I am so ready to pull my hair out trying to figure out the best way to cover breakfast for my son and avoid such high spikes within the two hours after eating. We try adjusting the carb ratio and basal, normal vs dual wave or squared, trying to avoid specific foods. It is just so frustrating when one day something seems to work well but then it doesn't the next time! It's like there is a delayed insulin affect. It does nothing until 2 hrs later. This has made it difficult with morning snack at preschool. Some times we just end up taking him home because his bg is too high for a snack and meltdowns occur and it is just chaos. Sometimes I can attribute it too bad site or insulin nearing it's expired date but most of the time I just can't figure it out. Does anyone have any thoughts or any ideas on what has worked for their child? Rory is 5 years old now, uses a Medtronic paradigm 522 pump, has started using the sensors and CGM a couple times a month.

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We have only ever had success with dual waves when covering pizza (from Pudgies and specific size slice) Again today the nurse suggests dual wave at breakfast but that just doesn't make sense to me with him spiking so quickly and a normal bolus not taking effect soon enough how would delaying part of it would help? So then suggested to increase am basal. So we will have to test that with meal delays. 
He used to eat scrambled eggs when he was younger and first diagnosed but then stopped. But now since Easter he has liked hard boiled eggs so that has been very helpful. 
I have never heard of the super bolus, but I can see how that may be helpful at times. It just seems like there is some degree of resistance or something in the morning maybe because his basal has been lower and just increases at 7am and he is up and eating by 7:30. Tomorrow we shall see how things go. Thanks so much. Thanks Amy. We had a similar issue here, with struggling with Rorys highs finally changing the site and getting a snack and my 4 year old getting the ice cream out for her snack. I really didn't want Rory to have it since we were finally getting him under control and Ava saying "I ate all my dinner" so she wants the treat. And she just loves to show Rory what she is eating! Lol 

I would get rid of the treats too but I am sort of a food dud and do most of the grocery shopping. I always ask the other team members, MrsAcidRock and junior if they want anything from the store but, if they ignore me, no treats besides mine!

My daughter always spikes after eating. She has been T1 a little over two years and is 10 yrs old. She boluses before she eats but always stays btw 200-400 in the 2 hours after she eats. This does not affect her in a bad way(ie. mood, disposition, general feeling of well being). She does seem to spike higher after eating foods that are considered "high glycemic". Her endo does not have a problem with this. The endo tells me that a spike after eating is normal, and that it is better for her to have slightly elevated numbers as opposed to trying to keep her lower and having low blood sugars which adversely effect brain function.
The thing I always to try to remember is that diabetes control is more of an art than science. That is to say that you can do the same exact thing every day and get different results. I try to trust my and my daughters intuition and adjust as needed.

I'm a little mind-boggled by this. You are ok with blood sugars between 200 and 400?? Her endo does not seem to have a problem with this, but he is not the one who will be suffering from severe complications down the road!

Currently not overly concerned. I have not had any experience with her in the last two years where she has not spiked after eating. Her A1C is under 8. When I have tried to increase her Novolog to combat the spike, she has had a black out low. The research I have read to date indicates it is not unusual for children to be higher after a meal. If you can provide information that can help me help her maintain lower BS without black out lows, please provide.

I'm sorry, mojavenation, I don't understand your not being "overly concerned" Spikes of 200 to 400 on a regular basis are not ok. She has many years to accumulate complications and if that is a regular event for her she is in danger of having life altering complications in adulthood. And an "A1C under 8" is quite high. You list your current A1C as 9.4 in your profile; that is extremely high! You need to work with your endo to find ways to balance her basal and bolus doses so that she doesn't spike that high, without of course, putting her in danger for extreme lows. A couple suggestions would be doing basal testing first to make sure her basals are right; if basals are not right, then you can't begin working on bolus doses. After doing that, then the goal is to make tiny changes in bolus ratios to see if you can achieve less spikes, while not going low. Ratios might need to be different for the different meal times. Another thing to consider is what she eats. You are right that different foods will affect her blood sugar differently. Do experiment with foods until you find those that are easier to bolus for accurately. As Type 1's we can't always perfectly control our blood sugars and highs do happen. But to accept highs of 200-400 pp on a regular basis is not ok. If your current endo thinks that is acceptable, you need to find a new endo. You say your daughter's "mood is not affected" by highs, but her longterm diabetes management is. Not to be too blunt, but are you willing to accept kidney damage, loss of limbs and loss of eyesight as "normal"?
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Zoe, a "goal" A1C for kids is 8- 8.5 so if its under 8, thats not high at all.

I wonder if this is at all related to the Dawn Phenomenon. It might be worth asking the endo about.

I know starting out our endo told us only to check before meals and bedtime, don't cover highs closer than 4 hrs.,..So at first I wasn't even checking after meals. He was only 1 and I didn't want to have to do more checks than necessary. But one day I did and he was in the 500s within those 2 hrs!! It was scary! But yet he would be down to a near normal number by next meal. They told us the same thing to not worry too much about the highs at this age. I never felt comfortable with those highs and I can imagine it isn't good to rise so quickly and then drop so quickly. :( I can't even imagine what that must feel like. But target ranges for glucose control and A1C are different for children. We really have to do whats best to avoid dangerous lows. Rory is getting better now with letting us know if he needs a snack but kids may not always be able to communicate that well. I can remember a time him going from an active bouncing around the house toddler to floppy and barely conscious! Very scary! Mojavenation, is your daughter on a pump? The pump really helped us bring down his A1C and have more control over the basals. When we were doing injections we would try to increase the Lantus just a bit but then dealt with more lows, went back and then had more highs, very frustrating! The pump has been great for helping with that!

I have been looking up the suggested Apidra insulin. From what i have read so far it peaks quicker than Humalog, which sounds great! But it also says it should not be diluted and with him still currently using diluted insulin maybe that is why they have never mentioned it. Maybe once he is on full strength and we still have issues I could ask about it. It definitely seems like he needs something that peaks sooner.

I have very limited experience with the pump, having had my Ping for a little over a month, but had a similar problem, in that I get a big spike 2-3 hours after I wake up whether I eat or not. Evidently it's some kind of variant on the DP. We increased the basal rate around 5 am, and then I take a bolus to cover 20 carbs I don't eat in the morning when I get up. It's a crude kind of system, but it's working. But I'm not a kid- so may be different.

I have the same problem. I have breakfast and my blood sugar is usually normal or a little high then and after, it will spike to almost 300. Are you sure you are counting the carbs right? My carb ration was changed to 1 unit per 5 grams. Did you change the carb ratio for 2 hours before the high blood sugars? My ratio is higher starting at 7am because of my high bgs after breakfast.

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