# utterly confused!



## hybriduno (Jan 15, 2013)

Hi, we as parent s are new to this >4 days in<
Our 8 year old has been diagnosed with type 1 , and today (4 days later) the nurse came to see us.

While she was here she said theres no reason why he can't enjoy the food he used too, as long as there in moderation.

So then came the question, can i have pizza? to which she said yes as long as the fat content isn't to high.

So whats to high....how do we adjust his insulin to it.

we really have been left in the dark with it all and as you can imagine its worrying


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## Pumper_Sue (Jan 15, 2013)

your son can have pizza, it can be difficult to bolus for pizza due to the fat as it causes a very late rise in blood sugar.
So plenty of pizza is needed to test all methods of delivering the insulin at the correct time


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## Northerner (Jan 15, 2013)

Hi, as Sue says, pizza can be difficult for some and how it affects your son personally can only really be determined by trying it and doing some tests to see what occurs. You might find bev's Pizza Food Experiment useful to see how others handled pizza:

http://www.diabetessupport.co.uk/boards/showthread.php?t=6288

I'm personally fine with it, hope your son doesn't have too much of a problem


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## hybriduno (Jan 15, 2013)

Thanks guys she basically said that we would need to inject his novarapid after his meal instead of before, so do i check his blood sugar before pizza and give him insulin to suit those blood sugar levels? or do i wait till hes finished eating?


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## Northerner (Jan 15, 2013)

hybriduno said:


> Thanks guys she basically said that we would need to inject his novarapid after his meal instead of before, so do i check his blood sugar before pizza and give him insulin to suit those blood sugar levels? or do i wait till hes finished eating?



Check before eating, then (if he doesn't mind too much!) hourly or two hourly.  Tell him it will be worth it in the long run!


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## everydayupsanddowns (Jan 15, 2013)

Quite often Pizza seems to need 2 injections like this:

Work out the dose for the whole meal
Inject a proportion up front say 50% (you might need to try 40%... 60%... or whatever)
Inject the rest of the dose two hours later (or 1 hour... or 3 hours...
Test BGs before, and at say 2hrs and 4hrs 

That's what Sue meant by experimentation... Keep notes and if it works OK do the same again, if there are highs or lows change one thing and try again. The idea of 2 injections is to 'spread the action' of the insulin to cover the slow absorption of the pizza (fatty things absorb more slowly). 

Everyone is very different. First off you might want to try 'all up front' but watch to make sure they don't go low at 1-2 hours after food only to zoom high 3-4 hours later.

Still all that experimentation is a good excuse for lots of pizza!


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## hybriduno (Jan 15, 2013)

Thanks guy's were finding it all very difficult to get in our heads (lack of nhs information isn't helping), but im sure we will get there in the end 
He's excited that he can have a slice of pizza now though


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## Pumper_Sue (Jan 15, 2013)

hybriduno said:


> Thanks guy's were finding it all very difficult to get in our heads (lack of nhs information isn't helping), but im sure we will get there in the end
> He's excited that he can have a slice of pizza now though



Only one slice  take his temp quick he must be ill 
If you google bdec it brings up a carb counting course which will help no end.

Learn together by having carb counting guessing games. This way he learns in a fun way


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## Northerner (Jan 15, 2013)

Pumper_Sue said:


> Only one slice  take his temp quick he must be ill
> If you google bdec it brings up a carb counting course which will help no end.
> 
> Learn together by having carb counting guessing games. This way he learns in a fun way



Here's the link to the course: http://bdec-e-learning.com/

But don't worry if it makes your head spin a bit at this point, your son will still be settling down after his diagnosis and finding the right levels for his insulin  (took me a few weeks before I started carb counting my food)


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## everydayupsanddowns (Jan 15, 2013)

hybriduno said:


> He's excited that he can have a slice of pizza now though



That't the GREAT thing about modern treatment methods for T1. There's nothing we can't have any more. Chocolate... cake... pizza... takeaways...

It all boils down to how much and how often... and whether or not you want to put the work in to develop an effective strategy or just decide that a 'challenging' food is just not worth the bother.

Pretty much the only thing I don't eat now is breakfast cereal - I'm sure I *could* but I just don't enjoy it enough to put the work in!


