Purposely overdosing to cover snacks with a grazer?

Does anybody do anything like this?



Here’s my dilemma with my 4 year old diabetic in the afternoons with snacktime(s).


  1. We need prebolus our meals AND to wait a full 3 hours to let the insulin work before eating again. Makes sense.


  2. My child likes to eat small, healthy things frequently throughout the day. As part of parenting and diabetes care, I’m trying SOOOO HARD to follow the ‘wait for 3 hours’ rule. Personally I think it’s healthy to eat small things throughout the day, but with diabetes not so much. She’s a small girl. Filling foods or no filling foods - this has become an impossible thing. She’s always hungry before the 3 hours are up. Snacking on veges all day long as a free food gets old, right? It’s a combination of fast metabolism, boredom, and immaturity and is creating a LOT of stress in our family listening to her saying “I’m hungry” all the time. Constantly trying to distract her from the snack idea is exhausting us.


  3. We have postprandial spikes in BG no matter what I do.



    SOOO…

    I am calculating out how to bolus for lunch and snack together, but splitting the eating. In theory, the ‘overdose’ would help with the post meal spike, and then the extra insulin would cover the much needed snack before she crashes.



    Example:

    -Bolus 40g for lunch 60% now and 40% over an hour and a half.

    -Eat only 25g for lunch.

    -At the hour and a half mark (or something like this) eat the other 15g.

    -Then, at the 3 hour mark check a fingerstick BG and see where you are for bolusing for the next snack like normal.



    We pump and use CGMS.



    And I know someone is going to say, “what if you forget that you overdosed her?” Trust me. I won’t.

I think that if the hunger is satisfied by something healthy, then she is hungry and should not be denied.

I do not have children, but I have noticed that when children say they are not hungry - but suddenly are when it comes to sweet things - say leaving the majority of a main course and then find room for a cake or pudding then it is playing you up and holding out for something that it is nicer, but when a child is truly hungry then it will eat anything it is given, healthy or not.

Your daughter might be hungry if her blood sugars are going down rapidly (even if they seem a bit high at the time) - this happens to me, I feel hypo, but really I am not, it is just because I am dropping - and because my body has been used to being high - anything lower feels like a low. Now, I am an adult and can usually work this out and ignore this, but it is sooo unfair on an active child to deny them something when they truly are hungry.

I think the 3 hour rule you have been given is not the norm. She is a growing, and presumeably active little girl and I am sure that most of the adults on this site will agree that we normally are instructed to test at 2 hours.

I think overdosing is a dangerous thing - what happens if she is sick after the overdose and cannot keep food down or a sugary drink? You may not forget, but if something were to happen then how would you deal with that?

If this is your doctor’s ruling, then I suggest you go elsewhere to a more child savvy endo.

I agree w/ LC that it’s dangerous. I have some friends w/ a 2-3 year old iT1 and I think their usual plan is to dose her after she eats and estimate what she ate?

I have a child, but he is not diabetic. (But I am scared constantly it will happen, but I digress…)
I understand the grazing thing, I used to work in a kitchen where food was available all the time, and just… dissapeared into my mouth. That being said, it is hard to answer your question without knowing what your child is eating. How much carbs is she eating per meal as a percentage?
Your child is growing, and whoever says that a 3 hour window is the way to go is only covering their butts. (In order to allow the tail end of the insulin to taper off.) When I was first diagnosed, I was given an amount of insulin to take at breakfast, lunch, dinner, etc. An arbitrary number, where I was required to eat X amounts of carbs to “cover” that insulin I took. In effect, the exact same thing you are proposing.
One thing I discovered is that there is too much swing from all those covering carbs. Your daughter is complaining about being hungry because she has burned through those carbs like kindling. My advice? I am not an endo, or a dietician, but here goes:
You need to introduce more fat to your daughter’s diet, and reduce any carbs that are grain based. The reason for this is that they burn quite quickly. (As evidenced by the glycemic load, or GI if you will.) That includes rice, breads, etc.
Now, people may squack and say, “you need carbohydrates to live!” They are right, but no one says it has to be from grains!
I would go with vegetables, fruit, meat/eggs/nuts, and good fats. (Like lard, olive oil, matzo, bacon fat)
The main meals should be the baseline - where you are bolusing. So, it looks like this:
1/2 plate vegetables, 1/4 plate meat or eggs, 1/4 “carb” of legumes, pulses, potato, or other “vegetable” source (not grain.)
This meal should cover that 3 hour window without that gnawing hunger that occurs after 1 hour of eating. (Think of the Chinese Buffet effect - where you are hungry an hour after eating because of the rice, sugar-laden foods you eat.)
If a snack comes up, then make it something that is “free” or low-GI, that will carry her over to the next meal. That could be a handful of almonds with some dark (99%) chocolate, or a hard boiled egg with salt, or a celery stick with peanut butter and a couple of dark chocolate chips.
I realize that it might be hard with a 4 year old to follow this regime - but talking from experience (my mother when I was young, and with my boy - also 4 years old) that they will eat what you eat, as long as you involve them in the decidion process, and make it fun. In the example of the celery stick with the peanut butter plus dark chocolate chips - your daughter will be all over it if she gets to help make them, and put the two or three chocolate chips on the “log”.
You shouldn’t need to bolus for the snacks, as by the time you are eating the next meal, they are just starting to break down for the next meal. If there is any concern with BG, as yopu are testing for the next meal - you can add a correction bolus for your daughter.

