# Breakfast hypo after 2 -3 hours



## Clairel (Jan 30, 2021)

My son was diagnosed in August 2020 he's 8years old and to be honest it's been a rollercoaster ever since. Recently he's sometimes having high readings after breakfast and after about 30 mins dropping quite fast to the point he's having a hypo or close to. Anyone had experiences with this?


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## Inka (Jan 30, 2021)

Hi @Clairel It could be the honeymoon period where his own islet cells have made a temporary and slight recovery and are now randomly producing some insulin of their own. This can contribute to hypos.

You say it’s recent - could it be a change in routine eg lockdown? Has anything else changed? 

I’m presuming you’re carb counting and adjusting his insulin? Do you bolus in advance of meals?


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## stillgoing (Jan 30, 2021)

Readings can do this. Rollercoaster is the game you are now on. Can you identify any cause. Is he running around a lot or more. Is he on a growth spirt. I'm 62 now but started as a 5 year old. Could run around until I collapsed! Need more information like the readings you are getting. insulin type and regime. Lots of causes and lots of solutions but best to get as much information as you can and talk to your son's DNS.


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## Clairel (Jan 30, 2021)

He's on 0.5 Levemir which I give him 30 minuites after his breakfast bolus (aspart) I found this worked for while. He's breakfast ratio is 1-8 and his readings were 13.5 the last few days and today only 9.3 dropped to 6.3 a still dropping after 2 1/2 hours.


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## Clairel (Jan 30, 2021)

No


Inka said:


> Hi @Clairel It could be the honeymoon period where his own islet cells have made a temporary and slight recovery and are now randomly producing some insulin of their own. This can contribute to hypos.
> 
> You say it’s recent - could it be a change in routine eg lockdown? Has anything else changed?
> 
> I’m presuming you’re carb counting and adjusting his insulin? Do you bolus in advance of meals? No change in routine he has the same breakfast everyday (his choice) we believe he's out of the honeymoon period. I've spoken to his DNS and they say because he's not always having a hypo then there's nothing to change. I try to catch him before he gets that low. He was previously only on Levemir at night as he was really sensitive to it during the day but we found he started creeping up between meals so started him on 0.5 2 months ago.


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## Clairel (Jan 30, 2021)

No change in routine he has the same breakfast everyday (his choice) we believe he's out of the honeymoon period. I've spoken to his DNS and they say because he's not always having a hypo then there's nothing to change. I try to catch him before he gets that low. He was previously only on Levemir at night as he was really sensitive to it during the day but we found he started creeping up between meals so started him on 0.5 2 months ago.


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## Inka (Jan 30, 2021)

There’s no problem having the same breakfast every day. It’s one less thing to think about   

Two thoughts - are his hypos in any way related to his blood sugar before breakfast - that is, is he more likely to have a hypo if he starts below a certain number? I find that if my blood sugar is lower than 5.5 very approx, I need less bolus for my breakfast.

Second thought - how far in advance of his breakfast are you bolusing? Sometimes if you bolus more in advance you can reduce any spike and also sometimes then reduce the amount of insulin (because it’s there more in advance so at work quicker). That helps reduce hypos.


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## stillgoing (Jan 30, 2021)

OK. Not really sure about this but the aspart reaches maximum effect 2 to 3 hours after injection and up to 5 hours before it stops.  The levemir is like a 24 hour acting one. Sorry to hear DNS not helpful. Always difficult with children because you don't feel the hypo! His absorption rate may have changed as he grows and is now a larger mass but this should be a DNS or consultant decision.


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## Clairel (Jan 30, 2021)

He usually wakes up with BG between 6-7.3 on average, We've been told to leave 15 minuites between bolus and food which for his other meals works perfectly.


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## Clairel (Jan 30, 2021)

We use the MY LIFE app and also the libre sensor. The levimir is 24 hours and aspart we check the two hours after. For all other meals he stays at a reasonable level it's just breakfast that there is a sudden drop. He's asking for something new for breakfast which has sent my anxiety through the roof!!


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## Kaylz (Jan 30, 2021)

Timing is a completely individual thing and can vary on time of day and also the site used for injection, for instance I need to inject 20 minutes before breakfast in a thigh but only 15  minutes before dinner in the opposite thigh and then by tea when I use my stomach I need to eat immediately or I end up hypo xx


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## Kaylz (Jan 30, 2021)

What is he having for breakfast at the moment? And what is it he's wanting to try instead? xx


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## Clairel (Jan 30, 2021)

Oh wow!! I tried injecting in his thigh to see if it helped and hes readings were 13.8 after the two hours and still dropped. His belly seems to work faster but still drops regardless of injection site.


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## Clairel (Jan 30, 2021)

He's having ready brek and asked for cherios.


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## Amity Island (Jan 30, 2021)

Clairel said:


> My son was diagnosed in August 2020 he's 8years old and to be honest it's been a rollercoaster ever since. Recently he's sometimes having high readings after breakfast and after about 30 mins dropping quite fast to the point he's having a hypo or close to. Anyone had experiences with this?


Hi Claire,

Sounds like the bolus is too much _and_ too late (assuming your sons basal (levemir and partly own insulin) is working correctly and keeping background blood sugars steady 24hrs a day).

What I mean is, a classic spike like that is caused by taking the bolus (aspart) too late e.g too close to when breakfast is actually eaten and its been compounded, because it looks like there is also too much insulin, which is dropping levels below where they were before the meal, causing a hypo.

