Horrible Math Grades and Hyperglycemia during math

Type 1 and LADA Parents of Children with Type 1 Diabetes
1

Hi All, Kennedy is 11 and im middle school, omnipod, still in honeymoon, 9 months out from diagnosis,

she is having lots of trouble in her math class, which is right when her blood sugar peaks after lunch. We do have in her 504 plan an upper limit she must be below to test. So she missed lots of her tests due to high blood sugars, and then also there is just the regular work daily s=when she doesn't test, that also she is having a hard time with.

Her teacher has been completely not helpful with her and we have been working with the pricipal to make special arrangements to get her work done outside of class time. But she is missing key concepts, due to hyperglycemia and partially due to being out of school for illness ( last week she wiped out in gym and got a contusion on her foot BS 330, btw) and had to miss math that day.

I guess I thought having the 504 would make everything easy to make up, but there is still that problem of the HYPERGLYCEMIA which is persistent and really keeping her from learning...

we do pod changes every third day in the morning before school, so every third day there is a decent chance of a spike right during the class. Lunch is a problem, as we have been unable to figure out how to bolus enough time for her insulin to kick in, so her peak is even higher than it should be.

To top it off her teacher has type two and makes comments to her like " are you sure you're going to eat that" in front of her peers.

Kennedy is just starting to be able to tell her highs and starts to feel bad upwards of 200 now.

Ideas? I'm toying with the idea of a carb free lunch, that is about the only thing that will probably work here, but the poor kid, she's already restricted so much... ( celiac too)

2

We went through something similar the year my son was diagnosed. Honestly, my best advice is to tell them you want her removed from that teachers class. This is what we did and it was my sons saving grace. His old math teacher was an idiot. I would explain to this teacher that if my son isnt in class, he doesnt learn how to do the work, so how is he expected to do the work and turn it in. The teacher would harp on my son for missing work and my son was so stressed over it all.

3

This makes me sad. Its so hard when people are insensitive.

Does her bg come back into range without a correction? Are you bolusing before or after lunch?

4

usually she tests at lunch at noon then again around three when she's home from school and ready for a snack, so she never waits the five hours our endo wants to see between meals, so we usually don't know whether sh'd be back down by five. But she is on apidra, so it's super fast, and by three hours ( really two) we she where she is. She always boluses before, and other meals she waits 15 minutes with apidra now. At lunch she has to eat so fast she doesn't have time to wait.
She's having a hard time with kids making fun of her for eating indian food ( she has celiac) and sometimes if she forgets lunch she'll just sit there and not eat at all, she is afraid of doing anything to look different. Her principal is keeping an eye out for her, but he just doesnt seem to be able to catch this while it is going on...

5

Is she bolusing 15-30 min. before eating? That might help. But I think pretty much there will *always* be spikes in BG after eating lunch (w/carbs). Unless she has gym directly afterwards, perhaps. I have type 1 and I can see how I shouldn't take a test if I'm low, since my brain is not working properly, but why not high? The brain is getting plenty of sugar. Maybe she is different, but I can't say highs affect me like lows do. My brain still works, I just may be thirstier and have to pee more. (maybe she is more sensitive being newly diagnosed?) If the hyperglycemia is "persistent" in that it doesn't come down all afternoon, then she needs a higher lunch bolus. But if it spikes after lunch then comes down, that is normal. Anytime you check right after a meal, it will probably be high. It is going to take a few hours for BG to come down after eating, any meal, that is just how "rapid acting" insulin works-- it's not all that rapid. She may be just missing too much class, too many tests, even unnecessarily... and high blood sugar after meals is basically a fact of life in type 1. Maybe they can switch her to gym or an easier class after lunch? How high is her sugar, by the way, after lunch? Maybe just raising the upper limit for a test, knowing it will tend to be high after eating? Say, to 300? (I don't know what it is now, but it's tough to prevent a spike into the 200s after meals, IMO).

I hadn't read the other comments when I wrote the above--
can she bolus before lunch? (sounds like she waits till lunch to bolus, then waits to eat, why not bolus during the class before lunch?) I don't know, I haven't had a middle schooler w/type 1, only a younger kid. I do agree that it's probably affected the whole relationship w/the teacher at this point and switching would be good if possible. Or at least next year.
And I just don't notice being in the 200s but maybe others do!

6

Thanks! I did think about that earlier in the year, but they were going to have to switch every other class just to switch that one class. I have worked with our principal for next year, because i figure that right after lunch there wil always be the best chance to be out of range, so maybe she needs some easy blow off class then... the principle is aware of the situation and the teacher is actually getting in some trouble over it, so I want to be careful, because if I push her she may give her worse grades just to spite me... I did download this ap called infinite campus which my school uses, so I get all her grades texted to me so at least I can find out sooner when a bad grade comes in. For example yesterday, she was 330 at 3 at home, and she made a 74 on a math grade that day...

7

So when she tests at three, is she in range? Maybe I misunderstood - is that when she is high?

Caleb uses OmniPod and Apidra. He boluses before lunch too, but just before lunch. He doesn't normally see a spike and when he checks at dismissal he is typically in range (about 2.5 hours after lunch bolus).

Within the last couple of weeks, I saw a spike into the 200s and then he would come back down. The quick rise makes him feel not himself. What I did to counter that was to add an hour of his basal to the bolus and turn off his bolus for an hour (modified super bolus). He went up only to about 150 and stayed there. It helped a great deal with how he felt.

