Rapid Acting Insulin

Does anyone give their child rapid BEFORE their meal? We were told to give it after and carb count. My daughters BG after meals is high so we are changing her ratio - but we are wondering if it\s ok to give her 1/2 a unit of the rapid before and if necessary (depending on the carbs) give her the rest after.

I have two children with diabetes. My fourteen year old take it before a meal. My 18 month old baby takes it after. The reason why the baby takes afterward has to do with his age. There is no way to tell he is going to eat a certain amount of carbs you have to see what he does. You don’t want to risk giving him a low. This may be why your daughter is told to take it after because of her age and playing it safe from the lows. If you think your daughter could eat the carbs you tell her, will eat the carbs you bolus for then talk to your doctor and see if they think she is ready. In most cases before is better, in cases with infants and young children you have to way it out sometimes it is going to be that after is better.

We were told to prebolus Novolog by fifteen to twenty minutes. But she will eat everything you give her, once insulin is given (it makes her hungry). If you have a young child who is a picky eater, I would probably prebolus for some of the food and bolus for the rest after she has eaten if she has a pump. If on MDI, I would just bolus before eating but make sure she eats everything or you can substitute juice if she won’t finish her carbs.

Gigi is almost 3, so she can be an unpredictable eater, but we have found some ways to deal with that. There is no question that pre-bolusing helps to keep the BGs from spiking after a meal, but as others have mentioned, the downside is a low BG if your little one does not eat all the carbs that you bolused for. Typically we bolus Gigi 30-40 minutes before she eats (if she is at or above her target), or 10-20 minutes before she eats if she is below her target. If she is low (70-90) and/or trending down (insulin on board), then we will bolus after she starts to eat. If we are concerned that she may not eat her regular meal (ie, because she had a big snack earlier or has not been feeling well) then we will usually pre-bolus for 1/2 of her planned meal, and then give her the remaining bolus, if any, after she is done eating.

Although not a good habit to get into, we can almost always give her soy-milk to make up any carbs that she leaves on her plate, so we don’t worry too much about her not getting enough carbs to match her insulin. Her BGs are just so much better (steady) when we pre-bolus that we just try to make it work out by spacing her meals and snacks so her eating habits are more predictable. She is a toddler, so it is never perfect. If you have a really unrpredicatable eater then I agree that it is probably better to wait and see in order to avoid risking a low. I have also read from others that some kids will figure out that if they have been bolused for X carbs, and they don’t eat them, then Mom and Dad will break out the ice cream to make up those carbs (or jelly beans, or chocolate chips, etc)

My son also goes too high after meals, so we have recently started giving meals in smaller portions and give insulin bolus after each portion. We end up giving 3 or 4 boluses for each meal, but is better than waiting until he is finished eating.

number one… is she on a sliding scale? if so make sure that you follow the diet and make sure that she do ate anything without you knowing

Yes. In fact, we were told to prebolus 15 minutes. Don’t prebolus anymore unless it is a problem food as she is such a slow eater. Will prebolus only very fast acting carbs.

My daughter will turn 3 on tuesday and she was diagnosed at 13 mos. She is using an Animas Ping pump.
I normally bolus 10 - 15 minutes before her meal if she is high. If she is on range I bolus when she starts eating. If low I wait until she is on her normal range to bolus.
I found that if you know that she is going to eat exactly the carbs you give her, I just go ahead and bolus before all her carb count.
If I’m not sure (as she is a toddler) and has those days when I’m just not sure she is going to eat all, I bolus 50% of her meal when she starts eating and the other 50% when I see she is going to end her plate.
Although sometimes I bolus for all and she does not eat all, than I compensate giving her food she likes. for example there are some pretzel sticks that have 1 carb per stick, or apple with skin…
If she tends to be high after her meals you should look at what she eat, her dietitian told me that it’s always important to balance her meals. I try to include protein, grains, veggies, fruits and starch. Since I started including all those components she is doing soooo much better.
I read a book about glycemic index, too, which tells you by type of food which are absorved much faster into your system making a peak in glucose… It really helped me understand how different foods impact her numbers.