# Breakfast and school



## matjk (Feb 16, 2011)

Hi I'm hoping with so many people going through similar experiences I can get some advice.
My son nearly 6 (diagnosed April 09) has wildly varying levels depending on the breakfast he eats. We are having to change his ICR depending on his breakfast. We have spoken to our diabetic team and they say the ICR should be the same for all foods???????

Also with the school the diabetic nurses require us to give the school permission if he needs a correction dose, just wondered if anyone else had to do this or are the school allowed to make the decision. The school have to ring round and contact us if we are out, to get the permission.

Any help will be gratefully received

Matjk


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## Fandange (Feb 16, 2011)

Hi Matjk,

we have a home/school lunch diary where I write out my sons lunch items and their dosage. At lunch time, he tests under supervision of a TA or teacher who have been trained by a diabetes support nurse, and if there needs to be a correction because of high BG, or he isn't going to eat everything in his lunch box, they will write it in his diary. The correction doses are also written clearly in the front of the book. The TA/teacher has to sign when he has done his blood test, calculations and injection properly. If you PM me with your address, I would be happy to photocopy some pages for you and show you what I mean.

As for the breakfast issue, I'm sure there will be someone else along shortly who has some good suggestions for you.

Take care


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## novorapidboi26 (Feb 16, 2011)

Hey, Ideally there would someone at school trained to adjust his doses or give him corrections , but its been a long time since I was in school so I really don't know how these things work....

As far as the ICR, which I assume is insulin carb ratio, is concerned, its more to do with insulin resistance at different times of the day, so the ratios may very well be different for breakfast than it is for lunch etc, as opposed to what food is being eaten.......

You say varying levels, is that at the next meal, lunch, or in between times....


The system Fandange has got going sound quite effective, maybe you should give that a try........


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## Fandange (Feb 16, 2011)

Also, have you had a look at www.childrenwithdiabetes.com ? There is a UK mailing list that you can join and everyone there has experience and knowledge that they are more than happy to share. And there is plenty of advise about getting the best care for your child at school. You are not alone


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## Adrienne (Feb 16, 2011)

Hiya

You could take a look at our email group, www.childrenwithdiabetesuk.org and maybe join the email group.

Most children (most people infact) will most definately have a different carb ratio for each meal.

My daughter is on a pump but regardless of that her ratios are breakfast 1:6, lunch 1:9 and tea time is 1:12

They are very different and even one change makes a difference.

You generally need more insulin in the morning due to insulin resistence and less at night due to insulin sensitivity.   Your DSN is unfortunately wrong, well done for questioning it, many wouldn't.

Most children will get a mid morning spike and then hypo by lunch time.  It is extremely hard to change this.   What some find is that you have to give the breakfast insulin about 20 to 30 minutes before eating and then always have a snack at mid morning to stop the lunch time hypo normally between 10 and 20 carbs.   Each child is different though.

You may find, like us, that the mid morning spike just never went and a pump was the only way to go.

Good luck and take a look at the CWD (children with diabetes) website.  There are hundreds of us.


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## bev (Feb 16, 2011)

Hi Matjk,
Regarding School, I would need to feel happy that they know what they are doing because if they dont feel trained enough or if they dont have a flow chart to refer to then perhaps they are worried they might give too much insulin and need your reassurance that what they are doing is right. I wouldnt want anybody giving a correction dose unless they had the proper training and I felt confident with their decisions. Even using a flow chart might be difficult, because there are times when, for example, your child may only need half the correction dose if he has just done P.E.

Breakfast is a difficult meal to get right, because there is insulin resistance at this time of day. You can change the ratio's to try to stop the spike, but this may cause a drop later in the day, but you could give a snack for this once you know what time levels are likely to drop. This is much easier to deal with on a pump, have your clinic talked to you about pumps. When are you giving the bolus for breakfast as this is important to try to meet the peak of food.Bev


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## Northerner (Feb 16, 2011)

I think things have strayed slightly away from the original poster's question, which wasn't about different mealtime ratios, but different ratios according to what was actually eaten at breakfast (say, toast and jam, cereal, porridge?). I'm wondering if it's not the ratio, but the time tests are being taken. If taken at the same time to try and determine peak this may seem to indicate that cereal, for example, is much higher than porridge. Here, the problem is more likely with timing of insulin dose, and getting the insulin peak to coincide with the food peak. Time of day affects ratios, but the same ratio should apply to all food at the same time of day - but digestion of the food may vary depending on what was eaten.


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## Adrienne (Feb 16, 2011)

Northerner said:


> I think things have strayed slightly away from the original poster's question, which wasn't about different mealtime ratios, but different ratios according to what was actually eaten at breakfast (say, toast and jam, cereal, porridge?). I'm wondering if it's not the ratio, but the time tests are being taken. If taken at the same time to try and determine peak this may seem to indicate that cereal, for example, is much higher than porridge. Here, the problem is more likely with timing of insulin dose, and getting the insulin peak to coincide with the food peak. Time of day affects ratios, but the same ratio should apply to all food at the same time of day - but digestion of the food may vary depending on what was eaten.




Ah right sorry, I must have read the post wrong.  Sorry.

