My son and I go round and round on this issue! How much post meal spike is ok? He is 22 with a history of 3 major hypo seizures (one life flight, one glucagon, one ER) Therefore, he has an overwhelming fear of lows that controls all his decisions. He overrides all the doctor’s numbers, with “I’ll get low”. He WILL NOT bolts pre-meal. When I question a huge BG spike, he says, “I bloused, it’ll come down”. I don’t think it should spike more than about 85 points if the blouse was right. Any advice appreciated!
I don't go by "how many points it rises" but by it not going over my goal which is 140. Studies show that complications accumulate with time spent over 140 so if I hit 140 I correct.
In terms of numbers, I'm not sure w/o more info. Passing out from hypos is certainly no fun, I had a bunch of those when I was his age, often the day after benders, I'd take a shot (mixing R/NPH) and wake up at the hospital vaguely remembering being tired and wanting to take a nap or stuff like that.
That being said, these day, I aim for 120 after meals, if it hits there, I keep an eye on it and sometimes will nudge my pump to make sure I don't go much over Zoe's figure of 140 as, as she points out, that seems to be about where damage starts. That being said, there's quite a few folks you can encounter (Spock, Richard Vaughn, Shoshanna [sp?] and many others...) who have hit the 50 year mark and many of them didn't even have A1C tests for much of their diabetes career and, to all appearances are excellent people who have done a great job beating diabetes. The 20s can be hard, maybe as hard for you as it is for them but it might be better to let him figure stuff out on his own. My parents (I was dx'ed at 16, in 1984...) were pretty hands off and, while they have always been and continue to be very supportive, they didn't do what seems to be the standard drill now of getting up at 1 and 3:00 AM to test their kids BG and, for better or for worse, I've done ok at it.
I don't get not bolusing pre-meal at all though. That's just asking to roller coaster. I have a pretty freaky history and definitely agree with you that when my control is tighter, I am much less likely to have catastrophic lows.
I was taught at the DOIT program that T1s should attempt not to spike more than 30 points at 3 hours post and as Zoe said time over 140 is not quality time.
But the real problem isn't that he is spending too much time high right now; it's that he doesn't have confidence in his ability to avoid lows. Would it be possible to get him a CGM so that he can work with better information? If he likes animals, a diabetic service dog or even just the right pet dog can give him additional protection. If you live near a major diabetes center, he might be able to find a behavioral therapist who could work with him to develop the ability to anticipate and treat lows while they are mild.
Maurie
Whether your son pre-boluses or not will not make much difference to his postprandial blood sugar 3-5 hours after a meal. If he is regularly 85 mg/dl 3-5 hours after a meal, that is a result of systematically underbolusing and deliberately running high. It isn't related to whether he boluses pre-meal. I would worry mostly about his levels 3-5 hours after meals. That is probably what the doctor is concerned about, not the specific spike after eating which occurs about 1 hour after a meal.
If your son is making decisions to run high out of fear for lows he is not alone. Others have had the same problem, but there are ways of working through things, it just takes some concerted effort. He will have to decide to do this and work on it.
I think the 85 is the amount of the spike, not where he ends up. We would need more info to totally figure out what's going on. I'd suggest the son might benefit from hanging out although maybe he's not really at a point where he wants to do that. I have a 15 year old, not quite the same thing, but we are constantly grinding away at each other about various issues, room cleaning, homework, staring at media, etc.
You can lead a horse to water, but you can't make it drink!
Try setting some intermediate goals. His fear is understandable and he has developed a method that works for him. It seems that the more difficult task is to get him to start seeing there could be a better way to prevent the lows, while having better numbers 3-5 hours after a meal.
For example, if he is underbolusing by 2 units for a meal, ask him to consider adding 0.5 or 1 unit to his mealtime bolus. Put another way, if he typically is @ 200-250 3 hours after a meal, start shooting for 175 - 200. Then, after he gets comfortable with that, step to the next goal.
Also, just a reminder, to praise the positive (which I am sure you do).
Here's a photo from 2guys Photo
I do not feel that post-meal spikes are the worst thing in the world for a T1.
Small tidbit about my perspective... I'm T1 for 31 years. First few years no home bg monitoring. I've had a couple of extreme hypos that resulted in ER trips, and IV or glucagon to bring me back to consciousness.
There is some research that shows post-meal spikes in non-diabetics may be a health risk and a lot of folks really actively promote post-meal spikes as the main health risk.
I think that in non-diabetics, that post-meal spikes may in fact be the main indicator of health risk.
While I think there is some value in this... bolusing to eliminate post-meal spikes will also result in an increased risk of a hypo just after a meal.
Since switching to fast-acting insulins... I have had several "surprise" hypos right after a meal, when for some reason or another the insulin got absorbed faster than the food. These hypos are EXTREMELY disconcerting.
