I need to figure out if my DD's carb ratio for the morning is off or if she just really needs a good amount of protein with breakfast.
She was 160 when she woke up this morning, a bit higher than I'd like, but this was her birthday weekend with grandparents in town and you know what excitement does to BS.
I gave her 1.5 units (we are MDI still) for a 35 carb breakfast, cherrios and milk. Her CR is 1:25 for breakfast, correction factor is 1:200. Usually I give her scrambled eggs or something with her cereal for the protein, but this morning she wanted a hard boiled egg, something I didn't have any of, so she just got her cereal.
I checked an hour later and her BS was 344. She also got her Levemir at the same time as her Novolog for breakfast. We do Levemir morning (1.5u) and evening (1.0).
What should we see 45 min- 1 hour post meal in terms of BS? I have read that it should only be 40-50 pts higher than the pre-meal reading.
Molly is on her way out of her honeymoon so everything is getting a bit scrambled and I am having trouble making heads or tails of what needs to be fixed.
A couple thoughts. 1:200 is a very large correction factor! You said she is on her way out of her honeymoon so perhaps that ISF needs to be altered. You will want to keep careful records and through trial and error gradually reduce it until you get the new ISF. I wouldn't do those trials before eating but to correct after so food won't be another variable.
Then speaking of food. Cereal, unfortunately, is one of those foods that many of us can't eat at all no matter how much insulin we take! It just doesn't work. I've tried every kind of "healthy" "hi fiber" cereal etc and finally gave up. Perhaps it worked ok for her when she was in her honeymoon and no longer does?
I don't test 45 minutes-1hour. I just test at 2 hours because that is a typical peak time. Personally I don't think in terms of "40-50 pts higher" but in terms of an absolute goal. My goal post prandial (like many of us) is under 140. So if I started at 160 I would probably correct first and wait a bit on breakfast. If this were not practical I would be sure to add a correction in according to my ISF. Then with my I:C ratio for carbs the post prandial would hopefully be under target.
So bottom line - possible change in ISF and what she can eat.
I agree with Zoe about the cereal. It is one of the few foods that I found impossible to dose for. But if your daughter is going to eat cereal with breakfast, eating protein at the same meal will slow the spike somewhat. I try to eat the carb intensive parts of my meals towards the end so that the insulin has a chance to catch up. For example, I eat egg beaters for breakfast before I have my toast and milk.
The ratios you are using are honeymoon ratios. If the honeymoon is ending everything will have to be refigured - basal, carb ratios, correction ratios. And since kids' honeymoons end quickly, you'll probably be playing catch up for a while. It can't be helped.
I was taught (as an adult) that the 2-3 hour post spike should be no more than 30 points. 40-50 for a child seems reasonable but I would ask you endo for guidelines.
Good luck sorting this out. I'm sure you'll do your daughter proud.
the 1:200 is actually really good for now. She was 1:100 and she was constantly going low, now 1:200 will occasionally send her too low, but it's much better. The problem is being on MDI, I can't give a 20 pt correction. I can correct in increments of .5u or 1u, or I can ballpark somewhere in between, but that is asking for trouble, lol. I can correct at a minimum 100 pts, or .5u at a time, or I can draw up a "smidge" and hope for the best, but I really don't like doing that, it just doesn't seem to work.
I get a little confused with acronyms, ISF, insulin sensitivity factor, right. 1 unit drops her approximately 200 points, so that is her ISF...right?
I hate to say this, but....cut out the cereal. I know for me cereal is probably the most evil food out there. Something about the way it digests that just causes my BGs to go all wacky. As much as I love it, I feel a lot better when I don't eat it (and it's been this way since I was a kid).
Her correction factor may need tweaking. 1:200 is a pretty small correction factor and while kids are usually pretty insulin sensitive, I think that's a bit much.
If she's staying high throughout the day, she may need some more basal insulin, especially if her honeymoon period is ending.
I agree with what most people have said about cereal. Even if it's a high fiber, no-sugar cereal, and you measure it exactly it will be notoriously hard to bolus for. There is something strange and mystical about cereal that a lot of us just can't figure out or handle. Try toast instead, maybe, and see if it has the same effect. Then you'll know whether or not it's the cereal or the actual carb ratio.Good luck! Sounds like you're on the right track!
Right after diagnosis her CR was 1:30, then once honeymoon kicked in it shot up to 1:50 and now we are down to 1:20 or 25, it depends, sometimes 1:20 makes her go low, other times 1:25 keeps her high, we need somewhere in between but on MDI, it doesn't really matter since I can't dose that exactly anyway.
We are going to start the Omnipod within the month so then I will be able to tweak it down much more accurately.
Children with Type 1 are very different. There are a lot of old timer Type 1s here, but the advice we can give is old fashioned, and not as good as the parents with diabetic children forum.
We are adults. They have children who are Type 1s.
Although I completely agree with the cereal thing. Have not eaten any in 40 years.
Mornings and breakfast are difficult for me regardless of whether I eat cereal or no carbs at all. I have never found a regimen or meal that is 100% reliable. My aim is to have a plan that works most of the time and then correct when things don’t go to plan. Hormones can be very powerful in the morning, and sometimes I feel it’s a crap shoot to get things right.
I have been Type 1 for 35 years and I have never been able to keep my 2-hour BG at only 40-50 points higher than my pre-meal number unless I go low later. I have noticeable insulin action 4 hours after bolusing and the math just doesn’t work.
I am currently eating fairly low carb (60-80g per day) and I have definitely minimized highs and lows. But I still don’t flatline or have perfect results from day to day. I used to be able to have cereal for breakfast as long as I exercised immediately after eating. However if I didn’t go high, then I usually needed to snack mid-morning to avoid lows.
I don’t have great advice for you except to keep fighting the good fight. Do your best and know that perfection is not possible. You’ll have to balance everything you read here with reality and with your endo’s advice. Type 1 in children is usually more volatile than with adults because their bodies are so small, they are growing, and there a so many unknown and uncontrollable factors.
I have dawn phenomenon every morning after breakfast so I always do extra insulin for my meal, but then it can cause problems later, and being on the pump I then cut back on my basal for a few hours.
Anytime I start a meal with higher than a normal reading I will go high. The best is not to eat on anything but a normal bloodsugar. Also shoot up the correction and dosage for the meal and wait awhile before eating, to get bloodsugar in normal range.
I DON'T EAT CEREAL, and with diabetes it is not an exact science and everyday is different.
The only cereal I can eat and accurately bolus for is Kashi Berry Blossoms cereal. Also I think milk has a LOT of unnecessary carbs in it. You might try giving her unsweetened almond milk instead. I love it. It took a little getting used to but I love it more than milk anymore..and instead of adding another 13-15 carbs...I cut that down to 1 carb for an 8 oz serving. I agree her rates/rations are going to be crazy for a while, and definately if you are planning on getting her on a pump soon that will make dosing in my opinion a LOT easier, more able to fine tune it, and if you see you are going low, you can do a temp basal rate, and recover relatively quickly. I love my pump. Have been diabetic almost 30 years and spend the good majority of it on shots that never seemed to work. Good luck.
