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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Natalie: What empathy I have for you. I was 9 when diagnosed 56 years ago, and treatment then and treatment now are 2 different worlds. I'm sure you have discussed this with your doctor, but you might ask him/her about the possibility of introducing your son to small amounts of glucerna drink. I have been very successful with it; the taste is good (although Boost I think is better...Boost Glucose Control) and maybe substitute that for part of his meal. It's filling and helpful. A Good dietician will help as well. Good Luck! Hugs from Los Angeles.

Thanks Michael. So they suggested to increase the 7am basal. I decided to just keep him home from preschool so I could let him sleep in and delay breakfast a little and see how that basal would work. He was running in the 80-90s from 7-8 and I was trying to hold him off until 9 (he was not happy about that)Then just before 8:30 when I was helping my oldest brush her hair for school I found lice in her hair and then it was just chaos! I was tending to her and Rory was climbing on the counters getting into the cupboards and crying because he wanted a granola bar, so maybe he was feeling his Bg dropping, I don't know. So he had a granola bar and 1/2 cup of milk at that time, covered him as usual and within 45 minutes-1 hour he was up to 300! We just kept checking sensor, did not give an snack in between and by lunch time, approx 2 hrs later he was 124. So it seems like the carb ratio eventually works but it is just so delayed. Then after lunch he doesn't spike as high, but then doesn't come back down and hangs out in the 200s. By dinner he was 108. He played outside for a while in the afternoon so maybe that helped bring it down before dinner. So...it seems like he needs a bolus given sooner for breakfast or just ensure that he eats a much slower absorbed food and possibly have a basal increase in the time between lunch and dinner. And this is a pretty standard trend for him, I know we have to see a continued trend when making adjustments. So we will see how the next few days look and review everything with nurse on Monday. We have never tried the Boost or Glucerna drinks. That might be an option for him in the morning if that helps control that high spike. But he gets pretty particular with foods he likes. Haven't talked with dietician in a while, we may be due for a visit with her at next appt. He is excited to tell her he is eating more of his vegetables now!! He ate all of his broccoli for dinner tonight!! :)

Hi, Natalie! I'm sorry you all are having such a hard time. If it makes you feel any better, I just spoke with our endo about this same issue this morning. We have an ICR for breakfast of 1/10 and we switched to Apidra insulin which does seem to help bring her BG down quicker. We got 2 vials as samples from the endo office, then made the switch.
EA will spike to 300-400 in the morning despite my pre-bolus. Today the Endo told me to try to pre-bolus 30 minutes prior. I also met with the nutritionist to get some better ideas on breakfast. We're toast & egg people, but EA won't eat wheat/fiber bread, so the white bread spikes her. The nutritionist recommended having some fat with the protein/carb combo. She also said that rye & pumpernickle bread has less of an effect on BG. (not that my kiddo would eat that!!) :)
One other thing I did last week to help EA with her standardized testing was to pre-bolus 30 minutes prior, and have her do some jumping jacks in the morning, or walk around after eating. Her spike was in the 200s instead of 300s, so that was a big help. However, she crashed midway through the morning, so I have to work on that.
Hope this helps! You're doing a great job. Take care~ Jessica

For the most part, you cannot avoid going high after a meal - most food, and especially cereals, are relatively high GI, and it takes a while for the insulin to cope with it, no matter what dose or insulin type you use.

The trick here is to either use a low GI food for breakfast, or, accept that you will spend a short amount of time after each meal being high.

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