Type 1 Pre-meal blood sugar rise

[foxesocks]

I'm the parent of a two year old who was only recently diagnosed three months ago with Type 1 Diabetes on an MDI routine with Levemir and NovoRapid (we're on the waiting list for a pump...but that's another story). He's quite sensitive to insulin so only has 5.5 units of Levemir in the morning and 0.5 at night with mealtime ratios of 0.5 units per 7g at breakfast, 10g at lunch and 10g at dinnertime.

He usually wakes up within his target range somewhere around 5.5 mmol but recently we've noticed that his readings are rising right before lunch and dinner. We've checked his readings 90 minutes after each meal and they tend to return to back where they started +- 2 mmol. For breakfast we also give him insulin early in order to dampen the post-meal spike (which seems to work well - he hasn't turned down breakfast yet) followed by a second injection to make up the shortfall if need be.

We initially thought it might be his mid-morning or mid-afternoon snack (10g max) but trying him with no-carb alternatives didn't seem to make much of a difference.

Does anyone have any advice or insight as to why his blood sugar is rising before lunch and dinner? Could it be too little Levemir? It seems like giving him more insulin at breakfast or lunch would cause him to hypo since his readings return to where they should be after an hour and a half.

Thanks in advance!

 

[himtoo]

hi foxesocks
welcome to the forum
I must admit to being slightly torn on what to say-- on the one hand I am thinking best bet is to talk to your child's DSN for some assistance. They will have experience , your child's medical notes and will hopefully advise you sensibly.

On the other hand your thought on tweaking up the levemir dose is a very good one( that i agree with) but........ normally basal testing should be done before making changes to the background insulin - but with a 2 year old that won't understand why they cant eat for a 5 hour period for a couple days in a row doesn't sound good for household harmony.

I think on balance ringing the DSN for advice is best bet

 

[Squire Fulwood]

Disclaimer before we begin: I am a type 2 and I understand children less but if his sugar is rising he must be getting it from somewhere.

The other clue is that it happens just before major meals which suggests to me that those meals could be too widely spaced for a tot.

Could you try letting him have a treat between meals to see what happens.

Good luck with it and if I am wrong then my address is Santa, North Pole, AA1 1AA.

 

[foxesocks]

Thanks for the reply himtoo.

Part of the issue we have encountered is varying advice from the diabetic team that we deal with; sometimes we phone and are told to significantly reduce or raise this or that only to later have the advice contradicted when we phone up to report frequent hypos or highs. For example phoned last week and were told that his morning Levemir was too high and should be reduced from 5.5 to 4.0. Two days of highs later and we were told by someone else that we should never have reduced it!

They admit themselves that we've been given the wrong advice on several occasions.

Rather than just doing what they say I'm trying to understand why they say what they are saying to apply some kind of sensibility filter!

hi foxesocks
welcome to the forum
I must admit to being slightly torn on what to say-- on the one hand I am thinking best bet is to talk to your child's DSN for some assistance. They will have experience , your child's medical notes and will hopefully advise you sensibly.

On the other hand your thought on tweaking up the levemir dose is a very good one( that i agree with) but........ normally basal testing should be done before making changes to the background insulin - but with a 2 year old that won't understand why they cant eat for a 5 hour period for a couple days in a row doesn't sound good for household harmony.

I think on balance ringing the DSN for advice is best bet

 

[himtoo]

well the theory on how things work is that background insulin should keep you child more or less level
and that the dose of fast acting is "matched" to the carbohydrate eaten and pretty much that is it

unfortunately life has a way of sneaking around and complicating things

as a diabetic I take ownership of my health and i do make adjustments without consulting the medical team at my hospital.
But i have 2 advantages == experience and age ( ability to reason )

you at this point don't really have either -- not much experience and your son is not old enough to reason with yet
hope this does not sound harsh and I really empathise with you.

as you have a 1/2 unit pen that is ideal for making small adjustments so upping the levemir at 1/2 unit then testing for a couple of days before any further adjustments are made would be the course i would take.

do make sure to keep written records too as this assists the "learning" .