Keeping average bg low is, from everything I read, the key to preventing complications for T1's. The post-meal spike is a component that contributes to higher average bg so it should be watched. But I think it is unreasonable to think that any T1 will always stay under 140 post-meal. Heck, most of us struggle to stay under 140 at other times too.
I thought I would go low too when doing pre meal boluses so I calculate the insulin for what I think I’ll eat and split in in half, so I do half pre meal and then the other half +/- depending on what I actually ateI’m 18 and have had 3 seizures as well.
AR is correct. Richard goes back even further, but the only testing I had at all was called TesTape. You peed on it and it turned green--the deeper the color, the higher your BG. I could go on about this, but...
I know exactly how your son feels, as I have been there. I was away at college at 22 and invincible---the last thing I wanted to acknowledge was diabetes. And nothing really changed until I had a child. That was when the lights went on--I needed to behave for the baby, our family and the future.
I have always lived by the rule that the 2 hour should be below 180. You can only maintain the rigid BG control like Zoe and AR WITHOUT A LOT OF LOWS with a lot of knowledge about diabetes, how food and insulin work in your body, understanding of all the nuances of the pump, etc. Your son does not seem to be at that point yet. AND a CGM--I think that would alleviate his anxiousness about the lows.
I agree that it would help if he hangs around this site--even with 50 years of D, I learn so much here. It had also helped me understand that I am not alone.
Unfortunately, there isn't a lot you can do. Only he can change--you can't make him.
Maybe a different marketing strategy might work more effectively, pitching it as "you need this to help your anxiety about lows" might not appeal to his sense of escaping the parental helicopter patrol.
I had numerous suggestions (friends, family, doctors, etc.) to try pumping before I did but had to find my own way to it (over Mexican food, of course...). If you are engaging with the process and working to sell it, it might be better to a manly young creature to sell it as something that will allow you to kick more ■■■. Then, when you kick some ■■■, it can engender good feelings which, of course, can be sort of addicting and lead you, or at least they sort of led me, to keep trying to kick diabetes' ■■■ over and over again. I think there might be a "crossover point" too, where you can have more kicking ■■■ than "oops" and that that might be an interesting key to find. Oh well, more philosobetes...
Does he have a CGM? I was afraid to sleep and having a bad low while I was sleeping, and then I got my dexcom and now I'm fine.
Thing is, I can set it to simply alert me when I'm going down. Like, I could be at 200, but it will beep and tell me that my numbers are going down. If they're going down super quick, even though I'm at 200, I can go ahead and get whatever sugar I might need ready. I keep an eye on it, and if I'm at, say, 100 but falling fast, I go ahead and drink my sugar. It will go down to, like, 80 or 90, and then level out at 100 again, and I don't have to wait until I'm low to take the sugar.
I've got to agree with this, and the other comments. As his Mom, I'm afraid that you don't really get a say any more in these sorts of things. Just out of curiosity, are you also admonishing him to wear condoms to protect himself? For us Ds, talking about our blood sugar with pretty much anyone (other than another diabetic) is an extremely personal issue and can in many ways be seen as intrusive. I think the best you can do is simply be there for him if/when he needs help.
Boy, that brings back memories.
Hi ive had type 1 for 24 years an have lost hypo awareness for 5years an am scared to run my bs at the right level my memory is starting to get bad so i understand his fear but going to high isnt good either i think aiming for 8 9 mg will make him feel less fearful of going low thats what i aim for now.also a cgm would be great for him but they are soo expensive thats the only reason i dont have one
I'm trying to stay within the 70 - 140 range, but since I check myself into the hospital for a foot ulcer over the summer (which has healed) I found myself going from using Humalog and Lantus (which I've been using since 2002) to the 70-30, which I was given before I left after a week. But before I abruptly moved from Dallas back to New Orleans and have it changed again because the 70-30 was unpredictable (too many lows). Now, I'm on Levemir, which they originally give to take once a day, with no fast-acting insulin, which I started to question and I got into it with relatives over this as if this is my first rodeo when it's been 13 years since my initial diagnosis and I can tell when something doesn't add up. The doctor here wants me to take it once a day starting in the morning before meals. and it never stays below 140 during the day after three meals and maybe a snack in between. Then I was given the Novolog to take before meals, but not take it if it's under 110, which I thought was ridiculous. This is what bothers me. If you know so much about how to treat T1D, why have me on this regimen that is detrimental? I've been told and had drilled in my head by previous doctors, co-workers and relatives, who either know someone or have it themselves that anything over 140 was considered too high. I'm ready to "Up Jump The Boogie" and move on to another PCP because I don't agree with anything over 140 is okay. IT'S NOT OKAY!!!!
