Friday, October 17, 2008

What Do You Think?

I need a little help please. Riley has a doctor’s appointment in another week and I’m going to run this by his endo too. In the meantime I want to hear what you guys think.

Since Riley was diagnosed his eating pattern has pretty much been breakfast, snack, lunch, snack, supper, snack. Since school started the morning snack has been eliminated. He eats breakfast around 7:00 then lunch at 11:00. He has snack at around 2:15.

I rearranged basals to accommodate for the new schedule. At first he was low at lunch and high at snack. I did a little more rearranging and had better results for the lunch. Now, he is almost always in range at lunch. But, for snack he is usually in the upper 200s or lower to mid 300s.

I have increased his insulin as much as I’m comfortable doing. I’ve increased his lunch carb coverage a bit. Still, he has these stubborn highs. He’s had a few days where things are pretty good at snack, but most days he’s high.

He has recess in between lunch and snack. You’d think, if anything, he’d go low instead of high after activity. I don’t think he’s going low and rebounding because when he does that the resulting high usually lasts a while and takes several doses of insulin before it comes down. These highs come down just fine with insulin. By supper he’s normally back in range.

His teacher called me on Tuesday to let me know how great his sugars had been: 120 at lunch and 87 at snack. She was thrilled and so was I. Riley was out of school Monday. Holden had him eat on his usual schedule and his sugars were just fine. In addition, he got out ½ a day on Friday. His lunchtime sugar was great as was his snack time sugar.

It seems that when he is not in school his snack time sugar is just fine. So, what is it about school that’s causing the rise in his sugar? It is not what he eats at school. Riley is allowed to eat from the cafeteria 2 days a week. The other days he takes his lunch. The highs occur whether he eats a lunch from home or not. Also, when he eats at school but gets out early (early release is at 11:40) his sugar is fine at 2:15.

Any ideas as to what is going on? His teacher called me on Wednesday. His snack time sugar was 345. He had PE prior to snack and she said they had run around the football field several times so she was afraid that he would go low. Instead he was high. She also said that the day before when he his sugar was good at snack that they had not been outside to play at all.

I’m at a loss as to what to do next. Do I keep increasing his basal from 11-2? Right now it is at 0.400 units per hour. That’s the highest basal he’s ever had. On the weekends when he’s not in school his basal at the same time is 0.275 units per hour.

I’ve told his teacher to start having him check his sugar before and after recess to see if that tells me anything. Do you guys have any other advice?


Anonymous said...

Oh man. I so hear ya penny! Maddison is the same way, great numbers at home but if you send her to school everything is too high! For Maddison it is stress in the classroom. Her after breakfast was running higher so I took a few days corrections it took to get her back in range and figured she needed an extra .3 each morning to avoid highs after breakfast. WEIRD but changing the ratio plummeted her. Changing basal was worse. I still dont get it but she needs an extra .3 for breakfast on school days. (sitting at a desk all day?)She eats the same thing almost everyday so that isn't it, and she will still be higher 200's sometimes in that time frame!! AHHH!

I used to go high from my treadmill each morning during my workout. (no eating) I think the running panicked my body into thinking it needed more sugar,(because I didn't eat since the night before) so my liver dumped it. Hard to say! I wouldn't change a basal for Riley, but I dont know him like you do either. Maybe he goes high on the days he runs alot on the playground from adrenaline? I would start with adding in extra for how high the high goes...Make sense?

Anonymous said...

Hi Penny, testing before and after activity should help to sort things out (hopefully :). You may also want to consider the type of activity. For example, hard running or sprinting (going into anaerobic zone) drives my blood sugar up rather quickly, while running along at an easy to moderate pace (aerobic) drops it. Race day stress also increases it, so maybe Riley gets all charged up before running. All of the above seems to be fairly common with diabetic runners, so maybe for Riley ???

Anonymous said...

Stress makes my nephew go high.

Anonymous said...

Is there more of a time lag between his eating and the dosing of his insulin when he is having lunch at school? I have found with my 9 year old that if she waits even an extra 10 minutes after eating to bolus - it just takes more insulin to cover the same amount of food. (because I would suppose the food is already making the sugar levels rise before the insulin has a chance to work.

Anonymous said... suggestion is adrenaline. Skylar's bg almost always goes up with activity. If he goes out to play I have to increase his basal. Checking like you said will help find it I'm sure. Highs and lows just stink! Good luck.

Anonymous said...

Testing before and after recess should definitely help you get a grip on what is happening. I would suspect lows from recess, but you have ruled that out. I would next suspect composition of lunch, but you have ruled that out also. Once you are absolutely certain he is not going low and rebounding, I would simply increase bolus insulin at lunch while he is at school. Would not change the basals first but the bolus insulin. You can then test two hours after the bolus change to see if that helped.

Bernard said...


I can't offer much help. But I just want to point out that if you're trying to regular blood sugar for a 2:15 snack, I'm not sure changing basals between 11 and 2 would help. Because the basal between 12 and 1 is (I think) the one that's most active between 2 and 3.

It might be stress. Is his activity level in the classroom higher in the morning? Maybe the afternoon is more sedentary (besides recess)?