any ideas?

[Mini-Mimi]

for quite a while now we have had high readings 2 hours after breakfast,(today she is 18) if i correct it, then she'll be hypo before lunch, if i leave it, she'll be on target before lunch, but i dont want the high reading in the 1st place...................any ideas what i could be doing wrong or what i could try?
were on i unit of levimir in the morning, then her ratio is 1:10 (novorapid)for breakfast, 1:15 other meals, and 2 units of levimir at bedtime.
any ideas/advice is greatly appreciated.levels the rest of the day are mainly ok.

 

[wsmum]

Re. correction doses. My son goes down 8 mmls with one unit (!) so we have a half unit pen which makes things easier. It does mean he can only correct if he's quite high, but there is always a danger that he'll go hypo ... agree it's much better to avoid the high in the first place
I'd think about tweaking the breakfast ratio in this situation. As your daughter is so young I imagine she doesn't pack away the huge breakfasts that my 14 year-old gets down him, so I suppose tiny amounts of insulin might have quite a big effect? Hopefully other parents with little ones will chime in here. Good luck, Catherine

 

[leggott]

it sounds like the levemir is the culprit here but you will probably need to do some fasting tests at breakfast to find out what is going on.

We had a similar problem with my son, if I gAve more novorapid at breakfast he would be hypo by lunch. We overcame this by giving him a small snack at ten am which worked well. His fall however was down to the levemir which we couldn't alter as he would be too high at other timed of the day. ideally you want bloods below 10mml two hours after eating, so there is a bit of tweaking necessary.

Worth giving her a non carb breakfast one morning and then checking bloods every hour until lunch. if she is falling then the levemir is to blame. A small fruit snack or biscuit may be necessary if you are unable to amend the dose of levemir if all other readings are good.

 

[SophiaW]

It sounds like your daughter needs more rapid with her breakfast to keep her readings down and then a mid-morning snack to keep away any hypos that may occur later before lunch. My daughter was the same when on MDI and that is how we dealt with it - a small mid-morning snack. Now she's on the pump we can adjust the basal hour by hour so avoid the problem.

 

[Mini-Mimi]

she usually has a bowl of cereal for breakie, say 50g of carbs, and now an then i may have to correct her morning reading, she sometimes wakes at about 10mml, so she'll have between 5 and 5.5 units of novorapid yet she is still really high 2 hours later, i'm reluctant to give her more novorapid cos to me it seems a lot for a child her age (but then i still cant fathom out this whole diabetes ride) and the 1:15 for other meals works fine. i have a pen that works in 0.5 units, should i try giving 0.5 of levimir when she wakes, my dsn has told us to persevere but i want to try lowering that reading.

 

[leggott]

I find that my son needs more insulin in the morning to cover the same amount of carbs any other time of day.

it sounds like you may need to up the novorapid at breakfast and resort to the snack mid morning to ensure a good 2 hour reading after meals. I wouldn't be concerned about the amount of insulin too much, your main concern is to get her bg lower after the 2 hour mark.

Managing diabetes in small children can be tricky so don't beat yourself up too much. My husband also has type 1 and has excellent control which he works hard to get. We put even more effort in with our kids, but we still don't always get the result we anticipate. Growth, hormones and activity levels to name but a few are all things outside our control.

 

[annettekp]

Hi I find it so interesting that kids are all so different. If Erland had 50g of carb for breakfast he would be high after 4 hours! We try to give him between 30-40g of carb each meal. 50g is just too much for his body (and the insulin) to handle at one time.

Sounds to me like you need to adjust your breakfast ratio, make sure she has a snack and keep an eye on the levemir (aswell as everything else you have to do!)

Erland is 3 and he has 4.5 units of levemir in the morning and 2.5 at night. We have a sliding scale we work with for his novorapid. He get 2 units if he has 30g of carb with a blood sugar reading between 6 & 15. We adjust it by 0.5 if he eats less than 25g, more than 40g or if his blood sugar is lower than 5 or higher (and yes it is sometimes) than 16. its rare for us to give him more than 3 units of novorapid at a time. But it works for him.

Annette

 

[jopar]

It could as leggot say be her levemir out.

I would try a morning fasting test to see what her basal is up too, this will give you a better guide to how to tackle her breakfast jab..

As it may be a complination of factors..

Some of the problem could be to do with her resistence during the morning and she's crossing over from one to the other.. So the hypo is being caused by the tail end of the novorapid being more effective due to less insulin resistence at that time of the morning/day..

You could try pulling her injection forward, so instead of injecting the 10/5 minutes before breakfast you inject 15/20 minutes before, so that the insulin in starting before she starts spiking! It might also help with the tail end of the insulin effect burning out before her resistence factor changes..

It might be that changing something like Aprida insulin, which hits the system and burns out a lot quicker than novorapid or humalog would be a better.. So it's out of her system later in the morning..

I get a time slot in the morning, where I get problems with cross over of insulin resistence if I eat at 10am my carb/insulin ratio is correct and I have no probs through to dinner time, but if I eat between 10.15am-10.40am I get the problem my ratio's are the same at 10.am, but this puts me in the pardigament that the tail end of my insulin hits my lower ratio point causing a hypo...

When I was on injections I sort of just avoided eating around this time, if I did I would dependant on my levels either inject all about 25 minutes before hand, if BG was on the low side, I split my injection, enough to prevent hypo before I ate, but enough to get into the system, then I would inject the rest when I ate.. Life is so much easier on a pump, still haven't fully resolved this time patch with out having to faff... So tend to avoid eating between these times..

 

[Jen&Khaleb]

I'd use the option already suggested. By upping the morning short acting and give a bigger morning tea you should smooth out the day. I imagine that if you reduce the Levemir you end up high in the afternoon. This would be what would happen to us anyway.

 

[SophiaW]

Just to give you an idea of how it worked for Jess when she was on MDI. Her breakfast ratio for rapid acting insulin was 1:8, then 1:13 for lunch and 1:12 for supper. Her breakfast is usually around 30g carbs. If she's insulin resistant in the mornings, as many people are, then she needs more insulin to cover the carbs even if this seems high compared to meals during the rest of the day. You could also try giving her less carbs for breakfast as 50g is quite high and makes it more difficult to work with if she's eating that at an insulin resistant time of the day. A smaller breakfast and then a mid-morning snack will keep her going until lunch. You could try adding some carb free things like an egg to her breakfast if she's particularly hungry at that time of day. Jess loves a soft boiled egg with a slice of toast for breakfast or scrambled eggs. They're fairly quick and easy to make in the mornings. The other thing to look at is what type of breakfast cereal is she eating? Some of them are very high in sugar which don't give you that long slow release of carbs, they hit the blood stream fairly quickly giving a spike early on and then a hypo later on. Adding a banana to her breakfast might help to give a slower release of carbs over a longer period.

 

[Mini-Mimi]

thanks for the replies, they've come in very usefull, i'll admit that i havent really thought about what she has for breakfast, she usually has the same as my son and i now realise that some cereals make her way higher than others so i'm going to concerntrate on changing her breakfast totally, she loves fruit so maybe a fruity breaky will be more suited to her, i've also been told to lower her morning ratio to 1:9, so fingers crossed we see an improvment, thanks again

 

[SophiaW]

A fruit breakfast will probably work well. Jess loves fruit salad and she often has that with some plain yoghurt sweetened with maple syrup (you can add how much you want so have control over the amount of sugars). Banana is high in carbs but it is low GI so not all bad. Other fruits we use a lot are melon and berries as they are low carb so you can bulk out a fruit salad quite well with them, as opposed to something high in sugars like grapes.