the link to the entire paper below…

Summary… …
“An increase in delay between insulin injection and eating to 45 minutes would be a simple and safe way of improving blood glucose control in at least the 37% of the diabetic population surveyed in this study who currently allow less than 15 minutes.”

Careful on this one, as this study is from and 1985 and the participants were receiving porcine/pig insulin, which is very different to what most of us use for boluses.

I agree try a dual bolus if possible and if that doesn’t work you may need to increase the insulin to carb ratio. I know that for breakfast I need to count 1.5 carbs for each actual carb taken and use a dual bolus at 60% right away 40% over 2hrs. This has leveled out my mornings and made my day better overall both physically and mentally.

High two hours after breakfast, I personally would adjust the bolus insulin or ICR. You can test his morning basals the next weekend by letting him sleep in for a bit just to be sure. We do 1:8 for breakfast, 1:10 other meals. One unit seems to cover a lot of carbs for him, you are lucky! I don’t know if you adjust ICR by a full unit or a half unit when he uses such a small amount of insulin for coverage.