Missing a meal

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mummyange

mummyange

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Relationship to Diabetes
Type 1
Can anyone help? My son missed lunch as I took him to A&E but that's another story. Now his levels are at 13.4 and he is afraid to inject to have dinner. He feels shaky and light headed and I am terrified for him as no one is willing to help him!!! I.e hospital. Please someone give me advice!
 
mummyange said:
Can anyone help? My son missed lunch as I took him to A&E but that's another story. Now his levels are at 13.4 and he is afraid to inject to have dinner. He feels shaky and light headed and I am terrified for him as no one is willing to help him!!! I.e hospital. Please someone give me advice!
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Does he just inject as normal or does he have to adjust his insulin?
 
mummyange said:
Does he just inject as normal or does he have to adjust his insulin?
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He can miss a meal ok. He should just inject his basal insulin as he normally would (whatever time of day he does that). Then he should calculate the carbs and inject for his evening meal as normal.
 
Inka said:
He can miss a meal ok. He should just inject his basal insulin as he normally would (whatever time of day he does that). Then he should calculate the carbs and inject for his evening meal as normal.
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He is worried about how high they are. And worried incase they go up to over 15.
 
On a basal/bolus regime, missing a meal is fine. It shouldn’t make him go low if his basal dose is ok. When I moved house I missed breakfast and lunch (obviously I did not inject for them) and my blood sugar stayed steady.
 
Yeah he is just really worried. He is obsessing over diabetes now and hasn't been given the correct help! What does he do if they shoot up after dinner? Does he just inject more to bring them down?
 
No, if he’s had a correction dose with his pre-meal bolus, he shouldn’t correct again within 4 hours. This is because the insulin continues working for a number of hours so if he injected again he could go too low.
 
@mummyange If you can afford it, I’d pay for a few counselling sessions for him about dealing with anxiety.

I know it must be very stressful for you to watch, but with the diabetes, try to remain matter-of-fact as hopefully he’ll get some reassurance from your calmness.
 
Inka said:
@mummyange If you can afford it, I’d pay for a few counselling sessions for him about dealing with anxiety.

I know it must be very stressful for you to watch, but with the diabetes, try to remain matter-of-fact as hopefully he’ll get some reassurance from your calmness.
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Thankyou so much
 
I skip meals all the time and as long as my basal insulin dose is right, my levels should remain reasonably steady. The fact that his levels have gone up to 13 suggests his basal dose may not be holding him steady, particularly if that is a regular trend in the afternoon/evening.
Does he have a correction factor?
This is usually 1unit of fast acting insulin will drop your son's levels by x number of mmols? They usually start you off with a correction factor of 1 unit drops you 3mmols, unless you are really sensitive to insulin and then adjust it according to how his body responds to using that correction factor.

So you would calculate how many carbs were in the meal he was about to eat and use his meal ratio to calculate the dose for the food and then add an appropriate correction to that meal bolus, to bring him down to a level that he is comfortable with.
So, if he was having 70g carbs for tea and his ratio was 1:10 then that would be 7 units for the meal plus the correction. So if 1 unit drops him 3mmols then a single correction unit would bring him down from 13.5 to 10.5, which is a level he seems reasonably comfortable with at the moment, from what you have said. I am guessing he doesn't have a half unit pen as 1.5 units would probably be a better option as that would drop his levels about 4.5 units with that correction factor which would leave him on 9mmols (13.5-4.5= 9). I think 2 correction units might make him feel anxious as that could take him down to 7.5. If he has a smaller correction factor like 1unit drops him just 2mmols, then I think a 2 unit correction would still be very conservative and should bring him down to somewhere about 9.5 (13.5-2-2=9.5) four hours after his meal, which seems like a reasonable level to be at for bedtime. He would add that extra unit (or 2 units depending upon his correction factor) onto the 7 units for the meal (if 7 was the calculated dose) and inject all 8 units about 20-30mins before the meal.
Being high means it will take longer for his levels to start coming down, so giving it a bit longer for the insulin to start working before he eats will help prevent it spiking significantly higher. That said, spiking up to 15 or above occasionally is not a big deal as long as it comes down again.
NB. He doesn't need to test for ketones unless his premeal reading is 15. It doesn't matter too much if he spikes up above 15 after his meal as long as it comes back down.

If you can give us the actual carb values for his meal and his meal ratio and his correction factor, then we can show you how to do the actual calculation rather than an invested example I have described above. If he isn't carb counting and is just taking fixed doses then it all becomes much more variable and with significantly less predictable results.
 
There was a mention of A&E @rebrascora so it might have been stress causing the higher sugar. Hard to know without seeing the whole pattern.
 
Hello @mummyange , it’s no big deal to miss a meal of MDI. If your son has had trauma from either A&E or what put him there, that could push up BGs where his basal hasn’t handled it?
I know how much insulin would lower a reading of “13.4” into normal range, for me. Then if I intend to eat, add the correction to the carb count. I’d probably be comfortable waiting a little longer to eat (than the recomended 20 minutes.) after the bolus? If this was my position.
 
Inka said:
There was a mention of A&E @rebrascora so it might have been stress causing the higher sugar. Hard to know without seeing the whole pattern.
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I did have it in mind to suggest that might be the case, but looks like the thought floated into and out of my mind before I typed it! 🙄 However it sounds like his levels have been pretty volatile recently which can often be an indication that basal insulin isn't holding steady.
 
I know the feeling @rebrascora ! :D Things float out of my head in seconds nowadays!

It’s hard to know what the problem is because it can be a bit of a vicious circle. Erratic sugars cause stress and anxiety, and then the stress and anxiety cause erratic sugars, and so on.
 
rebrascora said:
That said, spiking up to 15 or above occasionally is not a big deal as long as it comes down again.
NB. He doesn't need to test for ketones unless his premeal reading is 15. It doesn't matter too much if he spikes up above 15 after his meal as long as it comes back down.
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As long as he has taken his basal insulin I'd really not worry at all about ketones due to overshooting on bolus dosing. For longer term high trends (e.g. illness or completely incorrect basal) then perhaps one should think about it, though IMHO if you have some insulin on board I think you're likely to be quite safe (aside from the other downsides of running high).
 
SimonP said:
As long as he has taken his basal insulin I'd really not worry at all about ketones due to overshooting on bolus dosing. For longer term high trends (e.g. illness or completely incorrect basal) then perhaps one should think about it, though IMHO if you have some insulin on board I think you're likely to be quite safe (aside from the other downsides of running high).
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Personally I don't worry about ketones at all, but then I have never had DKA and I am not afraid to use my insulin to bring my levels down if they go above 10. The OP's son is suffering from anxiety so I imagine he will worry about ketones as well as hypos, so was just trying to reassure that they are not a problem in that situation even if his BG meter flags it up to test for them. Perhaps I didn't word my post very well.
 
Sorry to hear about the anxiety your son was caused by the trip to Casualty :(

Those stressful times are bound to be worrying, and a little frightening - especially in the early years. And some blood glucose upheaval can result from illness, and injury, or even just hormone responses from anxiety and excitement :(

So in some ways, it’s quite natural for son to be a little anxious - but it does sound like he hasn’t had enough support to deal with what happened :(

Hopefully with a little more experience he’ll be able to build up confidence in how to take on these unusual situations with his best guess, and whatever hints and tips his team has given him.
 
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