My growing ten year old is about to go back to school and we are struggling with some breakfast ideas.... Here are some of his particulars.... He has been living with diabetes since he was two, has always had GREAT A1Cs, on MDIs, very lean, active, healthy GROWING boy...
In the morning he is STARVING - his morning numbers are in great range with some random 200s. I have been giving him 2 whole wheat (scratch) pancakes/ cheese eggs/FF milk/ 1/4 cup of strawberries/ bacon and base dose is 3 and a sliding scale of 1/2 units up from 150....In the winter, he enjoys low sugar quaker oat instant oatmeal- so i replace the pancakes with the oatmeal.
Some days this is a great combination- yet recently his BS is through the roof at his 9 am check....This is especially true if I substitute a hollowed out bagel for the pancakes.....As a result we just had the WORST AIC in his almost eight year history...
On weekends, because he is out playing- this breakfast is no problem- but during the school day he does not have PE until the end of the day.
Would love some suggestions on what I could correct or substitute.... his other post meal numbers are great.
Is his insulin/carb ratio higher at breakfast? My daughter just turned 11 and I noticed last summer that she needed significantly more insulin in the morning than any other time of day. For awhile her I:C ratio in the morning was nearly three times what it was the rest of the day. If it's a daily occurance, maybe the issue is more that he needs more insulin than different food. Sarah usually just eats two wheat waffles with peanut butter, and she needs a lot more insulin in the morning or her bg is sky high at lunch.
On school days, he may need a higher I:C ratio because he won't have the exercise to help drop his BGs. I actually think the breakfast looks pretty good - it's not too ridiculous on carbs. I'm guessing it's somewhere close to 50-60g? It's also a fairly high protein and fiber meal, which means it will take longer to break down. This could result in higher BGs over a longer period of time because it's digesting slower. Would he be willing to take another dose of insulin about 1 hour after breakfast to help combat the high BGs? This is something similar to what pumpers do - they can split their meal dosages up so it is given over time instead of all at once. This helps bring down those high numbers that occur because of slowly digesting meals. If he doesn't want to take 2 shots (which is understandable), I would consider trying the higher I:C ratio. This would take a little bit of experimentation, as you want to increase it slowly to avoid lows. If you're nervous about this, you can always contact the endo about how to increase it safely.
A lot of people (both diabetic and non) have insulin resistance in the morning. Their body is slow to wake up and properly utilize the insulin. This could be another reason for his higher post-breakfast numbers. In addition, he's a growing young boy. He's going to have hormones running around helping him to grow and develop that can interfere with BGs as well.
Good luck! Let us know if you have more questions :o)
FIrst you are an amazing mom if you are making scratch pancakes, eggs and bacon every morning! That is a Sat. only meal at our house!
I would look at increasing the amount of insulin for his just his breakfast. My son needs more insulin at breakfast than at lunch and dinner too and he is only 5. You are obviously giving a breakfast with carbs, protein and fat. Nothing jumps out at me as really causing a big BG spike, but some people will react more to certain foods - like some will say that cold cereal will send them sky high no matter what they do for insulin.
Also remember that he is growing and this can cause lots of BGs that are higher - due to all the hormones. I would consider that more than just a post breakfast spike is affecting A1Cs. (Not saying that the breakfast spike isn't having an impact, but overall, it seems odd to me that it would really throw off his A1Cs unless you have been really consistent and now it is just higher than before.) Is his average BG running higher? What does his meter say his average BG is?
Thanks for the compliment... but it was out of necessity b/c he is one of the kids who cereal does him in... so all three eat like that.... and just for the record I make the pancakes every other day and reheat them in the microwave-
his AICS- have been very good- 12/09- 7.2, 4/1- 7.1, 8/10- 6.5, 12/10- 7.9..... It is the highest it has ever been-- granted we had Thanksgiving and Halloween- but we have also been through basketball and flag football season.... we live in a very temperate climate so he is usually outside after school/homework. The craziest thing is that his meter had his average at 134??? When the nurse called, I actually asked her if they sent the wrong results....
I know his summer numbers are always better b.c of the outdoor play and lots of pool and lake time- but this just really caught me off guard.... I think better record keepting (bad mommy) and an extra unit at breakfast is the first combination we are going to try.
It could also be puberty contributing to the spike in the morning?? I know when I hit puberty, my sugars were out of control. Or maybe the fat content from the bacon and cheese is giving it the spike?? Just some ideas.. these were problems I had :)
P.S. That's awesome you make him a big breakfast; I only got those on weekends :)
You definitely win mom of the year award... I often skip breakfast myself and my non-diabetic son eats pretzles on the drive to school.
If the morning high continues 3 days in a row eating the same breakfast, you may want to adjust carb or insulin dose slightly.
My base rate of insulin in much higher in the morning. I use a higher carb ratio on the mornings that I eat breakfast. And if it's a weekday I also give myself an extra unit of insulin. Blood sugar is slightly higher on weekdays, probably from racing to get everyone ready, traffic, and work stress.
Because your son's A1c was higher than average test results, it might mean he's having higher blood sugars in the middle of the night. You might also ask if he's eating extra or sugary food during the day. If he is, make sure he gets a bolus to cover it.
Ooh -- I feel your pain! Post breakfast is the worst! I can never eat more than 20-30 grams of carbss at breakfast without a major spike. :P (and I have a 1:3 or 1:4 am ratio)
I try to add extra protein and fat (even if they have some carbs) when I'm hungry at breakfast (greek yogurt, peanut or almond butter, microwavable veggie sausages).
Just 1 thing I remember (I wasn't diabetic) as a growing boy that after a good weekend of play. I would be very hungry next day. I agree with Sarah swap some carbs for protein(muscle building). For my reading and his growing a increase in insulin would be a good idea. I have read where body builders are using insulin to build muscle. They work out hard then eat a bunch of carbs and proteins with insulin and because the body in building the insulin helps make more muscle not fat. Kind of like your son playing hard weekend??? Just my thoughts.