In my case, I went on a sliding scale with my insulin, then I “graduated” to covering the carbs I eat. I went from taking 20 units of levemir and 22 units of novo rapid per day to 22 units of levemir and 6 to 8 units of novo rapid per day. My BG sometimes climbs high if I am stupid (like eating PIzza and not covering it correctly,) but I normally keep within 7 at times, and my A1C is around 6%.)

I hope that helps, if there is anything I can help with, message me and I will try to help you!

Attempting to cover fast acting carbs with insulin, your child will always be on a blood sugar roller coaster. The only way is to reduce the carbs and increase the proteins and fat. You will also notice your child will not be as hungry once you increase the protein since it takes longer to digest. It also makes blood sugar management much easier.

My A1C is 5.2 ---- with that in mind I have a pump and a CGMS. I do the very same thing. I take extra insulin so I don’t have a huge spike in my meals. Then around an hour or 2 later I know I am heading lower so I have a 10-15 carb snack and level off around 110-120. I know people say that is wrong but it works for me. I rarely spike and I snack often after each meal. I am very thin also so the added weight isn’t a problem.

Agree with Jim about adding protein. Protein fends off hunger & growing bodies need a lot of protein. Carbs make us hungrier. Does she like peanut butter or cheese? The combo of fat & protein may be just what she needs & these will help her BG be more level.

Her sensation of being hungry is likely a real signal from her brain. I wouldn’t just assume that it’s not.

Blood-sugar fluctuations are real. They impact the brain in real ways. Just because her hunger isn’t “normal” that doesn’t mean that it’s not “real”. She isn’t “normal” but she is “real”.

Most diabetics will report feeling like they could eat everything in the fridge after a bad hypo. I am STARVING after a bad hypo and it takes all my strength, as a 54-year-old woman, to distract myself and watch the clock and wait until my blood glucose rises enough after I’ve treated a hypo for the hunger signals to settle down.

When “normal” children go through growth spurts, they’re very, very snacky and hungry all the time, too.

It sounds like you’re doing an amazing job of trying to juggle all her needs, and I applaud you for it. I just wanted to weigh in on the issue of her “not starving”. If her brain tells her she is starving, then she is experiencing starvation, no matter how well nourished she may be. If you can distract her, that’s good, but please don’t forget that our brains are wired to respond to chemical signals which, in diabetics, are not always in sync with external reality.

I like your thinking. Meat roll-ups (e.g. turkey and cream cheese) would be much more satisfying over time than say, animal crackers or raisins.)

A lot of the high-carb finger-foods people feed “normal” children would probably cause quite a roller-coaster in a diabetic child.

It’s kind of like asking your mother in law for advice. Some of the advice is wanted and a lot of it is not.:slight_smile:

I am sure that people aren’t meaning to anger you, but given what you are asking, they are giving the best advice that they can. I can’t find one instnace where someone talked about you feeding animal crackers or rasins… but I could be mistaken.
You asked, " In theory, the ‘overdose’ would help with the post meal spike, and then the extra insulin would cover the much needed snack before she crashes."
What people are trying to say is that you may not need to if you change your paradigm on what you are feeding your child. The point is to avoid the crash so your daughter doesn’t need to compensate by eating again. I don’t feel that it was in any way a slight against your excellent parenting skills. Please don’t get angry.

Agreed. Plus, using words like, “overdose” will get more opinions than most. She is talking of her daughter there, not herself. Poor choice of words, IMO.

I have recently found that a 30 minutes square bonus before I eat has helped with my post meal spikes. Plus since it is spread over 30 there is not as much of a slam of the peak of the insulin.

Hi Montanasugar: I hope you found some good tips from the members here. I’m trying to retain some of this information for the day when I need to take insulin. As a teacher, I am learning more about students like your child. I have only been on Tudiabetes for 2 months and have been saddened by the number of members who, in that short time, have stopped participating because they felt that they had issues with certain members. I hope you will continue to participate and post. I’m sure that other parents have been reading this and are learning from your experience. Cheers! Joanne

Ok I bite what is a super bolus?

Did anyone recommend the book pumping insulin?

Interesting. I too have a 4-year-old with diabetes, but unlike your daughter he is not a grazer. In fact sometimes I have to really push him to eat at all. He only actually says “I’m hungry” when his BG is dropping low and he’s starting to feel it, so I know that “I’m hungry” really means “I gotta eat NOW Mama, cuz otherwise I’m gonna crash!” BUt with him, sometimes the problem is not that he’s going to eat more later, but that he wouldn’t eat everything NOW. In other words, we’d bolus for what we thought he’d eat, and then he wouldn’t eat it all, so he’d have too much insulin on board for the carbs he had accepted. And then we’d have to try to encourage him to graze!

Our way of dealing with him was not to split the eating, but to split the dosing. THat is, planning for a meal of 40 g, we gave him 20 ahead of the meal. Then, we let him eat. If, halfway into it, he showed no signs of stopping, he got insulin for the other 20 g. (This was before I figured out the square and dual wave bolus features on the pump.) He’s just now getting to the point where we can give him the full dose up front with confidence, but I would never dare do it the way you do – he’d go low for sure. But, “your diabetes may vary” is a phrase I’ve heard a lot around here, and I’ve taken it to heart.

extra bolus coupled with cutting back your basal after the large bolus.

I think you owe everyone an apology – me, especially as I’m the one who mentioned animal crackers and raisins – merely as examples of the kinds of snacks that PEOPLE IN GENERAL often feed small children.

If you go back and re-read my post, I didn’t “assume” anything about you. I merely made an observation based on five decades of being around children.

Your response was over-the-top mean and completely uncalled-for.

I don’t believe people are assuming that you don’t feed your daughter protein. They’re merely suggesting that additional protein will help because you mentioned her constant hunger.