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Breakfast hypo after 2 -3 hours

Clairel

Active Member
Relationship to Diabetes
Parent
My son was diagnosed in August 2020 he's 8years old and to be honest it's been a rollercoaster ever since. Recently he's sometimes having high readings after breakfast and after about 30 mins dropping quite fast to the point he's having a hypo or close to. Anyone had experiences with this?
 

Inka

Well-Known Member
Relationship to Diabetes
Type 1
Hi @Clairel It could be the honeymoon period where his own islet cells have made a temporary and slight recovery and are now randomly producing some insulin of their own. This can contribute to hypos.

You say it’s recent - could it be a change in routine eg lockdown? Has anything else changed?

I’m presuming you’re carb counting and adjusting his insulin? Do you bolus in advance of meals?
 

stillgoing

Well-Known Member
Relationship to Diabetes
Type 1
Readings can do this. Rollercoaster is the game you are now on. Can you identify any cause. Is he running around a lot or more. Is he on a growth spirt. I'm 62 now but started as a 5 year old. Could run around until I collapsed! Need more information like the readings you are getting. insulin type and regime. Lots of causes and lots of solutions but best to get as much information as you can and talk to your son's DNS.
 

Clairel

Active Member
Relationship to Diabetes
Parent
He's on 0.5 Levemir which I give him 30 minuites after his breakfast bolus (aspart) I found this worked for while. He's breakfast ratio is 1-8 and his readings were 13.5 the last few days and today only 9.3 dropped to 6.3 a still dropping after 2 1/2 hours.
 

Clairel

Active Member
Relationship to Diabetes
Parent
No
Hi @Clairel It could be the honeymoon period where his own islet cells have made a temporary and slight recovery and are now randomly producing some insulin of their own. This can contribute to hypos.

You say it’s recent - could it be a change in routine eg lockdown? Has anything else changed?

I’m presuming you’re carb counting and adjusting his insulin? Do you bolus in advance of meals? No change in routine he has the same breakfast everyday (his choice) we believe he's out of the honeymoon period. I've spoken to his DNS and they say because he's not always having a hypo then there's nothing to change. I try to catch him before he gets that low. He was previously only on Levemir at night as he was really sensitive to it during the day but we found he started creeping up between meals so started him on 0.5 2 months ago.
 

Clairel

Active Member
Relationship to Diabetes
Parent
No change in routine he has the same breakfast everyday (his choice) we believe he's out of the honeymoon period. I've spoken to his DNS and they say because he's not always having a hypo then there's nothing to change. I try to catch him before he gets that low. He was previously only on Levemir at night as he was really sensitive to it during the day but we found he started creeping up between meals so started him on 0.5 2 months ago.
 

Inka

Well-Known Member
Relationship to Diabetes
Type 1
There’s no problem having the same breakfast every day. It’s one less thing to think about :)

Two thoughts - are his hypos in any way related to his blood sugar before breakfast - that is, is he more likely to have a hypo if he starts below a certain number? I find that if my blood sugar is lower than 5.5 very approx, I need less bolus for my breakfast.

Second thought - how far in advance of his breakfast are you bolusing? Sometimes if you bolus more in advance you can reduce any spike and also sometimes then reduce the amount of insulin (because it’s there more in advance so at work quicker). That helps reduce hypos.
 

stillgoing

Well-Known Member
Relationship to Diabetes
Type 1
OK. Not really sure about this but the aspart reaches maximum effect 2 to 3 hours after injection and up to 5 hours before it stops. The levemir is like a 24 hour acting one. Sorry to hear DNS not helpful. Always difficult with children because you don't feel the hypo! His absorption rate may have changed as he grows and is now a larger mass but this should be a DNS or consultant decision.
 

Clairel

Active Member
Relationship to Diabetes
Parent
He usually wakes up with BG between 6-7.3 on average, We've been told to leave 15 minuites between bolus and food which for his other meals works perfectly.
 

Clairel

Active Member
Relationship to Diabetes
Parent
We use the MY LIFE app and also the libre sensor. The levimir is 24 hours and aspart we check the two hours after. For all other meals he stays at a reasonable level it's just breakfast that there is a sudden drop. He's asking for something new for breakfast which has sent my anxiety through the roof!!
 

