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?
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.
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...
"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.
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.
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?
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!
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.