# Any ideas welcome!



## Hanmillmum (Jun 20, 2011)

Hi, 
can I ask you parents how you manage breakfasts i.e timing of insulin, what your kids eat and how to tackle post brekkie spikes ? Seems like everything been trying either doesn't work or doesn't consistently work. Been posting on the pumping forum, tried change in carb ratio, and basal but sent her low (despite being the tinest of change!). Only option with these is to give her a snack mid morning so she doesn't get the spike too badly but also doesn't plummet.
Just interested to know how others are managing, if at all, and any success stories, many thanks!


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## trophywench (Jun 20, 2011)

Can I ask a Q - is it essential she actually has carbs at breakfast, or as many carbs as whatever she has?  Would there be any reason (other than the mere fact that most kids would probably rather eat eg coco-pops than most things LOL) why she couldn't have a protein-based brekkie? - you can go further on protein than you can on carbs and that's a fact; you stay fuller for longer.

I know it may be NOT the classic way of doing things for diabetic children/teens - but would it be worth a punt?


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## Mel (Jun 20, 2011)

hi 
We find things like Rice Krispies send us way high 2 hours after but fine later. Cornflakes too send us high but not as much as the rice krispies. Weetabix keeps us steady.
Tend to keep ricekrispies and cornflakes for the weekends as treats and give insluin 15 minutes before them and have some longer acting carb whole meal bread etc . Bagels are another favourite , and we don't get too much of a spike even with the cinnamon and rasin ones. Sympathise with the sending low have done it myself!!! Also we changed to Humalog form Novarapid due to diffrent rates for insulin peaking , sport and food spikes
Hope this helps


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## Pumper_Sue (Jun 20, 2011)

Hanmillmum said:


> Hi,
> can I ask you parents how you manage breakfasts i.e timing of insulin, what your kids eat and how to tackle post brekkie spikes ? Seems like everything been trying either doesn't work or doesn't consistently work. Been posting on the pumping forum, tried change in carb ratio, and basal but sent her low (despite being the tinest of change!). Only option with these is to give her a snack mid morning so she doesn't get the spike too badly but also doesn't plummet.
> Just interested to know how others are managing, if at all, and any success stories, many thanks!



How far back are you making the changes in basal pattern?
Would your little one be happy to eat a sugar free Jelly for breakfast? This would be the easiest way to test her basal.

I'm not sure but think it was Adrienne's daughter who had spike problems so worth a pm to ask.
Another option though is to use a dif type of bolus. But no 1 priority is getting the basal right before changing bolus ratios etc.


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## ruthelliot (Jun 20, 2011)

Like you we've found no change gives totally consistent results but then that's just the nature of the beast. I find playing around with basal helps more than the carb ratio. We have a higher basal from 8am until 10am then it drops quite a bit from 10 until 12. Ben has always spiked mid morning then hypo's before lunch - was worse on injections though, we are now getting some days where he is perfect at these times. He is still spiking 90 min after breakfast but this is much better than before when he would be high teens 2 and a half hours later. He often doesn't want his morning snack now but was still dipping at lunch hence we've just reduced the pre lunch basal again. His also gets a bigger bolus for breakfast than proportionately for any mid morning snack. Hope this helps. 
Ruth


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## Hanmillmum (Jun 20, 2011)

Hi thank you all for replying.

- Basals are correct, we did the post-poning food business a short while ago.

 When tried upping basal to cover the spike we were told by nurse to start back from the spike with the smallest increment, hour at a time, which we tried, just the once, but was hypo mid morning so seemed worse than the carb ratio change. 

Some things she is not as bad with i.e toast. She will have low carb brekkie some mornings but wouldn't tolerate all the time.

I think it is the food and how she reacts to it. Weetabix we avoid like plague at the mo, sends her up to 18-19 ! Ready Brek 11-14 , Oat crisps 15 ish, toast(50/50 bread) is around 10 which isn't too bad and better still less so with an egg.

I was hoping we could sort these problems on the pump without having to restrict her diet but looking like might be the case. Just want to know if I have exhausted all potential options first.

Dietitian mentioned drawing out the bolus over a couple of hours but feel she is probably better with more bolus up front if spiking, any suggestion here ? Currently experimenting with the timings and dual bolus. She is on novorapid on the pump.


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## Hanmillmum (Jun 20, 2011)

Ruth, you must have posted while I was writing. Your sons basals being higher pre spike and lower post make sense, not tried this approach as basals were set when fasting so the spike wasn't an issue. Will discuss this with team, thanks.


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## Pumper_Sue (Jun 20, 2011)

Have you tried a bolus a bit earlier ie. instead of 10 mins before what about 15 or 20 mins before? Not to sure how risky that would be for a little one though.


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## Hanmillmum (Jun 21, 2011)

Giving this a try, something went right this morning, though it helped that she woke at 4.8, always gives us a head start. Gave bolus approx 10 mins before she had some milk then ready brek, dual bolussed 65/35 over 2 hours and 2hrs later she was 8.5!!!! Marvelous, though my cynical self has a sneaky feeling about whether this can be repeated and probably that a different formula will be needed for other foods.


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## Pumper_Sue (Jun 21, 2011)

Hanmillmum said:


> Giving this a try, something went right this morning, though it helped that she woke at 4.8, always gives us a head start. Gave bolus approx 10 mins before she had some milk then ready brek, dual bolussed 65/35 over 2 hours and 2hrs later she was 8.5!!!! Marvelous, though my cynical self has a sneaky feeling about whether this can be repeated and probably that a different formula will be needed for other foods.



Fantastic result well done. 
Just a tip for you incase it hasn't been passed on. Have your self a filofax so you can jot down in it all the foods you have tried and what ratio you have tried. This way you don't have to keep on trying to remember if it worked or didn't.

As you have already said dif foods need dif ratios. It's a steep learning curb but you are well on the way.


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## Hanmillmum (Jun 21, 2011)

Good idea, memory like a sieve ! thanks for the advice


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