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breakfast time

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ky333

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Relationship to Diabetes
Parent of person with diabetes
I have been trying, with very limited success to bring down the post breakfast spike in my 8 yr old. I posted on here a couple of weeks ago and have taken on board those suggestions to try moving the insulin time back a bit gradually.
I have tried this over past week or so. She has 2 weetabix ( no longer has any toast ) She starts the day on around 4.9 ish. We would give her insulin and then he waits 15 min. After about 60 min she would spike to 14.7 when getting to school so we altered it every day by 5 minutes.
Now we are at waiting 30 min for her weetabix after injecting but instead of lowering the spike it has just brought her spike on earlier so it starts after just 20 minutes.

Any tips? I dont really want to stop her having weetabix as she has already had so many foods rationed already.
 
Now we are at waiting 30 min for her weetabix after injecting but instead of lowering the spike it has just brought her spike on earlier so it starts after just 20 minutes.

I don’t think that could be the earlier bolus. It doesn’t make sense. If she’s still going high, then perhaps you also need to look at the amount of insulin she’s having. She just might not be having enough.

She can still eat Weetabix - don’t worry. It will just take some jiggling, which is completely normal for Type 1 and especially soon after diagnosis.

The other thing to look at would be her basal. I have a pump and my basal rate is highest in the morning to cover my Dawn Phenomenon and Waking Rise. I need that in addition to bolusing in advance and having a higher ratio for breakfast than other meals.

One thought - is she putting sugar on her WB, and what milk is she having with them?
 
I agree that it is likely a combination of the carbs in the Weetabix and Dawn Phenomenon (DP).
Do you measure the sugar she has on her breakfast as that will hit the blood stream faster than the starchy carbs from the breakfast cereal and would cause a spike sooner?
I usually inject my breakfast insulin + 1.5 or 2 units for DP as soon as I get out of bed and then sometimes need to wait as long as an hour for NovoRapid to start working before I eat breakfast..... I have gone as long as an hour and a half before eating on very rare occasions when I have got distracted and not hypoed. I watch my Libre for when I see the arrow start to angle downwards and have breakfast ready to start eating then. It can be a fine balance though and sometimes I get it wrong and drop a bit low whilst eating breakfast.

I think there is probably room for you to try bringing the insulin injection forward a little more..... maybe another 5 mins.

What I find affects the timing and insulin requirement for breakfast is how much exercise I have done the previous day. Just recently because of increased exercise I have not needed any bolus for DP and I only need 30 mins pre bolus for breakfast, so it can vary quite a lot depending upon other factors.
The Freestyle LIbre is certainly a huge benefit in helping to get it right but 3 months on with it I am still experimenting with my breakfast timing and doses so don't be disheartened that you haven't cracked it yet.
 
Thanks for reply

We have tweaked her basal slightly and her BG are ok apart from this spike. (Her BG return more or less to the same level after food and insulin has worn off) - Im taking that as a positive that the basal is working ok??

We also changed her carb ratio rate from 1:12 to 1:15 a short while ago as she was hypoing just before lunch everyday.

Shes definitely not having sugar... at least I really hope not, shes very good on what she can and cant have.
Its semi skimmed btw

I was thinking if as a one off i cooked her eggs instead and she had this with no insulin would this give me an insight into the spike?
 
rebrascora said:
I agree that it is likely a combination of the carbs in the Weetabix and Dawn Phenomenon (DP).
Do you measure the sugar she has on her breakfast as that will hit the blood stream faster than the starchy carbs from the breakfast cereal and would cause a spike sooner?
I usually inject my breakfast insulin + 1.5 or 2 units for DP as soon as I get out of bed and then sometimes need to wait as long as an hour for NovoRapid to start working before I eat breakfast..... I have gone as long as an hour and a half before eating on very rare occasions when I have got distracted and not hypoed. I watch my Libre for when I see the arrow start to angle downwards and have breakfast ready to start eating then. It can be a fine balance though and sometimes I get it wrong and drop a bit low whilst eating breakfast.

I think there is probably room for you to try bringing the insulin injection forward a little more..... maybe another 5 mins.

What I find affects the timing and insulin requirement for breakfast is how much exercise I have done the previous day. Just recently because of increased exercise I have not needed any bolus for DP and I only need 30 mins pre bolus for breakfast, so it can vary quite a lot depending upon other factors.
The Freestyle LIbre is certainly a huge benefit in helping to get it right but 3 months on with it I am still experimenting with my breakfast timing and doses so don't be disheartened that you haven't cracked it yet.
Click to expand...


This morning, I had her running up and down the stairs 10 times and jumping on her trampoline after breakfast just to see if the spike would not materialise ...... it didnt work
 
ky333 said:
I have been trying, with very limited success to bring down the post breakfast spike in my 8 yr old. I posted on here a couple of weeks ago and have taken on board those suggestions to try moving the insulin time back a bit gradually.
I have tried this over past week or so. She has 2 weetabix ( no longer has any toast ) She starts the day on around 4.9 ish. We would give her insulin and then he waits 15 min. After about 60 min she would spike to 14.7 when getting to school so we altered it every day by 5 minutes.
Now we are at waiting 30 min for her weetabix after injecting but instead of lowering the spike it has just brought her spike on earlier so it starts after just 20 minutes.

