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Permalink Reply by acidrock23 on July 13, 2012 at 4:19pm

My target for an hour is usually less than 120? I will start to get nervous if it gets there and look at it closely and try to decide if it's still going up or if the rate of change is slowing down. W/ the CGM, I can sort of tell if it's 105-120= "eek" or 118-119-120-120 which is ok? If he's where he wants to be at 2 hours and it's relatively flat, it may also reflect something about teenage portion sizes?

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Permalink Reply by Zoe on July 13, 2012 at 5:02pm

I don't have a one hour target because I've discovered my peak is closer to 2 hours so that's when I test and my target pp is under 140.

But yes, I would be concerned if I was spiking that high at one hour. Do you bolus ahead of time? For his peak to be at one hour I'm wondering if he isn't getting the insulin active quickly enough. But my intuition says it's probably a combination of things. The 140 is pretty borderline so if you change his I:C by a point or so you might cut out those spikes and still be good at two hours.

The pre (next) meal numbers aren't related so much to the mealtime insulin as to the basal and it sounds if he is around 100 by the next meal that the basal is well set.

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Permalink Reply by AustinMom on July 13, 2012 at 8:25pm

Thanks, Zoe. I'm wondering if it was the lack of protein - certainly could have been the issue today. I don't know about the other days.

We don't typically test at the one hour point, but he had cause to test a few times this week at the one hour point for various reasons - sports, hungry again, etc. He just got back from a 2 week backpacking trip and lost about 5 pounds - he's been eating constantly since he got home. I think his body is trying to gain back those few pounds he shed while hiking.

You're probably right - a number of factors. I'll pay a little closer attention to the composition of what he's eating and then decide whether adjusting his ratio a smidge is in order.

Thanks!

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Permalink Reply by Spock on July 13, 2012 at 5:35pm

My thoughts: Don't test at 1 hour (unless there are symptoms of lows) if his two hour is 140, and normal when it should be. Relax a bit..

Under 180 is the usual 2 hour metric, so 140 is great. He is a child (don't know the age, but hormones can have a HUGE effect.) Basically, I suggest relaxation...

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Permalink Reply by Zoe on July 13, 2012 at 6:05pm

"Under 180" is the ADA recommendation but I think it is much too high. Studies show that damage and complications begin to form at 140, so many of us use under 140 or even 120 as our two hour post prandial goals.

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Permalink Reply by AustinMom on July 13, 2012 at 8:28pm

We don't usually test at one hour, but have had reason to this week a few times. I'm not stressed about it - just trying to figure out what's going on & figure out if tweaks are in order. His 2 hours and fasting numbers are usually pretty good, but, you're right, those hormones can throw a wrench in the works for sure.

Thanks.

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Permalink Reply by Marps on July 15, 2012 at 8:02pm

Spock's right. I spoke with a few doctors that I really trust and they said they target 180 at the one hour postprandial. Since I'm not eating carbs (only about 40g per day) I target my postprandials much lower (around 120 or 130).

But, with eating carbohydrates and any processed foods, it takes a little while for the body to absorb and digest those.

Also, if you correct that number, then his two hours postprandial is going to be around 100, but his next meal will be LOW, which is going to require rebound eating to correct the low. I don't believe a 180 for a mere hour is grounds for panic.

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Permalink Reply by Tim on July 13, 2012 at 6:31pm

I don't have a strict target at the one hour point (that's a remarkably hard target to hit!!! Others here may be able to do it consistently but for me... the further out numbers I feel like I have much more under my thumb.

But I would be feeling a little skeevy if I was above 200. Pediatric endos don't like hypo risks though, and probably with some good reasons!, and your son is clearly taking the right amount of insulin if he's got such good numbers at the two hour point, so the 1-hour number cannot be solved with just more insulin.

Sometimes taking the insulin or dialing in the bolus just a little more (say half an hour earlier) in advance of the meal helps make the timing match up better.

Your son, using good old "Regular" (R) or Novolog or Humalog?

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Permalink Reply by AustinMom on July 13, 2012 at 8:45pm

Thanks, Tim. He uses Humalog & boluses immediately before eating, sometimes "topping off" after he eats if he eats more than planned. He's almsot 14 and growing like a weed (passed me in height last month - ugh!), so he frequently has a pretty big appetite.

I was thinking along the lines you were - numbers are good on the back end, so just adding more insulin seems like it could make the back end numbers too low. Timing could certainly be an issue, and, as I responded to other posters, it could be what he's been eating. I think he's been kind of light on the protein the past few days.

When he was diagnosed, we were taught that he should bolus after eating - that seems to be the standard recommendation for kids these days. A few months after diagnosis, as I started to get more educated, we made the switch to bolusing before eating but that has been a hard switch for him. I think 30 minutes before would be a stretch and a battle, as well as requiring more planning ahead than my teenage son seems to be capable of these days! Maybe bolusing before setting the dinner table or prior to making a sandwich for lunch would be a reasonable starting point. That would give his insulin a few minutes' head start or so. His insulin seems to kick in quickly, so maybe just giving it a few minutes earlier would work on the spike without the hypo risk.

Thanks for chiming in!

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Permalink Reply by Shawnmarie on July 13, 2012 at 9:07pm

I'm 47 and I still have a hard time bolusing any significant amount of time before eating. Couldn't imagine trying to do it as a 14-year-old boy! But it does seem to help when I manage to do it. I have an extreme post-meal spike after most meals, but then it comes down by two hours. Tricky to get it all to work when the bolus is sufficient to cover the carbs, but it's just behind the curve in terms of timing. My problem is that, when I'm ready to eat, I'm ready to eat!

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Permalink Reply by AustinMom on July 13, 2012 at 9:19pm

If I were the one with diabetes, I would be in all sorts of trouble trying to do the myriad things my son has to do to be ready to eat - test, count carbs, bolus, blah blah blah. He is my hero and manages this SO much better than I would have at his age and probably at mine!

Thanks for the input!

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Permalink Reply by Tim on July 15, 2012 at 5:14pm

I grew up in the days of regular and to get it to match up to food I had to take it an hour, two hours, or more in advance. Any dreaming of keeping after meal numbers in check was about eating to match the insulin. All that said, Regular comes on real slow, and without a lot of surprises. Humalog in contrast is full of surprises especially when it kicks in much faster than the food.

I don't think it's onerous to be able to handle most situations with pre-bolusing. Sure, there will be exceptions where pre-bolusing simply cannot be done (i.e. cannot predict when food will be ready or what the food will be), but they are the exception not the rule.

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