No, I didn’t give an extra bolus as he had just eaten an hour prior to this spike up, so he had IOB with a lot of time left However, his IOB ran out at 10:48 and here is a screen shot of his CGM! Thank you guys so much I feel so incompetent about this!
Edit- I did have a meal correction added to his meal bolus but that seemed to make no bit of difference!
So if this was my child and using the correction factor you mentioned which sounds like you think 75 is reasonable (we use 35 so your is probably still on the high side my opinion), I would calculate it like:
First. Double check Dex cgm with meter.
Assume 140 target for nighttime.
Assume 75 correction
Assume 301 is starting BG
301 - 140 = 161 point drop you want
161 / 75 = 2.15 units
Probably not enough also because correction factor is not linear and it takes more at higher BG. I would probably knock it up to 3 units, bolus and watch it on the cgm.
This exactly. What did he eat?
We went out to a Mexican Restaurant tonight, he had 15 tortilla chips with half a cup of cheese dip, and fries and grilled chicken! Ok I will give a correction and see how it does! How long does it or should it take to see an effect? I have never given a correction outside of meal time so I have no idea yet! This is what the correction information says in my binder from his Endo and Childrens Hospital below! Also, what about him honeymooning would that affect your advice?
And I did have a class with his dietician, however, this was a day after being released from the hospital stay and I was in such a way that I just could not comprehend any more information! I had not slept in days and was on auto pilot. So, does the carb ratio go out the window depending on what the fat content is?
How many units did you bolus for that meal?
@Tim35 is replying now, I want him to give the advice at this point.
EXCELLENT !!!
The best way to learn is to do.
Note the time and hopefully the cgm will show a good downward curve and note that time. That is good information to know.
The sheets they give you are all basic starting to give you an idea. They would generally be extremely conservative. Just to get you moving in the right direction. But not blueprints to be kept and used verbatim. Everybody is different. As well, children are obviously growing.
You will find what works for your child.
And then it will change. lol. But you will also get used to that.
Ok great he is getting out of the bath then we will do the correction and watch and wait! He is also hungry AGAIN! Which I am sure is bf he is so high! And he is up wide awake at midnight! I split his meal up hoping it would help with the spike! I gave him the first half which was 2 units bf he ate and then have the last half after he ate!
Sorry I replied to your question below in the reply to Tim35.
That’s not enough insulin to cover that meal. Most of the food he ate was all carbs and would spike his BG a lot later than normal.
Although I do like to let my child eat what they want, at the same time, I do not like them going to bed with bunch of carbs and insulin working it all out and waiting until later in the night to find out how the dosing worked out.
Ideally, I like to end the majority of eating 3~4 hours before bed.
Otherwise it often ends up being the parent up all night trying to deal with correcting the late night meal. And realistically there is only so long you can do that. I prefer to keep my nighttime D related activities for unusual things that really need attention that realistically could not have been foreseen.
Ok, I have only been told to follow the carb ratio of 1:10, the total carbs for the meal was 45, 18g for the chips, he only ate half of the fries, that was 22g and the chicken was like 3g and same for the cheese dip. Or, did I make a mistake?
You followed the ratio perfectly. Unfortunately, the human body doesn’t always cooperate. Any time you eat carbs like that, the bg is always going the spike out of control. I’m not being judgemental at all. My eating habits are terrible, I’m just pointing out that the meal bolus was not enough. These are the things that you’ll learn through trial and error as @Tim35 has suggested. Don’t get super frustrated (I know easier said than done), just take note of what happens with meals and boluses. You’re doing great, even though it may not feel like it. You’re gaining a lot of experience in a very short time.
I assume by your endo or CDE?
Keep in mind that it is an average/approximation. You may want to keep notes on his common meals and what dose worked best.
I think it is less critical now to get an exact correct ratio, since realistically they are not constant. Just get you in the right ballpark. With CGMS and pump, you then do the fine tuning.
Some call this Sugar Surfing, coined by a T1D Endo in Texas. There is a book and website if interested in learning more.
Thanks, I see what you mean, he started at 1:15 carb ratio. But we seen quickly that was not adequate! It is frustrating, especially when I just want him to get better! We will get there!
Thanks for the information! I appreciate the link!
I’ve never successfully used a carb ratio for a bolus. My BG always spiked out of control when I’ve tried it. Over the years I’ve learned to guestimate my bolus and use a special basal rate to control my BG when I eat. I keep saying this, but it’s true, you’ll find the magic formula. Everyone who’s giving advice, has been in your shoes. Our knowledge was gained from decades of managing this disease. You’re off to a good start though. I would definitely call your Endo’s office tomorrow and have them look at the CGM data.
Oh I most definitely will be talking with them tomorrow regarding these issues. I have already sent them an email so they see it first thing tomorrow and hopefully get back to me soon. I am not sure how to give them the CGM info yet I need to read up on that tonight!
Open the clarity app on your phone and select share from the bottom menu. Select generate code, the doctor’s staff should have all the Dexcom software. Give them the code, they will be able to generate all the data/charts for the Endocrinologist to review.
Oh great thanks for the info! You have been so much help in these last few days and I wanted to say that I really appreciate it!