Any tips? I dont really want to stop her having weetabix as she has already had so many foods rationed already.
Click to expand...
Hi,

As Inka suggested, once you've got to the point where the bringing of the insulin dose forward as much as possible (could be more than 30mins it's trial and error) to prevent a spike is not having much of an effect, then I'd be looking at the amount of insulin. My ratio's changes throughout the day and as others say, the dawn rise also can add a few points extra onto blood sugar readings, but not always and not every day.

At breakfast my insulin to carb ratio is twice the carbs at 2units for every 10 grams of carb.

2 weetabix and skimmed milk will be about 35g of carbs, so for me personally i'd have to take 7units of insulin 30mins before eating to avoid a big spike.

The other thing worth trying is full fat milk, it may make a significant impact on the spike?
 
Ok - I think I remember talking to you before. Apologies for forgetting or repeating myself. To my mind, you can either choose to give her a late morning snack to ward off the pre-lunch hypo while having enough insulin for breakfast to reduce the spike, or you can go with her being a little high after breakfast (how high is she at 2hrs?) and keep the breakfast bolus the same as she’s back in range by lunch.

When I was newly diagnosed, I’d spike after breakfast but be low at lunch in a similar way. This was my own remaining beta cells squirting out some insulin (too much, too late) before lunch. A friend had the same problem. Lunchtime seems a popular time for this to happen. So, it could be that.
 
I went through that process, doing squats and sit ups etc after my morning injection to see if it would get into my system quicker. It didn't work.
For me it takes 12- 24 hours for exercise to have an impact and it needs to be more sustained exercise ... for me a 4-5 mile (40mins -1hr) walk/jog the morning before and making a regular daily routine of it to have a sustained impact.... I also need to significantly reduce my evening Levemir dose when I do this or I hypo in the early hours.
I appreciate that this may not be a practical solution for a child, so experimenting with injecting a bit earlier still (up to an hour before breakfast) worked for me before I started my exercise regime.
 
That sounds unusual (and a pain) @rebrascora , having to wait for exercise to take effect like that. Do you think it could be an element of insulin resistance? I was thinking of how far in advance you need to bolus too. The only thing I’ve found that gets the bolus working quicker is to have a warm shower. Note - I’m not recommending this for the OP’s daughter as there’s a risk of hypoing if you misjudge, but it’s something I’ve done before and it does help.

Another thing occurred to me @ky333 - I find eating as soon as possible after getting up works best. If I delay breakfast, my blood sugar goes up and my normal insulin dose doesn’t work as well.

I know all these little things are a nuisance - trying this, trying that - but the early weeks and months are hard while things settle, so please be assured it won’t always be so difficult and you’ll gradually find things that work.
 
@Inka
As I understood it, it is normal for the effects of exercise to be seen up to 24 hrs afterwards.

You get used to the way your body responds and we all know how individual diabetes can be. I am getting much better at managing it with the help of Libre and I am averaging 90+% TIR so quite happy with how I am doing and learning all the time.
 
For me it takes 12- 24 hours for exercise to have an impact

I read that as you saying the start of the effect of exercise was delayed not that it continued over 24hrs.

Yes, there’s always something to learn or to consider with Type 1 - it’s an ongoing process. That’s why I welcome different people’s comments on the forum and weigh them up even if I later find out they don’t work for me. It’s interesting to read various discussions too.
 
I see some benefit initially during/after exercise but for me the most obvious effect is that my evening basal dose needs to be reduced and my morning DP is reduced or non existent. Oddly my daytime basal needs remain the same, so I still need 16 units in the morning but drop from my usual 6-8 at night down to 0-2 units if I am consistent with my exercise over a few days.
 
Hope you find a fix @ky333

I have also seen times where delaying breakfast just gets my liverLl twitchy... But I have also had times where 30-45 minute wait was needed to reduce the BG rise from breakfast carbs.

I have never tried it, but I wonder if having something low/no carb soon after rising like a babybel or some nuts/seeds in full fat greek yoghurt might keep the liver happy while waiting for the weetabix.

You could always halve the number of weetabix if it ends up being too much food in the morning?

Not something I’ve tried... but in my head the theory is an interesting one to try?!
 
Thanks everyone. She had 2 poached eggs on a potato cake this morning.... no spike! at all! Never went above 6 the whole morning. Obviously this was just an experiment to see how she got on, but just shows how much things differ.

Probably will revert back to her favourite weetabix tomorrow but will try with the full fat milk suggestion
 
Another thing I’ve found is that certain meals need a slight tweak to the dosage - ie either slightly more or slightly less than the carbs suggest. That’s something you only learn from experience.

I almost always have cereal and milk for breakfast, but on the rare occasion I don’t, I find I don’t need quite as much insulin even if I have the same total carbs.

Just another of the ‘fun’ things about diabetes. It always keeps you on your toes!
 
Does she like cream? - cos if the full fat milk still isn't enough, single cream might be. Wouldn't work too well for me cos I like my Weetabix soggy, if I wanted that, so warmed the milk in the microwave before I lobbed the W in the dish. Should delay the onset of the carbs enough to reduce that pre-bolus timing - all worth a try anyway. You'll all find things more predictable when her pancreas stops trying to help.

That sounds a bit nasty, I'm sorry - it's just hard until things settle down and start being a bit more predictable is all.
 
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