I can only say what strategy I woud try in that same situation. To prevent the spike and the hypo, I would try a little bit less insulin earlier before eating. For breakfast I can take my bolus 20mins before breakfast to prevent a spike like that. All depends of course what is being eaten, if it's cereal and milk then 20mins would work well for me. If it was a bacon sandwich I'd take a bolus just before.


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## rebrascora (Jan 30, 2021)

Just to give you a bit more idea of the spectrum of delay needed between bolus insulin and breakfast, I am also currently using Aspart (Fiasp) and I need to inject into my stomach as much as 45 mins before i eat my breakfast even with relatively slow release carbs (creamy Greek yoghurt, berries and seeds) but I only need 15-20 mins at other times of the day. I agree that less insulin but bolused earlier is likely the answer. Obviously my 45 mins is extreme but try bringing it forward by 5 mins each day until you don't get that spike and then drop. Having the Libre is wonderful for being able to see and iron out these problems.


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## Clairel (Jan 30, 2021)

Thank you for that I think I'm going to call his DNS Monday morning. It's ok while his at home and I can monitor him but once he's eventually back at school I will be forever worrying.


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## Clairel (Jan 30, 2021)

Thank you for all the advice. You all seem to think a similar thing. Calling them first thing Monday morning with a better insight to what I believe is happening. Really appreciate all the advice.


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## stillgoing (Jan 30, 2021)

For me the insulin seems quite quick so my blood sugar drops before the food gets there. If I am starting from a lowish number I can then end up hypo which I have to treat and then my body decides to process the food so I end up high.

Overall your numbers look good so try not to worry to much. I read somewhere on here that T1 monitoring at the 4 hour point is better for control as at that point both the food and insulin have done their matching but obviously you don't want too high a spike at the 2 hour point.

Try not to worry about changing the food. Read the boxes and match the weight to carb content. Then you know that the amount of carb is the same so should all work out. The speed of absorption may be different so insulin timing might need altering.  

Let us know how it goes with the DNS and good luck


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## stillgoing (Jan 30, 2021)

Reread one of your other posts. Being on libre then test timing isn't so important as you get all the data anyway. I understand there is a way to remotely monitor the libre system via a mobile phone. (Big brother or is that mother)

I don't use this system but I expect other parents will tell you if and how to do it. It might help you when he is back at school to relax.


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## Clairel (Jan 30, 2021)

We use it to scan him between meals but it's a hit a miss as it doesn't always give you the best reading. He honestly just gets on with it and I think it probably affects me more than him. Let's see what tomorrows new cereal brings.


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## trophywench (Jan 30, 2021)

How do they compare in terms of how many grams of carb are in the serving of it?


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## Clairel (Jan 30, 2021)

We calculate the carbs and put it into the my life app along with BG. We calculate it by the amount of carbs per 100g ÷ 100g x by the weight. Is this what you are asking?


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## stillgoing (Jan 30, 2021)

I think @trophywench is saying is how does the carb on one portion of cereal compare with one portion of the other cereal. If they are the same then no problem. Basically what I tried to say by saying look at the carb value on the boxes and adjust the serving size to match the carb ratings for the breakfast. Sorry don't wish to confuse. Hope it makes sense. If not I will try and explain another way.


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## Clairel (Jan 30, 2021)

Oh I see, yes completely makes sense. This is something I probably would have done anyway. Well hes decided he wants jam on toast and I've already worked the carbs to make sure I'm prepared. He usually has 33carbs for breakfast but tomorrows will be slightly higher. Already panicking.... Roll on Monday when I speak to his DNS.


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## stillgoing (Jan 30, 2021)

good luck.


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## trophywench (Jan 30, 2021)

Well 2 slices of large medium sliced bread could be 35g without the jam.  One slice of toast with the jam will only be 25-ish.  Unless you use far too much jam!


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## helli (Jan 30, 2021)

Is the high and subsequent hypo only recorded on the Libre or have you also checked with finger pricks?
Libre is much less accurate when high or low which is why I was told I can use Libre for dosing but not for corrections.

The other thing about the Libre is have the recent problems all been with the same Libre? If so, it could be a dodgy sensor.


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## Clairel (Jan 31, 2021)

Two slices of wholemeal=31 carbs 
streamline blackcurrant jam 3.36 carbs

He didn't spike today or have a hypo stayed steady until lunch time which is a first.


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## Clairel (Jan 31, 2021)

I only ever use finger pricks I use the libre as a guideline to give me an idea of which direction were heading. I've definitely had a few dodgy ones. Thank you


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## stillgoing (Jan 31, 2021)

Hi @Clairel  did your son enjoy his change of breakfast because that  is important too


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## Clairel (Feb 1, 2021)

@stillgoing he really did and it seems that the change has really helped the morning so far. His levels pretty much stayed level with no peek at all. In fact today has been an odd day as hes been in the 6s and 7s. I spoke to his DNS who agreed his insulin was too strong in the morning but only changed it to 1-9 so still had 4units this morning.


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## stillgoing (Feb 2, 2021)

Hi Good to hear. Remember plenty of advice here if you feel you need to talk. Lots of parents on here and there own forum area as well. Look around the information areas of the site as well. Lots of info. Best wishes.


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## trophywench (Feb 2, 2021)

My fave jam, blackcurrant.  Glad it worked out so well !


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