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Breakfast spike please help me

Gemmablower

Well-Known Member
Messages
178
Location
solihull
Type of diabetes
Type 1
Treatment type
Insulin
I can't stand to see the breakfast spike on my daughters cgm anymore.
My nurses don't seem to be as bothered as I am about this and tell me I can try timing the insulin before breakfast 5,10,15 min before breakfast but when I ask about what other parents do about it, there reply is they normally don't check so might miss it! This is not good enough answer for me and I know parents see it.

I know some people get away with eating porridge/shreddies for breakfast with out a huge spike 2 hours after and my question to you is please how do you do it? Is it all down to timing your bolus right?
 
I eat cereal for breakfast every day. I have my bolus quite a few minutes before I eat and that helps cover the spike a lot. I have mine approx 30 mins before, sometimes more.

I also experimented with my bolus dose as I found I need slightly more for breakfast than I would have expected.

It's a question of gradual and careful experimentation, I've found. I can now eat cereal with no spike over 8 and that's on a bad day. Usually it's more like 6 two hours after.
 
I've found that early dosing certainly helped, but another thing for me was to have yogurt instead of milk - that really slowed the spike down. How long after she gets up does she eat? Could dawn phenomenon also be adding to the spike? My understanding is if you eat as soon as you get up then the liver won't start dumping out glucose from stores and will just use the breakfast instead.
 
So she is poorly at the moment with an virus on her throat and chest and she is quite insulin resistant compared to normal and starting the day at horrible 11 and going to bed super high at 17. Increased her lantus 3 days ago. And constantly checking keytones.
Her bloods are all over the place with this illness but as an example right now she is waking at 11 and hitting horrible levels of 19/18 that's injecting 5mins before and then coming back to 10/11 before lunch. She can spike about 10 mmol 1hour after and still about 6/8mmol higher 2 hours after and still comes back into range to where she started. I know she's poorly but that spike is always there and even more now she's poorly I want to reduce it. Xx
 
Yes she injects as soon as she wakes up then eats after 5mins at the moment.
 
I'd try slowly extending that time between injection and eating.

(Also, I forgot to add that I gave full fat milk on my cereal. The fat can help slow down the rise too)
 
If it is a nasty Dawn Phenomen then you may have to look at her basal rates too. I have a pump so my DP is nicely squashed, but I'm sure some knowledgable people here can give advice if necessary.

Does her blood sugar still go up if she has no breakfast at all?
 
The timing of the bolus can make a big difference with postprandial spikes as her DSN says, quick-acting insulin like Novorapid & Apidra take around 15mins to work so if you inject ahead of your food it helps reduce the impact of the meal on bg levels.

I eat porridge 6 days out of 7 but use traditional porridge oats as opposed to the instant variety like Ready Brek, the reason being that when oats are highly processed they take less time to digest and will raise bg quicker than oats that are not highly milled, so Jumbo Oats, Irish Oats or Rough-Cut Oats are preferable over the Instant Varieties. Also by adding some fats by the way of seeds or natural yogurt helps slow down the absorption and it also helps bulks out the meal and keeps hunger at bay till lunchtime, I add linseeeds, pumpkin & sunflower seeds to my porridge as well as a generous spoonful of Greek Yogurt and a handful of frozen blueberries.

However Gemma it may be the case that your daughter just can't handle cereals of any sort on a morning without seeing a bg spike, some type 1's have to avoid them completely as no matter how they time their insulin they still end up in double figures, if this is the case with your little one then it would be best to avoid them and look for an alternative, eggs make a great and nutritious breakfast so something like scrambled eggs on a slice of seeded wholemeal bread may be better or something like poached eggs on toast.
 
Ok thank you for your help guys. I think the illness will be adding to the spike @himtoo she is not on fixed doses she has 20:1 ratio in the morn and eats 30g in total. 16g porridge or shreddies, 5/7g milk full fat and some in beaker and a 10g petite filous yogurt.
@noblehead the porridge is Quaker oats? Maybe we would do better giving the yogurt first? Could try this. I hope she can have her cereal I'm going to give it a good shot in timing etc but yes difficult with illness right now. Thank you x
 
Just mix the yogurt in with the oats, but maybe try using Jumbo Oats (not sure what Quaker Oats are like) and see if it makes a difference, they tdo ake longer to cook mind.
 
Porridge is a very hi carb breakfast, looks like she can't handle the oats, you need to find an alternative that is low carb that your daughter will enjoy.
 
I'd check the carb count (not doubting that you can count, it's just that sometimes you can re-count and realise there's a little extra here and there that can all add up).

I'd also bring her injection forward.

Finally, if there's still a big spike - and obviously only do this if you're confident and be very cautious - I'd look at increasing her bolus slightly. I need a higher ratio for a carb breakfast than I'd do normally.
 
I can't really check her basal by fasting her in the morning unfortunately as she's only 2.5.years old.
She has her lantus in the morning and fasts for 13 hours at night so can check the basal at night.
Things today seem to be calming down in terms of illness effecting numbers so fingers crossed the same tomorrow and I will carefully try injecting a little before and the other advice that has been mentioned. Thank you x
 
Ah no, you wouldn't want her not to eat at that age. It wouldn't be fair.

Wait until her illness is gone and her sugars are back to normal before making any changes. It must be hard with such a young child. I can't imagine how difficult that would be. It sounds like you're doing your absolute best for her. Nobody's blood sugars are perfect all the time and with a growing child you have so much more to think about.

Best wishes
 
Just a thought (and please run this by your nurse before you try it as I have no experience with a child of this age being diabetic) but could you have the lantus at night? It takes a good while to start acting (I think it's at least an hour before it does anything at all). If you moved the injection to night time then she would have basal insulin in her system already when breakfast comes along, as you are now she has no basal insulin at a time when dawn phenomina is likely kicking off (Lantus only lasts about 20 hours although I find it even less than that!)....
 
T
thank you I see exactly what you mean and will Look at that but first...
I have spoke with my nurse this morning and going to make a few changes gradually. Now that she is not poorly her numbers are settling down a bit.

The spike is still there in the morning but no where near as bad, she started at 7mmol this morning she woke unusually at 5.30/6 am which is normally what happens when her numbers start to come back into range after illness or a spout of highs for a week so held of till 8am to have breakfast and there was no rise at all.
I do think though her basal is to high and ratios now need to be adjusted to give her more insulin and that could be partly why shes sitting at 13mmol 2hours after breakie and only coming down after 3.5 hours after insulin. She does the same at lunch time. The drop is always between the 3rd to 4th hour after insulin.
This sounds like basal kicking in and mopping up a few glucose what do you think?
It's so tricky...
Originally she was purposely sent high at night and still waking at 5/6mmol as dealing with such little units per meal that the only way to give extra insulin through the day was to give more basal and this worked for a period of time.

I now feel that getting her down at night time to around 11mmol and putting basal back half a unit she will then have a flatter profile through the night and will be able to tighten up the day time ratios. I have discussed this with my team and going to give it a shot over the next week or so.
I will work in the spike again with morning injection a bit earlier when I have the doses right. Working progress, let's hope anyway. Thanks for all the advice Xx
 
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