8

a "modified super bolus" seems like a good idea, give the lunch plus the hours basal all at once... for her that would be a 3.5 unit bolus rather than three... I wonder if that would keep her post lunch peak a little lower, without getting low three hours later, did your endo tell you about that? I have read something about 'super bolus' in some book, was it John Walsh? pumping insulin?

some days she just needs more insulin with her lunch it seems, but it is definitely variable, which leads me to think it's sometimes just her carb counts are off ( tortilla chips before the 330)

I'll talk to her endo about it! thanks! she is really liking apidra, by the way... at first she really went on the low side and we had to go down on everything by about 10% or so. so far our third day has been ok, but were watching out for third day highs!

9

that's what I was thinking!! test and bolus in the class BEFORE lunch then just swing by the nurses office to let her know her numbers and carb count, it is actually on the way... it's just lately ( switched to apidra) and her numbers are overall better, that she notices being in the 200's...

maybe we should increase the testing limit? what number does everyone else use? maybe 250? our endo said anywhere between 200 to 250 would be ok

10

The Super Bolus will only work if she is in range for her post prandial check because it only moves the insulin around with the purpose of flattening the peak.

Yes, it's John Walsh's creation. It's not in my Pumping Insulin, but I don't have the just released copy. There are a number of uses for it. It's particularly helpful for many for breakfast as that is notorious for its post meal peak. We used it for that purpose for quite a while.

The new Tandem pump was suppose to be programmed with the option to deliver a super bolus so you don't have to do the math. I'm not sure if that made it to the final model. I look forward to the day when that is standard in all pumps.

Here is my write up on it with links to John's:
Super Bolus

11

Oh and for exams, Caleb is not to take them if he is over 200. He needs to be provided accommodations to take exams after his blood sugar is in range. We just exercised this a couple weeks ago during standardized testing. He was 209 or something and I would have encouraged him to take the test since it's not terribly high, but he expressed not feeling well, so we opted out. He went to the nurses office for about a half hour, started to improve, was 175, and took the exam in the principal's office. It went very smoothly and I was glad that we had provisions to allow him to feel well and thus perform his best.

12

Great! Read the post, come to think of it, why not do this with all meals ?? in a perfect world... I see what you're saying about that one hour later being 109, worried that he'll end up low... so if she's 150 before lunch, we'll correct .5 give 3 u for a 60 carb lunch, then two hours basal which would be .9

oh crap, that's 4.4 units! wow! quite a lot for her! it makes perfect sense. Right! I think walsh is on advisory board of the new tslim company, I wonder if it will have that feature?? ( has tubing, so kennedy would never go for it, but, just sayin!)

13

so you can do the " superbolus" with the 2 hour basal ront loaded, or the " modified superbolus" with just one hour of basal frontloaded, depending on the situation? How do you decide which one to use then?

14

I hope it does have it anyway and the other pumps follow suit. I don't think it should be used going into a meal on the low side or even for smaller or low glycemic meals. Like lentil soup for Caleb - he would absolutely go low first with a super bolus. In that case the normal meal bolus works. Yes! 4.4 I'm sure sounds scary! But you have to remember to turn that basal off. That's why the automation will be great bc you won't have to worry about remembering. Starting with just an hour of basal instead of two will soften the blow and allow you to see if it will help.

15

I just used the one hour to be on the safe side. He has recess after lunch and I didn't want to risk a low. The small spike was acceptable. The two hour likely would have avoided the spike altogether, but that was cutting it a little too close for my liking.

16

We don't use the POD but my dd we change her every two days and we do it after dinner but before bed time. This way if her sugar spikes during the night we know it is the pump malfunctioning and there is a good chance we can correct the problem. Also if the pump is working she does tend to be a little lower for those first few hours and it gives us a chance to fix that as well. She usually sleeps through the checks at night so that doesn't seem to be a problem. It works for us.

17

you know, after Caleb grows up... you should be a cde you know!! SERIOUSLY! I read a little more on your blag about what your endo said about a 200 post meal spike " that's diabetes" I feel like that all the time with them!! The tech is changing perhaps too fast for them to keep up... Is Caleb interested in doing an AP trial?

18

:) You are very kind. For the most part, Caleb doesn't think about D all that much and therefore is completely indifferent to a trial. But I sure would love to see him doing it! Can't wait for that to be available. :)

Oh - I forgot to mention - no the endo did nor recommend the super bolus. Just something we experimented with.

19

So sorry to hear all this, diabetes is hard enough without the added pressures you all are experiencing.

Both of our boys are on the OmniPod, and we do see highs after pod changes. We have started to bolus a tiny bit before the pod change, and that seems to help head off the highs later on. Our endo also has them extending their bolus an extra hour after a meal which works pretty well.

I would definitely check with your endo and see if there are any changes you can make to her basal rate at that time. Also, what is the insulin duration set for in her pod? That might be a factor as well.

My favorite sentence in their 504 plan is as follows: It is important that even though people around (name) may be frustrated, or blame the highs or lows on something or someone, realize that these feeling may be projected to (name) and makes him feel badly about himself.

As a side note, there is a terrific site for all sorts of subjects, but we use it for math. www.khanacademy.org

Good luck!

20

I have started splitting my son's bolus with meals especially if it's pizza or something higher in fat, or if he's higher. I seem to split more than not regardless of what he come to think of it. I usually do a 40/60% split and extend it over 1.5-2 hours. (usually 1.5) This seems to help him from getting too high or dumping a whole lot of insulin all at once if he's high.