Advice on morning spikes?

[Emma B]

Hi, any advice would be greatly appreciated, We found Sam has been having mid morning spikes and we're struggling to control them. He usually has 2 weetabix and fruit, maybe milk as well (approx 45-50 carbs) and although only two years old has no problem eating all this. His insulin seems to have more trouble! He is peaking at 16+ 2 hours later, then falling low before lunch.

We're trying increasing his novorapid (from 1:20 to 1:10) on advice from our diabetes nurse and giving his insulin 20 minutes before breakfast. Simultaneously we've increased his levemir (basal) slightly as his am levels are high too (around 9). We're told it's his honeymoon period ending but it's a bit new to us so any thoughts would be helpful🙂

Thanks
Emma

 

[LeeLee]

If it absolutely has to be cereal for breakfast, try porridge (the proper stuff, not instant) instead of Weetabix and see what his levels do. It's lower GI and may give a slower energy release. Eggs would be even better, perhaps with yogurt to follow.

 

[Redkite]

This is a tricky one, as I'd normally say try giving the novorapid even earlier, but with a two year old I wouldn't want to risk him then deciding he didn't want to eat it! That's a big increase in his ratio (double the amount!), I think I'd have increased it more cautiously, and not at the same time as a levemir increase, else you may not be able to see the wood for the trees (ie which insulin is causing hypos). Do you test him during the night at all? If he is waking around 9mmol, what are his levels like at his bedtime/your bedtime and around2/3am? It could be that the levemir is ok but he is starting the night too high, for example.

 

[Emma B]

Hi, thanks for your replies. We tried giving him one weetabix, fruit and yoghurt this morning (with 1:12) and he peaked at 9.8 which is a great improvement. An hour later he was 7.3, gave him a small biscuit with no insulin to stop the big drop and he was 4.3 before lunch. We are really pleased 🙂

We had to reduce his levemir back to 2 though as he went to 3.3 at 6am. We will test at 2am and see. Our diabetes nurse thinks his honeymoon period has ended and it's quite unpredictable. One predictable thing though is despite his age he's a great eater (hence the two weetabix dilemma!) he eats all his food without fail so at least that makes things a little easier and we have also started to give him his insulin earlier particularly when starting off high

 

[HOBIE]

Sounds good to me Emma. Keep at it 🙂

 

[Hanmillmum]

Sounds like you have it sussed but Weetabix was always a big no no for my little one, she had horrendous spikes with it. After trial and error found some cereals that she is ok with and now she's a bit older we can give her bolus 10-15mins prior to her eating which is a big help too.

 

[everydayupsanddowns]

Looks a lot like a timing issue to me. In an ideal world (ha!) the breakfast dose should mean that after 4-5hours he is back where he started. The spike is a problem, but falling low before lunch suggests that not only is the insulin not keeping up (I'm another who had huge problems with Weetabix, may as well have been eating a big bowl of jam) but also there is too much insulin as falling low before lunch.

Results seem better in some ways after the change, but now you are 'feeding' the insulin - snacking to avoid hypos, which is not good long term. V tricky with a little one, but I'd try other cereals. I think Frosties have a lower GI - which seems mad, but the finely milled grains in Weetabix are super-fast in absorption

 

[AlisonM]

I've had major problems with Weetabix as well. I've found I can get away with oatmeal or cornflakes, but none of the other cereals as they all seem to spike me and then I drop fast.

 

[Emma B]

Sounds good to me Emma. Keep at it 🙂

Thanks Hobie, we've got a CGM on him at the moment, so should help us see what different foods do more accurately. Typically though since then his results have all been in range! 😉

 

[Emma B]

I've had major problems with Weetabix as well. I've found I can get away with oatmeal or cornflakes, but none of the other cereals as they all seem to spike me and then I drop fast.

Thanks Alison, we will try cornflakes, he loves bran flakes but I know they are high too

 

[Emma B]

Looks a lot like a timing issue to me. In an ideal world (ha!) the breakfast dose should mean that after 4-5hours he is back where he started. The spike is a problem, but falling low before lunch suggests that not only is the insulin not keeping up (I'm another who had huge problems with Weetabix, may as well have been eating a big bowl of jam) but also there is too much insulin as falling low before lunch.

Results seem better in some ways after the change, but now you are 'feeding' the insulin - snacking to avoid hypos, which is not good long term. V tricky with a little one, but I'd try other cereals. I think Frosties have a lower GI - which seems mad, but the finely milled grains in Weetabix are super-fast in absorption

Thank you🙂 giving him the insulin earlier is helping further. The dietician was pro a mid morning snack but diabetes nurse not so keen, we will keep trying options and reviewing if its needed

 

[Emma B]

Sounds like you have it sussed but Weetabix was always a big no no for my little one, she had horrendous spikes with it. After trial and error found some cereals that she is ok with and now she's a bit older we can give her bolus 10-15mins prior to her eating which is a big help too.

Thanks, we will try other cereals and see whether we can get an improvement. I think the yoghurt with it may be helping slightly but as you say injecting earlier also helps 🙂

 

[Emma B]

Thanks

Thanks for all your replies it gave me a lot of ideas, so far the spikes are greatly reduced and we will keep on it