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## fencesitter (Jan 15, 2013)

Welcome to the forum! Good for you for starting to ask questions so soon. I have a 15 yr old, diagnosed 2 years ago. We found essential info from our health care team OK, but if we wanted anything more detailed we dug it out for ourselves. This forum has been fantastic for getting good ideas and support  On the pizza question, the odd slice might be fine if you just inject as normal, but for a whole one it's definitely worth trying a split dose. Good luck with the experiments


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## bev (Jan 15, 2013)

hybriduno said:


> Thanks guys she basically said that we would need to inject his novarapid after his meal instead of before, so do i check his blood sugar before pizza and give him insulin to suit those blood sugar levels? or do i wait till hes finished eating?




Hi Hybriduno,

I'm afraid that is not good advice. Quick-acting insulins take at least ten minutes to start working so if you inject after eating it doesnt stand a chance at matching the release of carbs. The aim of this is to try to match the peak of insulin to the peak of carbs that are released in the bloodstream. 

My son (14) uses a pump and for pizza's we give 45% before eating (at least twenty minutes) and then spread the 55% over 8 hours as it takes this long to digest. On MDI (injections) we used to do two or three injections to match the BG levels. You will get the hang of it but it isnt the same for each person so it will be trial and error and lots of pizza eating!Bev


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## Northerner (Jan 15, 2013)

bev said:


> Hi Hybriduno,
> 
> I'm afraid that is not good advice. Quick-acting insulins take at least ten minutes to start working so if you inject after eating it doesnt stand a chance at matching the release of carbs. The aim of this is to try to match the peak of insulin to the peak of carbs that are released in the bloodstream.
> 
> My son (14) uses a pump and for pizza's we give 45% before eating (at least twenty minutes) and then spread the 55% over 8 hours as it takes this long to digest. On MDI (injections) we used to do two or three injections to match the BG levels. You will get the hang of it but it isnt the same for each person so it will be trial and error and lots of pizza eating!Bev



I suspect that might be far too much to take in at this stage bev, only 4 days after diagnosis and the first time trying pizza.  You have to start somewhere and I think injecting after eating, whilst it may produce a higher than hoped-for level, is less likely to lead to a hypo. The information gained will be useful for the next pizza experiment when perhaps ( based on the results first time round) the insulin might be given before eating.


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## bev (Jan 15, 2013)

Northerner said:


> I suspect that might be far too much to take in at this stage bev, only 4 days after diagnosis and the first time trying pizza.  You have to start somewhere and I think injecting after eating, whilst it may produce a higher than hoped-for level, is less likely to lead to a hypo. The information gained will be useful for the next pizza experiment when perhaps ( based on the results first time round) the insulin might be given before eating.




Hi Northerner,

I disagree. I remember spending hours confused as to why things didnt work out and adding up the carbs over and over again thinking it was the maths out - when in reality if we had known from day one that you inject ten minutes before or more this would have taken one of the 'trial and errors' out of the equation so we could have focused on the rest of it. There is nothing more upsetting than being a parent and not knowing what you are doing - or worse still - not being given the right information from the start. Hybriduno is clearly asking all the right questions so it seems to me that she will be more than capable of taking all this information on board and if it helps another parent to get things right then job done!Bev


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## Pumper_Sue (Jan 15, 2013)

> she will be more than capable of taking all this information on board



Bev, she is a he


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## trophywench (Jan 15, 2013)

Well that just shows you.

With pizza I don't get a rise at all for abouthalf an hour, then it's modest until 2 hours and dwindles to nowt.  Then 5 or 6 hours later - Wham.

So that's the reason you weren't told to do what you worked out to do.

Because it's DIFFERENT for all of us !


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## bennyg70 (Jan 16, 2013)

trophywench said:


> Well that just shows you.
> 
> With pizza I don't get a rise at all for abouthalf an hour, then it's modest until 2 hours and dwindles to nowt.  Then 5 or 6 hours later - Wham.
> 
> ...



Took me 20 years to realise this is what happened to me  ... Well done on hearing it after 4 days!


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## hybriduno (Jan 16, 2013)

ok so we went to see the dietitian today and she basically told us some interesting stuff  which cheered him up   so my son chose his dinner  lol he had 

pasta in a sauce (30 carbs)
home made pizza (30.2 carbs)
sugar free jelly (0.5 carbs)
Milk shake (27 carbs)

His results so far

before meal 13.3
1 hour after 13.5
2 hours after 11.5
3 hours after 20.0
4 hours after 22.6
5 hours after 24.8
6.5 hrs after 21.5  <12:30 pm
morning level is 11.2   @ 7:30 am


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## HOBIE (Jan 16, 2013)

I keep out of the way of pizza.  Too much carbs & feel hungry with only having two or three bits.


