MDI Question

[Matt1212]

Hello Everyone - (been reading this site for a couple of months and greatly appreciate the help it has provided)

my daughter is 5 years old and type 1 , we moved onto the MDI regime around 3-4 weeks ago.
4 units levemir at 6 pm and then a carb ratio if 12-1 for breakfast and 10-1 for lunch and dinner when novarapid is injected.
Aislinns Mum goes into school to inject at 12.30pm before her lunch.
Most readings have been pretty good (better than 2 injections per day regime anyway)
However before lunch see tends to be around 10-14bg but she has a 10g carb snack around 1hour before this (11.30am)- so I guess this high can not be helped - unless any suggestions.
Also her bg 2 hours after her dinner tends to be 10-14 , is a carb ratio of less than 10-1 sensible ?
we correct before bed and then give additional novarapid if her bed time snack is over 10g carb and she tends to wake up with bg of 6-9.

Any advice or ideas would be much appreciated as MDI does pose a lot of variables.

 

[LittleSue]

Why does she have the snack - because everyone else has one at that time, or because she's hungry, or was it to avoid hypos on her previous regime? Traditionally snacks were used with fixed regimes of long and short acting insulin injected twice daily. Ideally with MDI or basal bolus regimes the long-acting insulin keeps blood sugar even and the short-acting just deals with the food. If the long-acting dose is right, snacks should be unnecessary except perhaps before a PE session or any unexpected activity.

Depending on the reason for the snack, the answer may be to remove/reduce the snack or to increase the morning insulin to cover the snack as well.

She may need more insulin with dinner too, but best to change one thing at a time for clarity.

 

[Matt1212]

All her class have a snack at that time so she would feel very left out.
Aim is to make the snack as carb free as possible but that is limiting.
think we will try to increase basal dose and hope for no hypo's at school

 

[jopar]

I would look at the snack first..

Ask yourself some questions

How many carbs does the snack contain?
What is the purpose of the snack (avoiding hypo's, because the other kids are having a snack)
Could the snack be brought forward if she needs one, say by an hour as a starting point?
If she having a snack because the other children are, is there any alternitive she could have that doesn't contain carbs or a lesser amount of carbs to lessen the impact on her blood glucose levels..

He lunch time ratio's I would leave at the moment, if she is 10 before lunch and similar BG after then it's likely that these ratio are correct... In general if there is only +/- of BG of 2-3mml/l then you petty well spot on...

Does your wife allow extra insulin to cover the snack she eaten when she injects for lunch?

In a rule of from from DAFNE, is that if you eat a carbs snack of over 10g carbs, if eaten around an hour before a meal, no need to inject insulin but if the next meal is longer then inject a dose to cover

As for Tea time, As littlesue already said might need adjusting the ratio's due to after she eaten she is more than likely less active and winding down for bed time, so not exercising off any of her blood glucose

But do sort one thing at a time, then give a couple of days to see how it effects her results... My self I would start with looking at the snack side of it all, and see how by changing or alter here effects the rest of the day..