Friday, March 6, 2009

Dear Anonymous commenter,

Here is the answer to your question about getting the BS to stay stable after meals without crashing later.....for us, it is a simple 15 min prebolus if blood sugar is 90-100. No basal reduction or fancy tricks, but Maddison also doesn't eat any high GI foods for breakfast, no cereal especially, and she typically eats the same 3 choice breakfasts during the school week so I have had alot of experience with which breakfasts need how much of a pre-bolus. (I guess her picky eating isn't so bad after all because it makes numbers much easier to figure out!)

*Normally* Maddison wakes up around 120-160 and she gets a standard 15 min prebolus for breakfast. At the 1hr post prandial mark she will be around 180 if she starts off in this range. I guess she typically is about 40 pts higher than the starting number at 1 hour after eating. This of course, happens only when our numbers havent had any highs streaks at all. As in, it doesn't happen all that often! Maybe half the days in a school week. (I only know this because she was complaining of feeling low in the mornings RIGHT as the school bell rang, so I started checking her to show her the number before she went into the classroom.) I think what Maddison eats for breakfast is a really good balance of protein and non-spiky foods for the AM hours. Today she had a less carby breakfast of 3 slices of whole wheat toast with cinnamon and Splenda and 1 cup of SF chocolate milk. She isn't a fruit eater either, unfortunately! If I could add in fruit to her breakfast I am sure she would have a much higher spike! Todays carb count for breakfast came in at 45c vs the normal pancakes w/ SF syrup and PB on top with SF chocolate milk that has about 60c. I dont know HOW we actually have these "stable" no spike mornings sometimes, but, we do. And no, we have never had a CGMS for backup. I think it is a good pre-bolus, balanced meal and LUCK! Hope that helps!


Anonymous said...

OIC. We basically do similar things but because Novolog has a 5 hour DIA, we must calculate so that she is no lower than 180-200 two hours postprandial or she will drop to the 50s or lower by the fourth to fifth hour after eating. At home, we try to get her to 140-160 range two hours postprandial then "feed the insulin." Must be a YDMV because there is no way I could get her at 90 two hours postprandial without a major drop within the hour In other words the IOB, of which there will still be perhaps one or two units will continue to drop her 80 points a unit. I have a vial of the magic elixir Apidra and I am pinning all my hopes on this to get her into range sooner. You see if she is 90 two hours post, I then have to look up IOB and give about 10 grams for each remaining unit (I try to space it out and give 10 grams an hour if home). With her DIA, I might as well be giving her Regular! Once I have the Apidra, I will try your formula (plus I can certainly reduce her basal after breakfast and lunch on school days). I may find a magic formula of my own. I'm very impressed you were able to figure this out for your daughter.

type1mom said...

Anonymous....are you sure you have basals right? I would think that 4-5 hour lows after eating would be a basal that is too high....but of course YDMV. Maybe a delay in absorbing carbs? Wow, that would be really tough to continue "feeding the insulin" and making sure your child is high enough in hour 2. Crazy disease this is! Amazing how it is so different for everyone! I guess thats what you call metabolism!

Good luck...maybe a basal test is needed?....then again...I am sure you are all over those numbers. How frustrating!

Anonymous said...

I always test DIA when I know basals are correct. Unfortunately Novolog has a DIA of 3 to 5 hours. I think most people would fall in between three and a half to four hours, but her DIA is still 5. I was so hoping she would build up a tolerance to the Novolog and that eventually the DIA would decrease. Your post is very encouraging though, because if I can find an insulin that works in three hours (hoping Apidra), I should be able to get her perhaps to 140 at the two hour mark and back to 100 at three. Hopefully, that insulin will then be GONE! Endo suggested we try Humolog, but I thought the insulins were practically identical. If necessary, I can tweak the basals lower than they should be after breakfast and lunch at school since she is on a set schedule. To get to 90 in two hours and hold steady -- that would be impossible for her, I think, but I would be thrilled to get her to 140 at hour 2 and back in range at hour 3. Haven't been able to get her to 140 at hour 2 unless I feed at hour 2 or 3 and even sometimes again at 4. This would mean something like 200 hour 1, 140 hour 2, check DIA, cover enough to bring up to 180, (depending on how much left, cover again a bit in another hour, etc. but not too much at once so you don't go too high), etc. I don't have to keep checking BS, I go by the IOB and she will be back in range probably hour fourish with a tail for hour five. Yes, your tip does help immensely, thank you!