Post meal spikes

[catw]

Hi looking for any suggestions please. My daughter now 3 was diagnosed type 1 in aug 12 ( 9 months ago). We got a pump almost 6 months ago. Her basal needs are v low ( confirmed with basal tests, however we cannot control her post meal spikes, esp after breakfast she spikes to low teens but if we increase her insulin to carbohydrate ratio she will plummet to hypo pre next meal. We are giving bolus 15 mins or so before meal and splitting meal and snack. We also tried different food types. She is an active toddler. Any suggestions greatly appreciated. I find it really frustrating to be unable to get better control. Huge spikes after meals (approx 2hrs) and then have to be v vigilant for hypos (3-4 hrs). Anyone experience similar? Any suggestions?Thanks


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[donnellysdogs]

Post meal spikes are bolus at 2-3 hours after meal.

What ratio are you giving? If you were giving say 1 unit to 15g. There is a way to give a gentle tweak... Instead of upping it to 1unit to 14g you could change the bolus to 1.1 unit for 15g... It will give just a little bit extra.. But less than if you change the ratio by a whole gram of carb and would have less impact at 4-5 hours.

The thing is with all alterations of bolus/ basal you may well find levels dropping 3-5 hours later from that one aleration earlier. I generally head this off nowadays.. Eg

Breakfast.. 8am up insulin for bolus.... As high at 10am...
This means I'm going to have more insulin in me working up until 12-1pm...
So in this case I would lower my insulin basal on the 2nd hour after My increase... In this case it would be my 10am basal I would drop... This is solely because of that kittle bit extra bolus at 8am in this example...

So often you will alter levels up or down .. But the impact will follow for up to 5 hours. It doesnt matter that your basals wete correct without food... Although it is seen as good because of flexibility etc... Because changing anything at all with insulin.... When the effects can last 5 hours... Doesnt just impact on the specific hour when you want it to....

Increasing or decreasing insulin doesnt just change 1hour's blood levels as insulin works for 5 hours... Then when you change the next say 10am insulin... Of course, this lower dose may still impat further on for the next 5 hours etc, etc, etc.