Maybe I didn’t explain how he tests. A typical day is:
Wake at 5:45, test & eat
7:00 test before cross country practice
8:30 - test after cross country practice
Between 10&11 - test before snack
1:00pm - test before lunch
3:00pm - test before athletics class
4:00pm - possible test if staying after school for band or other activity or if athletics was strenuous or if played basketball
6:00-6:30pm - test before dinner
9:00pm - test before bed
Midnight - last parent to bed tests
2:30am - parent tests if change in basal, sick, low during day, or other weird numbers
So, on an average day, he tests 8-10 times per day. As I look at this, it looks as if, by virtue of his schedule, we do test about 2 hours after most meals even though the reason he is testing isn’t to see where he is after a meal but rather to prepare for the next thing on his schedule.
He only recently began testing high sometimes, and his lows have been reduced a lot since he got his pump. His last a1c was 5.8, so, I guess with the combination of 8-10 tests every day and having a good a1c, the endo and I assume we’re at least fairly close with his ratios.
Sounds like you and your son are, in general, doing great, Austinmom! (I’d love to have an A1C under 6!).There is so much to learn, and you have done a great job in the short time since diagnosis!
But if, as you mention in your original post, you are starting to see highs after meals, and you feel his honeymoon is ending, it might be time to start looking at tweaking his I:C ratios, which the two hour post prandial test will help you to look more closely at. Since testing is a pain (literally!) and test strips can be limited, I always like to look at testing with purpose. DLife talks about “testing in pairs”. When you test before a meal and then two hours after, it gives you clear information about how the meal affected the blood sugars, which waiting to test before the next meal does not necessarily do.
Btw if you don’t have the books Using Insulin and Pumping Insulin by John Walsh, I highly recommend them!
We were always told to give Novolog before eating, then advised to prebolus. After switching to Apidra we don’t prebolus as it is faster. I’m would not prebolus for babies and toddlers or any child that will not finish eating the whole meal. Maybe I would bolus half up front and half after. A spike of 200 happens for us whether we prebolus, use faster insulin; I can’t prevent that type of spike all the time. I can prevent the spike only by changing the amount of carbs and type of carbs she eats. For instance, ice cream never spikes her over 140, but an apple will spike. You have to take into account the duration of the insulin. If Novolog lasts 4.5 to 5 hours, she must be 180 to 200 at the two hour mark or she will go low. Apidra is gone in 3.5 hours (for her) so you can time the spikes better. You can overbolus to avoid a spike, then fill in with carbs two hours later to avoid a drop (dangerous unless you are right on top of it). Smaller meals with carb counts around 40 work out better with insulin than 60 grams, but we do give 60 grams or a little bit more some times for dinner. You will have to observe carefully. You will find favorite combinations of food that your child can handle. It’s tricky. Keep a written food, insulin blood sugar exercise log to help.
