# Any suggestions?



## Gillsb (Nov 4, 2009)

My 14 year old daughter, 2 1/2 years type 1 has started getting high readings 2 hours after breakfast.  She generally eats and identical breakfast everyday consisting of a bowl of cheerios with semi skimmed milk and then a slice of toast.  Her level two hours later is now around 15 and we have tried increasing her rapid insulin but for some reason doesn't seem to have much effect.  By break time at school she has come down to between 6 and 7 which is around 1 1/2 hours later.  

Should we keep gradually increasing the rapid dose as her wake up reading on levemir is good so that seems fine.  

Forgive me if I am asking the obvious but does a meal of cereal and toast affect the body differently to one when the carbs are mixed with other things.

Any suggestions would be great.


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## bev (Nov 4, 2009)

Hi Gill,

Breakfast cereal is always hard to deal with! What we have found is that if we bolus 10 minutes before this is helping to reduce the high later. Some people bolus 20 minutes before - its trial and error really. I think breakfast is the hardest one to get right. You could give more insulin with breakfast and then have a cereal bar 3 hours later to help stop a hypo - may be worth a try? Are you sure the basal is right for this time of day?Bev


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## Gillsb (Nov 4, 2009)

Thanks for that Bev. She is going to try injecting 15 minutes before she eats in the morning which I had never thought of before.  Will let you know how it goes.  I think the levemir is ok as her early morning reading is usually between 5 and 7 (well depending on the time of the month).

Thanks again


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## bev (Nov 4, 2009)

Hi Gill,

I would suggest just 10 minutes just in case she has a big reaction - always better to start gently. Then if that doesnt work then the day after perhaps 15 minutes and so on. Let us know how it goes.Bev


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## MCH (Nov 4, 2009)

Just a thought, but has she changed the way she gets to school since term started? eg Has she stopped walking or started taking a shorter route which might have changed the amount of exercise she is getting? Is it every day or could it be to do with her new timetable and the subjects she is now getting in the mornings? 

Also, has she grown recently or could she be about to as I suspect that could change the amount of insulin she might need?
Hope things sort themselves out soon - if not have you got a friendly DSN you could ask?

Best wishes


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## Gillsb (Nov 5, 2009)

Well, pleased to say things went well today.  She injected 10/15 mins before breakfast, ate the same as yesterday. Unfortunately she was a bit longer than 2 hours doing her blood check but it came back at 8 which is much better than yesterday's 15.  We will do the same today and hopefully she wont forget to test on time so we know exactly what is happening.

She is certain that two hours has always been too quick to test so perhaps injecting a little before each meal may be the answer.

Thanks for the suggestion.  Always best to talk to those who know!!


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## bev (Nov 5, 2009)

Hi Gill,

I am so pleased things went well for her today!

Just a note of caution about bolusing 10 minutes before every meal - be very careful doing this because it wont work for some foods - very high fat foods take longer to digest - so she may hypo before the food hits etc.. Best to do this for foods that digest more quickly or for times like breakfast when there is a bit of insulin resistance. Also, the 2 hour check is the crucial time to be checking as this is when the insulin is peaking and gives a better picture of what is happening. But it sounds like you have helped with the peak anyway - great!Bev


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## Gillsb (Nov 5, 2009)

Sorry to be asking silly questions but should she test 2 hours after the injection or food?

You mentioned that some foods digest much more slowly, is that the ones higher in fat and protein?

Thanks for your help.


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## bev (Nov 5, 2009)

Not a silly question at all! The honest answer is - I dont know! lol

What we do is time 2 hours after the bolus - so actually we are checking at 1.50 minutes sometimes - I am not entirely certain what is the correct answer. I suppose it depends whether its a small meal or huge - sometimes eating pasta can take 20 minutes or more - whereas a sandwich can take less than 10. I will go and ask on the other site to get a definitive answer for us both!Bev


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## Gillsb (Nov 6, 2009)

Good levels again today so fingers crossed we are winning (for now anyway).  No doubt I will be back soon with the next problem diabetes throws us.


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