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Lunchtime highs for 4 year old.

S

SusieT

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Hi, I wonder if anyone can give me some advice please? My 4 year old daughter (T1) has two jabs a day, one before breakfast and the other before tea (Humulin M3 70/30), she's been on this regime for about two months and it does seem to be working better for her than her previous.

However, when she's at nursery she still seems to be experiencing lunchtime highs two or three times a week (15 mmols or over sometimes) and I'm getting worried about it. I spoke to our nurse and asked if I should be going in to school to give her a unit of Humalog but said not to worry too much and she would come down by herself, which she usually does but I still don't feel comfortable with her being this high and feel I should be doing something about it. Any advice would be greatly received I still find this all so confusing even after a year and don't think I'll ever get to grips with it. Thanks in advance.
 
High's 2-3 hours after eating basically means that the fast acting insulin within your mixture (30/70) wasn't enough to counteract the quantity of food....Would you be able to identify what foods your child has on these particulars days? If so, you would need less of the food to be given on these days.
 
Sorry, I should have said in my post, the high readings are before she has her packed lunch when they do her pre lunch blood test. So she has her lunch after this reading and she'll be going even higher before coming down. I just feel that I should be doing something about it if you know what I mean?
 
SusieT said:
Hi, I wonder if anyone can give me some advice please? My 4 year old daughter (T1) has two jabs a day, one before breakfast and the other before tea (Humulin M3 70/30), she's been on this regime for about two months and it does seem to be working better for her than her previous.

However, when she's at nursery she still seems to be experiencing lunchtime highs two or three times a week (15 mmols or over sometimes) and I'm getting worried about it. I spoke to our nurse and asked if I should be going in to school to give her a unit of Humalog but said not to worry too much and she would come down by herself, which she usually does but I still don't feel comfortable with her being this high and feel I should be doing something about it. Any advice would be greatly received I still find this all so confusing even after a year and don't think I'll ever get to grips with it. Thanks in advance.
Click to expand...

Hi Susie T my son was diagnosed T1 January 2000 before his 3rd birthday in April and started nursery the next day. He was also on 70/30 ratio twice a day. We never did any glucose testing during his time in school, only if he was not feeling well. He too had some similar high levels at the weekend sometimes he came down by himself, other times I would give him some novorapid quick acting insulin (after discussing this with his DSN). It is difficult to cut down on their packed lunch as at this age they need to eat. It would be interesting to know what her HbA1c is at the moment, as my son was always in the early 7%'s. But now at the age of 14, with puberty it went into the 8's so he is now on carb counting and 4 injections (basal/bolus regime) which is new to us since February this year. Still trying to ge to grips with that. Your words don't think I will ever get to grips with it are very familiar to me but keep on looking through this forum and you will feel you are not alone and it is very informative and useful.
Hope this helps
Onwards and Upwards :wink:
 
Right, sorry...I assumed the high was after the lunchbox. So, my next questions are:

1) Do you do a test when getting up in morning or before breakfast?

If so, are these below 7?
 
Hi, My children started off on the mix, but we too experienced fluctuating bg's with bloods taking several hours to come down to an acceptable level. You are right in thinking that 15mmol is way too high and the recommended level after 2 hours of eating for a child of that age I think is about 10mmol, although I like my kids to be under 7/8 mmol 2 hours after eating.

It might be worth speaking to your DSN about the basal / bolus regime, where injections are given at each meal / snack. It does mean more needles, but kids soon get used to it and the plus side for you is tighter control and more flexibility. Interestingly enough, there was an article all about this in the JDF magazine which arrived through my letter box today, They were basically saying that this is the best regime, apart from pumping, in achieving more stable bg's and thus preventing the long term problems associated with diabetes.

People don't realise the effort that we parents make to keep our kids healthy. Looking after small children with diabetes can be challenging and extremely stressful at times. Don't be afraid to ask for help from your DSN, they are there to support you and if you are not happy with their advice then take the matter further.
 
Thank you all so much for your replies, I get so stressed about all this as I just want to keep her well.

Her last HbA1C was 9.2 which is far too high so that's why we started on the Humulin mix which for the most part does seem to giving her better numbers, but I really don't like these highs. Her nursery are really, really good and test her at lunchtime or when they think she looks pale or is cranky. I test her every morning and she is usually between 5-7.

I have been thinking about talking to nurse about pumping but my daughter was really frightened by the pump when she saw it on my friends son and I'm worried that she would freak out! I have heard about a wireless Omnipod but I think that's a fairly new thing (though I'm not sure). I will speak to DSN again about basal/bolus too. God it's all so bloomin' confusing, does it ever get easier???
 
Hi Susie

Yes, it does get easier...eventually.

Pumps are great. Indeed by diabetic nurse at my GP surgery raves about our hospital and the amount of children especially that are being able to have pumps, and how much better control seems to be with them.

There are a quite a number of parents here with children using pumps, and they seem to prefer them to the regimes that they had with MDI. A shame that your child has been put off by seeing one-was there something specific that your child didn't like??

Your DSN will be able to advise you more, but using a mixtard insulin does not give you so much control over blood readings unless you can do extra fast acting only injections to bring down the high's, and without sending your child in to hypoland.