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## Northerner (Jan 16, 2013)

hybriduno said:


> ok so we went to see the dietitian today and she basically told us some interesting stuff  which cheered him up   so my son chose his dinner  lol he had
> 
> pasta in a sauce (130 carbs)
> home made pizza (30.2 carbs)
> ...



Was that all in one meal? That does look like a lot of carbs - I probably only get through about 150g a day, but I'm not his age. There is quite a jump at 3 hours, so it looks like this is the spike - whether it reduces will depend on his 4 and 5 hour readings. If they are still high or incerasing then there is probably insufficient insulin.


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## bev (Jan 16, 2013)

hybriduno said:


> ok so we went to see the dietitian today and she basically told us some interesting stuff  which cheered him up   so my son chose his dinner  lol he had
> 
> pasta in a sauce (130 carbs)
> home made pizza (30.2 carbs)
> ...



Hi Hybriduno,

Have you been taught about giving a correction dose of insulin for high levels? If 13.3 before eating you really should be waiting for the levels to come down before eating and also inject at least 15 minutes before eating to give the insulin a chance to start working. Pizza is one of the tricky foods as is pasta and milkshake so altogether you werent going to get decent levels to be honest! It would be a good idea to try just one of these on their own when levels are under 10mmls so you can get a better idea of meal spikes and how to dose for them.Bev


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## hybriduno (Jan 16, 2013)

Northerner said:


> Was that all in one meal? That does look like a lot of carbs - I probably only get through about 150g a day, but I'm not his age. There is quite a jump at 3 hours, so it looks like this is the spike - whether it reduces will depend on his 4 and 5 hour readings. If they are still high or incerasing then there is probably insufficient insulin.



TYpo!!! pasta was 30 not 130  ill check him again in a few minutes as at 10:30 its 5 hours later


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## Northerner (Jan 16, 2013)

hybriduno said:


> TYpo!!! pasta was 30 not 130  ill check him again in a few minutes as at 10:30 its 5 hours later



Phew! That sounds better!  Had visions of enormous amounts of spaghetti and a little 8 yo!


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## hybriduno (Jan 16, 2013)

Northerner said:


> Was that all in one meal? That does look like a lot of carbs - I probably only get through about 150g a day, but I'm not his age. There is quite a jump at 3 hours, so it looks like this is the spike - whether it reduces will depend on his 4 and 5 hour readings. If they are still high or incerasing then there is probably insufficient insulin.





bev said:


> Hi Hybriduno,
> 
> Have you been taught about giving a correction dose of insulin for high levels? If 13.3 before eating you really should be waiting for the levels to come down before eating and also inject at least 15 minutes before eating to give the insulin a chance to start working. Pizza is one of the tricky foods as is pasta and milkshake so altogether you werent going to get decent levels to be honest! It would be a good idea to try just one of these on their own when levels are under 10mmls so you can get a better idea of meal spikes and how to dose for them.Bev



Thanks for your response Bev. no we havent been told jack! this is whats upsetting, we have a very basic chart ie:

bs under 4 follow hypo guide..
bs between 4-10 give 3 units
bs over 10     4 units
bs over 20     5 units

nighttime levemir   5 units

now obviously its 10:30 pm and i dont know whether to give him another unit or 2 to try and bring him down  or wait till 2 am and re check him.

it's soo worrying that we have so little knowledge yet released from hospital


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## trophywench (Jan 17, 2013)

Shoot!  Or summat similar.


me -

1 unit of insulin deals with (negates) 10g of carb.

1 unit of insulin and no food, reduces my meter reading by 3.0


I'd be mega, stega hypo if I took 4u when my meter said 14 ........

For that meal then, I'd need 9u of insulin, plus another 2u as a conservative correction, so I'd have that in 2 jabs as it's less successful injecting more than 7u in one jab.  Your HCP may disagree with that.  But it isn't a hypothesis - most of us find it's true ......

I still think 90g of carb in one sitting is A LOT for an 8yo.


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## bev (Jan 17, 2013)

hybriduno said:


> Thanks for your response Bev. no we havent been told jack! this is whats upsetting, we have a very basic chart ie:
> 
> bs under 4 follow hypo guide..
> bs between 4-10 give 3 units
> ...




