Great advice from Adrienne. This bit is especially important ...
Does J have midmorning snacks.
On mixes you feed the insulin. On all other regimes, MDI and pumping you give insulin to cover the food so a totally different way of doing it which is much easier.
Chasing insulin, like you are doing is damned hard work so you are doing ok.
The normal way to deal with mixes is the following regime with food :
breakfast
Midmorning snack
lunch
midafternoon snack
tea
bedtime snack
The snacks are so very very important.
If F doesn't get her midmorning snack, she goes hypo almost instantly. Her teacher knows she MUST have it at 10:00 and no later. Because she has milk at school (10 carbs), she has a digestive with it at 10:00, which takes it up to 19 grams of carbohydrate. In the afternoon she has 20g of carbs at her desk at 3:00 - usually a cereal bar or something similar.
Here is F's current carb-counting regime, which should probably be about the same for J, as she's eating a similar amount to what an average adult female requires daily (still trying to regain weight after the DKA).
Aim for 200g - 240g per day of carbohydrate.
Breakfast - 50g
7:50 - 20 minutes after insulin
Mid-Morning - 20g
10:00
Lunch - 60g - 70g
12:00
Mid-Afternoon - 20g
3:00
Evening Meal - 60g - 70g
5:30 - 20 minutes after insulin
Supper - 20g - 30g
7:00
As Adrienne says, you ignore the breakdown of the carbs and just read the total on the packet. F usually has cornflakes and raisins for breakfast. I weigh it all out every time, and her numbers stay fairly steady if I do that.
Here is the information sheet I typed out for F's grandparents when we were staying with them...
The following list of mealtimes and carbohydrate requirements needs to be stuck to fairly strictly in order to keep F’s glucose levels stable.
She MUST have her breakfast and dinner about 20 minutes after her insulin, because that’s the optimum time for it to work at its best. She MUST have her insulin at pretty much the same time each day.
If she has too many carbohydrates or too few, her insulin will not deal with it effectively and her sugar levels will be too high or too low.
When checking packets for carbohydrate content, do NOT look at the “sugars” section, but at the section that is the total carbohydrates. Remember to check whether the portion size you’re reading on the pack is for 100g of the product or a specific serving, or your calculations could be wrong.
Each meal and snack must include a starchy carbohydrate (bread, potatoes, pasta, rice, etc…). There is a list of these on an information sheet which I will copy for you.
She can drink lots of sugar-free squash, but not fruit juice.
F now has semi-skimmed milk. She likes low-sugar hot chocolate as part of her supper. Cadbury’s highlights do one which has very few carbohydrates and she likes it.
Supper is generally toast and low-sugar jam with hot chocolate. The quantity depends on which bread you use and how thick or thin the slices are. I’ll photocopy the carbohydrate counting guide we have here.
She only has chocolate or cake rarely, and usually at the end of a low-carb dinner. If it is eaten after a dinner, it absorbs more slowly, which is better for her. For example, if I make dinner and it turns out to only contain 50g of carbohydrate, she might be allowed a single-finger Twix, which works out at 14g carbohydrate. This doesn’t happen often though, as the slow-release carbohydrates are better for her than the fast-release carbohydrates in sugary foods.
I also scanned this document for my mum, which the hospital gave us.
"Children With Diabetes" It's very useful and the explanations in it are easy to understand. There are some good snack suggestions too. If you think it would help I could also scan in the carb-counting leaflet they gave us. I use that, alongside the Collins Gem Carb Counter and we get along very well.
It is VERY hard to keep good control on mixes, but we've just got F's insulin dose about right, and had two weeks of numbers between 4 and 8, with only 2 hypos! This weekend ruined it slightly as she ate iced cake at her brother's birthday and went quite high for a while, but we're getting it under control again.
It's a pity that the hospital didn't take the time to teach you all this. I think it's essential for anyone dealing with type 1 diabetes.
The school will need to let J eat where and when he needs to. Explain the dangers of low blood sugars to them (I don't think most teachers "get" hypos unless you frighten them with worst-case-scenarios!), and if they are still reluctant to let him eat in class, ask to see their special needs policy.