The problem with breakfasts is that you have the insulin resistance but also it is the hardest meal.     Cereals are a nightmare for lots of people.   There are few on here who will argue that point but with the cwd group the majority have a problem with any cereal whether it be porridge, shreddies, coco pops etc, it makes no difference.

We find the oatsosimple sachets are ok and we do not spike.    

In theory you shouldn't need a different ratio for different foods, you just have to learn what each food does and how it works in the body.

For example take the difference between mashed potato and pasta.   So lets say they are both eaten at lunch time and the ratio that is set for that period of time is 1 : 10.    So lets say it is calculated and they both need 3 units of insulin according to that ratio.

Now I think I can pretty much guarantee you that with the mashed potato the levels will go up very quickly and come back down so a normal bolus of insulin is just fine which is great when on injections.   

However with the pasta even though 3 units is perfect for the amount eaten and the ratio, you may well find a hypo  even after an hour or so but a huge spike about 4 to 6 hours later.    This is purely due to how the pasta works in your body not to do with the ratio and amount of insulin.

The way to deal with that particular meal is easy on a pump as you can give the insulin in different ways.    Some people on injections spilt the injection so give say 50% immediately and then about 2 hours later give the other 50%, so 1.5 units when eating (or 20 minutes beforehand) and the remaining 1.5 units two hours after eating which should combat the pasta spike.

I hope that helps.

At school, they should have a sliding scale or a calculation of how to work out a correction.    They do not need to ring you.  However they may feel nervous and may want to ring you, afterall a miscalculation of insulin could be a disaster.    If this is a new thing then maybe you can allow them to call you for a few months and they will hopefully build up their confidence but no they do not have to call you but you have to have written down your guidance in a care plan on what to do and how to do it.


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## Rosie.H. (Feb 16, 2011)

Hi, you didn't say which way you are controlling your son's diabetes, injections or pump.  the insulin to carb ratio is the same for any food eaten at that time of day.  for instance my son's ratio for breakfast is 1:18, mid morning snack about 10am, 1:22 if he has it late then the ratio goes up to 1:25 and lunch time ratio is 1:28 and tea is 1:23 and mid afternoon somewhere between them both.

he has his insulin 15 mins before he eats he puts the kitchen timer time and then as soon as it beeps he knows it breakfast time.  you need to read up on the glyceamic index as this can make all the difference.  when he was on 2 injections low GI food like pasta was allowed because of the longer lasting effect of the insulin but when he went to 4 injections pasta went out the window.  he then went onto a pump so now all food is in.  with food that's slow release, low GI food like pasta, rice, porridge and fruit he has an extended bolus.  this was all trial and error as his nurse did not believe in GI.  pasta is extended for 5.5 hours rice for about 3.5 hours, porridge about 2hours but we haven't that quite right yet and fruit for an hour. 

 if your son is not on a pump but multiple injections he will have a big high later on at varying times depending on what he has eaten.  the higher GI the faster the glucose gets into his system.  it is all trial and error.  until my son went onto the pump we had no idea how much his insulin resistance varies through out the day and night.  

when at school (after me living at school for 3 months) he has a notebook with all instructions in.  i itemise his pack up so sandwich 28g, crisps 12.5g etc and give the total and how much insulin for the whole thing and how much to give him before lunch.  if he doesn;t eat everything they can roughly work out how much to top him up by.  when he was on injections he didn't have his insulin until after he had eaten so always spiked afterwards.( that would be the same for breakfast as well)  i have also worked out a correction chart so if he is between 2 readings then it is x amount of insulin and so on.  it took a long time of me being in school every day to train his TA. i also have provided a pair of electronic scales and a measuring jug so if they are eating other foods such as birthday cake it can be weighed.  they also have a chart of lots of foods where i have calculated roughly how much carb in 1g so all they have to do is multiply this by the weight.  i have tried to make it idiot proof.  

hope this helps and i have not confused you. Rosie


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## matjk (Feb 17, 2011)

Thanks 
Some great advice (which I knew I'd get on here).
Will maybe try the early injection 15mins before eating or just revert back to fruit and yoghurt (when his levels were stable).
Also some good stuff on the school and correction doses, Thanks.

Matjk


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## Adrienne (Feb 17, 2011)

matjk said:


> Thanks
> Some great advice (which I knew I'd get on here).
> Will maybe try the early injection 15mins before eating or just revert back to fruit and yoghurt (when his levels were stable).
> Also some good stuff on the school and correction doses, Thanks.
> ...



Hiya

Funny you should say that but it is also a proven fact that yohurt (with or without fruit) is the best breakfast overall to keep levels down without the spike.

We tried this for a week and it was great levels.   Unfortunately I couldn't put up with the moaning from my 10 year old. 

We use the cinamin flavoured Oatsosimple and it is ok.


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## matjk (Feb 17, 2011)

Thats the annoying thing we were giving him fruit and yoghurt and he was fine. The diabetic nurse was worried about the amount of fibre he was having so suggested toast. Which sent his levels all over the place. 
We have since gone back to fruit and yoghurt but are having to recalculate the doses amount of fruit.
AAAARRRGGGHHH.

We'll get there though.

M


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