Hi Hybriduno,

Hmm that does seem a little general! I dont understand why you would be giving a correction dose when levels are 5 for example? Your chart says between 4 and 10 give 3 units - but you wouldnt need a correction if levels are within range (i.e. between 4 and 7) so am a little puzzled. If you gave 3 units at 4 your child would be on the floor!

Our target is 6mmols - so if over that we know to give 1 unit of insulin for every 3.8mmols of BG that is higher - but Alex is on a pump so its easier to do such small increments whereas on injections you can only do half units as I remember. I am wondering whether your team are just being general because its such early days - but then if you followed the advice for correcting at 4 or 5 then not sure what would happen. Have you given a correction at these levels and if so what was the outcome?Bev

p.s. Your doing great by the way - your asking all the right questions and not just sitting back and accepting things which is great given its such early days!


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## hybriduno (Jan 17, 2013)

before meal 13.3
1 hour after 13.5
2 hours after 11.5
3 hours after 20.0
4 hours after 22.6
5 hours after 24.8
6.5 hrs after 21.5  <12:30 pm
morning level is 11.2   @ 7:30 am


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## everydayupsanddowns (Jan 17, 2013)

hybriduno said:


> Thanks for your response Bev. no we havent been told jack! this is whats upsetting, we have a very basic chart ie:
> 
> bs under 4 follow hypo guide..
> bs between 4-10 give 3 units
> ...



OK, so here is my assumption. This chart is supposed to be for doses before meals. You haven't been told to inject at any other time. And you haven't been told about monitoring the amount of carbohydrate your son is eating, but to eat a 'normal' healthy diet and avoid sweet things except very occasional treats.

This is approximately 25% of the information that you actually need to manage diabetes successfully.

I suspect that their guess is that an 8 year old will generally eat something like 30-50g of carbs per meal, so they have conservatively estimated starting doses based on that (but crucially *not* told you that this is the suggested limit). They are probably trying not to ovewhelm you in the early stages, but as you can see this does not necessarily make for comfortable reading on the BG meter!

You might choose to adopt this 'fixed dose' approach in the early weeks - to monitor carb intake at each meal and take those suggested doses. Then use tests 4 hours after meals to work out whether the carbs eaten have been too much or too little for the dose (after 4 hours the dose will more or less have finished).

Alternatively you work out each meal on a insulin:carb ratio, and include an allowance for pre-meal readings higher or lower than target as others have suggested. 

At your next appointment I would bring all this up so that your team know you are self motivated and aware of carb counting theory. In the long term this will be the most effective and flexible management strategy. And the more normal and less restricted your lad feels he is with food, the better his relationship with his D is likely to be IMO.


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## pgcity (Jan 17, 2013)

I think you are doing marvellously well but there is an awful lot of experimenting to be done and info to learn.
Your team have put you on fixed doses. If you give them the carb counts for each meal and the before meal and 2 hour after meal readings they can help you work out insulin to carb ratios. These will change periodically but are the next step to getting better numbers.
Once you get the ratios you can look at the impact of the glycemic load and digestion of fats, proteins and odd foods. Everyone has a different list of foods that don't behave but we all tend to agree Chinese, pizza and pasta are tricky. I was diagnosed in 2011 and I still haven't sussed pasta.
There are all sorts of non food related things that impact too. Exercise, weather, stress and excitement tend to impact us all but whether it is to make your levels go up or down depends on the individual. I also have problems with baths and showers, lie ins, time of the month and watching man city.
I have learned so much from this forum and you will too but the best thing you can do is get a diary and start writing down blood glucose readings, food, activity and anything else you think might be making a difference. This will help you spot patterns and develop your own rules for dealing with the ups and downs and sometimes sheer randomness of the blood glucose readings you get.


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## trophywench (Jan 17, 2013)

I was diagnosed in 2011 and I still haven't sussed pasta.


I have nearly 40 years start on you mate, and if I ever manage to get it right, I promise to let you know!

Less of it you eat though, the more manageable it is .... had spag for tea tonight.  Utterly forgot to do a 'fancy' bolus and just lobbed it all in.  4.4 at plus 2 hours, now at just over 4 hours, 7.4 so just had 0.5u.

We'll see, normally have a huge spike about 2 hours from now ....


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