Levels

[martina]

Hello, I was just wondering what others would be doing with these morning levels. I'm just wondering if I should b looking at reducing the breakfast bolus or not. Monday on waking 7.6, 2hr later check 4.9. Tuesday woke 6.7, 2hr later check 6.0. Wednesday woke 6.4, 2hr later check was 5.6, Thursday woke 6.8, 2hr later check was 6.9. Many thanks Martina.

 

[steve_p6]

Bear in mind meter accuracy may be making you see more change than is really going on. Those numbers are looking fine to me. I assume you eat and bolussed at the start of the 2 hours? Only other question would be where the BGs end up after 4 hours when the bolus has largely finished.

 

[martina]

Yes, my daughter does the check at school 2 hrs after breakfast so we know if the bolus is correct. The problem we are having is that she has had hypo's the past 2 days at 11.15 am and I'm just wondering if its basal change or bolus. It kind of depends on who you speak to but I think if I was to reduce the bolus with breakfast I would be pushing her up by 10am, If this makes sense.

 

[steve_p6]

Sorry missed your reply, that was reason for my followup question about what happens later, at 2 hours she has probably have only used 50-60% of the bolus. We will see what others suggest but maybe a small snack at 2-3 hours will give the BGs a boost before she goes hypo.

 

[azure]

I was going to suggest a snack for the low too. It doesn't have to be a big snack - she'll have to experiment with what works for her. When I have a 'medicinal' snack like that, I use something like a 10g carb digestive biscuit and then I try a whole biscuit (10g carb) or one and a half (15g carb) to get an idea of how many carbs my snack should be. After I'm happy, I can then vary my snack.

I too think the morning blood sugars look ok. The only thought that occurred to me was the timing of the breakfast bolus. Sometimes if you have it right before breakfast, you end up having more insulin to control the spike whereas having the bolus earlier can often mean you can reduce it slightly. That might be another thing to experiment with to avoid the lows at 11.15am.

 

[martina]

Thank you, I adjusted 9am basal as thought this would be affecting 11am reading, but these readings make me wonder as despite being 7.1 at 10am and having a 10 carb snack she was still 4.1 at 11am. Then for some reason rose to 13.8 by lunch at 1.10pm. I think the high at lunch was perhaps caused by her over treating the Hypo. (she had 3 glucose tabs and a biscuit). Or maybe it wasnt the basal that was causing the low.Basal testing on Monday morning would probably be a good idea.Martina

 

[1Sarah1]

Hi did she do any activity at school? Sometimes rushing about or excitement may impact. (How old is she?)
I think the morning tests look fine too. What time is breakfast compared to bolus? Snack definitely important too.

 

[martina]

Was just a normal school day, no extra activities. She is 12 years old. I was gonna basal test Monday to see what was going on but it wont be a typical morning as they are at another school for a project. She has a pump and I thought if I changed the 9am basal it would be working on the 11am reading. Unless it is the bolus causing the low at 11am, I'm a bit worried now for Monday as I don't really know what to do. Breakfast is at 8am and her carb ratio is 1 to 6.I give her the insulin 20 mins before multiwave or extended it just depend on the reading

 

[iHs]

Was just a normal school day, no extra activities. She is 12 years old. I was gonna basal test Monday to see what was going on but it wont be a typical morning as they are at another school for a project. She has a pump and I thought if I changed the 9am basal it would be working on the 11am reading. Unless it is the bolus causing the low at 11am, I'm a bit worried now for Monday as I don't really know what to do. Breakfast is at 8am and her carb ratio is 1 to 6.I give her the insulin 20 mins before multiwave or extended it just depend on the reading

Hi Martina

I always allow for a 2.5ml rise at the 2hr mark after eating food and doing a bolus so for me using the target of 6mmol before a main meal, I look to be 8.5mml at 2hrs and then about 7.5mml at 3hrs. If I was less than 8.5mml at 2hrs, I would either wait until 2.5hrs had gone by, test bg again and probably eat a 5g carb snack to deal with the tail of novorapid or risk starting to feel a bit low by the time 3.5hrs has gone. If daughter is less than 8.5mmol at 2hrs, then a small snack will deal with the remaining IOB. How much of a snack will be needed?.........trial and error unfortunately. Have you tried using the Combo to work out the carb calculation bolus but instead of delivering the amount, try entering the carb amount first without the bolus, then wait 10mins and enter the bolus without the carb amount. That should enable the carb bolus to show up on the top left hand side of the bolus advice screen as a correction and then as the hours go by, the correction bolus will be less and by doing a bg test, you should be able to see how much carb might need to be eaten to use up the remaining carb bolus. This might be easier to do though if the standard bolus is used instead of a wave.