Kaylz

Well-Known Member
Relationship to Diabetes
Type 1
Timing is a completely individual thing and can vary on time of day and also the site used for injection, for instance I need to inject 20 minutes before breakfast in a thigh but only 15 minutes before dinner in the opposite thigh and then by tea when I use my stomach I need to eat immediately or I end up hypo xx
 

Kaylz

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Relationship to Diabetes
Type 1
What is he having for breakfast at the moment? And what is it he's wanting to try instead? xx
 

Clairel

Active Member
Relationship to Diabetes
Parent
Oh wow!! I tried injecting in his thigh to see if it helped and hes readings were 13.8 after the two hours and still dropped. His belly seems to work faster but still drops regardless of injection site.
 

Amity Island

Well-Known Member
Relationship to Diabetes
Type 1
My son was diagnosed in August 2020 he's 8years old and to be honest it's been a rollercoaster ever since. Recently he's sometimes having high readings after breakfast and after about 30 mins dropping quite fast to the point he's having a hypo or close to. Anyone had experiences with this?
Hi Claire,

Sounds like the bolus is too much and too late (assuming your sons basal (levemir and partly own insulin) is working correctly and keeping background blood sugars steady 24hrs a day).

What I mean is, a classic spike like that is caused by taking the bolus (aspart) too late e.g too close to when breakfast is actually eaten and its been compounded, because it looks like there is also too much insulin, which is dropping levels below where they were before the meal, causing a hypo.

I can only say what strategy I woud try in that same situation. To prevent the spike and the hypo, I would try a little bit less insulin earlier before eating. For breakfast I can take my bolus 20mins before breakfast to prevent a spike like that. All depends of course what is being eaten, if it's cereal and milk then 20mins would work well for me. If it was a bacon sandwich I'd take a bolus just before.
 

rebrascora

Well-Known Member
Relationship to Diabetes
Type 1
Just to give you a bit more idea of the spectrum of delay needed between bolus insulin and breakfast, I am also currently using Aspart (Fiasp) and I need to inject into my stomach as much as 45 mins before i eat my breakfast even with relatively slow release carbs (creamy Greek yoghurt, berries and seeds) but I only need 15-20 mins at other times of the day. I agree that less insulin but bolused earlier is likely the answer. Obviously my 45 mins is extreme but try bringing it forward by 5 mins each day until you don't get that spike and then drop. Having the Libre is wonderful for being able to see and iron out these problems.
 

Clairel

Active Member
Relationship to Diabetes
Parent
Thank you for that I think I'm going to call his DNS Monday morning. It's ok while his at home and I can monitor him but once he's eventually back at school I will be forever worrying.
 

Clairel

Active Member
Relationship to Diabetes
Parent
Thank you for all the advice. You all seem to think a similar thing. Calling them first thing Monday morning with a better insight to what I believe is happening. Really appreciate all the advice.
 

stillgoing

Well-Known Member
Relationship to Diabetes
Type 1
For me the insulin seems quite quick so my blood sugar drops before the food gets there. If I am starting from a lowish number I can then end up hypo which I have to treat and then my body decides to process the food so I end up high.

Overall your numbers look good so try not to worry to much. I read somewhere on here that T1 monitoring at the 4 hour point is better for control as at that point both the food and insulin have done their matching but obviously you don't want too high a spike at the 2 hour point.

Try not to worry about changing the food. Read the boxes and match the weight to carb content. Then you know that the amount of carb is the same so should all work out. The speed of absorption may be different so insulin timing might need altering.

Let us know how it goes with the DNS and good luck
 

stillgoing

Well-Known Member
Relationship to Diabetes
Type 1
Reread one of your other posts. Being on libre then test timing isn't so important as you get all the data anyway. I understand there is a way to remotely monitor the libre system via a mobile phone. (Big brother or is that mother):)

I don't use this system but I expect other parents will tell you if and how to do it. It might help you when he is back at school to relax.
 
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