If you haven't been on a DAFNE course, they are meant to give good information that would so much help parents regarding foods and altering insulins to account for foods.

Me personally...I actually now prefer the thought of a child having a pump rather than MDI, as MDI still has a background insulin running, that when it is injected it is in you. Whereas on pumps, you can tweak the background insulin to activitys a lot easier, and if necessary they can be stopped or reduced immediately-or raised immediately. I personally wish I had the pump years ago, but I am an adult, and can rationalise these things.

Your DSN should be able to help you to. Do consider whether it is certain days that the levels rise pre lunchtime, and what activitys she is doing on those mornings....the more info your DSN has, the more she can work with you to achieve better results on those days. It could be for example, on those days in nursery that she is less active, it could be that on those days she has had had readings in the mornings that are slightly higher, so it could be the night-time ones the night before that need to be adjusted.

Life isn't easy initially with diagnosis of D whether as an adult, child or parent. Advice from some HCP's are at odds with places such as this forum. At the end of the day, I can see how much parents are concerned with their childs diabetes, and this will go on for life...my Mum still worries about me and I am 47!!!! It can get easier, but it is going to take time, there isn't an instant fix and all of us are so individual that it makes it harder for HCP's-what works for some-won't work for others...you will get there, honest...
 
We really didn't get along with the 30% 70% mix insulin very much at all. The trouble with giving more insulin to bring down late morning/pre lunch readings is that it will also have an effect on afternoon readings because it's mixed i.e. you're not only giving more fast acting, you're also increasing the slow acting.

We tried to get around it by having the 30/70 mix in the morning, plus a rapid acting insulin to cover the breakfast better. That gave us a better reading by lunchtime. But we moved on eventually to basal/bolus because we found it far too restricting sticking to lunch times. At the time our school had two sittings for lunch and each week the sitting changed so either 12 or 12.30. Eating at 12 was fine but by 12.30 my daughter was hypo so it just didn't work very well for us.

Something else you want to check is that she's not having a hypo mid-morning and that might be causing the higher reading by lunchtime, but I doubt that's the problem. We had exactly the same thing with readings still high by lunchtime. If we increased the mixed insulin dose in the morning then we had hypos after lunch and through the afternoon.

My daughter is now using a pump and it is wonderful, I really can't say enough good about it, it's the best change we've ever made since being diagnosed five years ago. You could ask your nurse about lending you a demo pump for a week, if your daughter doesn't have it attached to her but can carry it around in a belt or pouch and get used to it not being a scary thing she may get over her fear. Let her press the buttons and play with it so that she can become familiar with it.
 
I'm not sure what triggered her fear of the pump, she just got really upset when she saw it bless her. I think that either pumping or basal/bolus is probably the way forward and I definitely want to go on a DAFNE course too. I really just want it all to go away but I guess that's what we all want.

Thank you all so much for your advice and encouragement. I can't tell you how glad I am to have stumbled across this site it's been a godsend. I read and read info on the net and books but I think you can sometimes confuse yourself even more with information overload and end up learning nothing, so reading other parents and people with T1's experiences is so helpful. I'm definitely here to stay! :D
 
Susie

There is always somebody here that has experience of things that happen throughout trying to control diabetes. Like you, I have found the site invaluable for real experiences and advice.

Don't get me wrong, I'm not knocking HCP's at all. Just that we have all lived with a new diagnosis, ups and downs, hypo's and hyper's, good results and not so good ones. We live with diabetes 24/7/365...but HCP's just get glimpses of our live's really. We aren't professionally qualified but we all gain life's experiences of living with d...

I hope that you can get on a dafne course asap, but Bournemouth Hospital have got a good dafne course online that you can look at to give you an idea of what is involved.

It is http://www.bdec-e-learning.com/

Basal bolus whether with pump or without will give more flexibility, but a pump does allow a better flexibility with living diabetes on a longer term basis, and probably less hypo's than on MDI.
 
It is always hard trying to keep a steady bsl. Khaleb (age 4) has always been on MDI and the few I know on Mixard tend to find it too restrictive. There are so many things that can cause higher or lower levels than what would be 'normal'. Even stressful situations and periods of concentration change levels in Khaleb besides all the other usual variants ... exercise, food, hydration, illness, growth, the moon casting a shadow on pluto etc.....

Khaleb always runs a little higher at daycare. For a while I thought they were giving him extra food or he was getting stressed but it is basically me adding an extra spoonful of yogurt to his breakfast without even thinking because I am worried they wont notice him going hypo. :oops: Anyway, I'm trying to control myself and it is lucky he in only there for 5 hours/2 days per week.

Well, you can really only keep testing and adjusting diet and insulin to find what works. Small changes at a time works best. What is the general morning tea at Nursery? Do you carb count?

All the best.
 
Hi i had the same with my daughter but i am in the luck situation of working in the same school as her. I moved Leah on to the 4 aday injections since it was effecting her consentration in class ( she is in reception) It was effecting her school work. Since she has been better on the 4 a day but i have also noticed certain food effect her blood sugars more. especailly breakfast cerials (cheerios etc) Sarah
 
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