Hi,
My son (11) was recently diagnosed type 1 diabetic. While at the hospital, they would allow him to eat and inject insulin after he finished. At his first visit with the Endocrinologist, we were told that we need to inject prior to him having a meal. This concerns me as he doesn't always finish everything on his plate. Which of the 2 ways is correct?
It really depends on the person and their situation. I know with little kids, parents often inject after because it's hard to get them to finish their meal. The general "rule" is to take your shot 5minutes before eating, so your insulin is working at the same time the food is making your bloodsugar rise.
90% of the time, I inject first. 10% of the time, I inject after. If I'm sick or for whatever reason not sure I'll be able to finish my meal because it's so large(rarely a problem for me haha), I'll wait to inject until after.
The problem I have with injecting afterwards, is sometimes I forget and that causes a HUGE problem later. I once had a lunch date with a friend and his gf, I decided to inject after the meal since I was headed home to grab my camera stuff for their couples portrait session anyways. Well, I forgot. Two hours later, in the middle of the shoot I realized I didn't take my shot. I had also left my kit at home, thinking I wouldn't need it (yeah the ONE time I do that..ugh). So there I was, a 30minute(if the traffic was light) drive away from home and my insulin...running high and getting a major headache. I had texted my bf when we took a breather and he started flipping out (I couldn't hear my phone so I didn't get his texts until I got home) wondering where we had gone, if I needed him to drive out and get me, etc etc. We shot for another 30minutes and then headed home. By the time I got back, I was 30!
Now that's the first time it's happened to me with meal insulin (i've forgotten my lantus a few times in the last year or so ugh after 16years) but it IS a risk of doing your shots after.
I would try the before meal shot but also talk to your endo about switching to after meals when your son doesn't feel he can eat it all.
Maybe if it's a large meal do it halfway through, then you'll have some idea of what he might finish. I generally inject before eating. If I don't, and it's a meal with a lot of carbs, I feel my blood sugar getting high while I'm eating.
When I was in the hospital I injected afterwards but they told me that I could do either or. They said to just make sure to take it right away. Like Batts said one problem with injecting afterwards is that you sometimes forget.
As Batts said, it depends on the person and the situation. Probably by 11, your son can understand that he needs to eat the carbs if you've already given a shot for them. That reasoning does not work so well with a 2-6 yr old. While he may understand, it won't necessarily mean that he will like having to do it. Our clinic feels very strongly against creating food issues - psychological problems with food - by creating too rigid of rules around what, when, where, how to eat.
As long as he finishes the carbs, then he shouldn't have to finish the rest of the meal. If he really isn't hungry to finish them, you can supplement carbs with either juice or candy (though I personally do not like *rewarding* not finishing a meal by still getting a treat.) You can also consider doing 2 shots if your son is OK with that - 1 at the beginning of the meal for maybe half the carbs and then a second afterward - then you can adjust if he eats less or more than expected.
Whichever you and your son are more comfortable with is the right choice - at this point in his D life. It may change over time and as he takes more control of his care, etc.
If my blood sugar is on the low side then I will inject after eating, but if I am closer to being high then I will inject before eating.
If my blood sugar is on the low side then I will inject after eating, but if I am closer to being high then I will inject before eating.
Jennabenna, that's a really great idea! I've never thought of doing it that way before... thanks! :)
No problem :) That's the way I was taught to do it when I was diagnosed in Germany, they do a lot of things different there.
[quote user="Intlcff"]
Hi,
My son (11) was recently diagnosed type 1 diabetic. While at the hospital, they would allow him to eat and inject insulin after he finished. At his first visit with the Endocrinologist, we were told that we need to inject prior to him having a meal. This concerns me as he doesn't always finish everything on his plate. Which of the 2 ways is correct?
[/quote]
Everybody's advice is good. After usually works better for kids because you don't know how much will be eaten. Injecting before is ideal because fast acting insulins usually take about 15 minutes to start working. Also know that most hospitals staff are not up to date on treating type 1. They know very little about timing insulin, carb counting, etc. so it's better to get your info from an endocrinologist or diabetes educator.
The after-meal shot is standard in hospitals. My mom is a nurse and tried so hard to convince me to bolus after I eat, despite my CDE's and endo's instructions!
That said, I've heard it's really common to let kids bolus after eating because they are unlikely to know exactly how much they'll eat. That makes sense. Bolusing before a meal reduces your blood sugar spike, but I don't think that's worth risking a low if you know your kid is unpredictible in how much they eat.
But here's a compromise to consider, at least for carb-heavy meals. Shortly after diagnosis, I was going to a luncheon served in courses, so I had no clue how many carbs I'd eat until the very last course was served. I called my CDE ahead of timet o ask how to handle it, and she said to take a rough guess at how many carbs I'd eat, bolus for half of them before I begin eating, then to give myself a shot at the end to cover any carbs that I didn't eat. So it worked something like this: I guessed that I'd eat 40 carbs, so I bolused for 20 carbs. At the end of the meal I had eaten about 30 carbs total, so I bolused for the added 10. I do this a lot when dining out now that I have a pump so it doesn't mean two injections.
[quote user="jennagrant"]know that most hospitals staff are not up to date on treating type 1. They know very little about timing insulin, carb counting, etc. so it's better to get your info from an endocrinologist or diabetes educator.[/quote]
This is very true (really!), but there's a lso a practical reason hospitals do the after-meal shots. When you're sick or even just feeling crumby from sitting in a hospital bed, your appetite changes and you may be less likely to finish a meal. Also, I'd guess they probably have the occasional patient throw up when they attempt to eat. Things are just less predictible in a hospital setting, and nurses know that... even if they don't know the most up to date practices on treating T1 diabetes.
We started out this way, and it was a horrible fight every night. Our daughter is 4, and how do you figure out what a 4 year old would eat. Meal time was becoming such a stuggle every night, our doctor said he would prefer before, but allowed us to switch after to after, as it just wasn't working for us. Now we have piece in our house and we seem to have fewer lows.
I was diagnosed about 1 1/2 years ago, so I'm still a "newbie" in this diabetic life. I have found that if I inject 1/2 through, my sugars are ok. If I inject before eating, my sugars tend to drop.
However, a friend of mine who's a 6-7 year veteran injects before she eats. She's also on a different dosage and additional T1 meds.
I would try both ways for your son and keep an eye on his sugars to figure out what the BEST option is for him. It's definitely an adventure and roller coaster to say the least!
Good luck!
[quote user="Jennabenna"]
If my blood sugar is on the low side then I will inject after eating, but if I am closer to being high then I will inject before eating.
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That's my rule too.
Also, if your son has been drinking it's alright to deliver the insulin after eating. (Just kidding.)
When I was growing up, I'd take shots before eating, but the rule was that if you didn't finish the food, you had to find something else to compensate. My little sister (also diabetic) was an incredibly picky eater, so there was a lot of "shot, don't like what's on the table, have some cereal or pb&j to compensate" going on. Generally endos like to have the insulin get a headstart, but it really does depend on the individual's habits.
My daughter is also 11. We always do injections after meals because there are times when she eats what seems like nothing and then there are days when she is starving at meals.
My daughter is also 11. We always do injections after meals because there are times when she eats what seems like nothing and then there are days when she is starving at meals.
[quote user="Jennabenna"]
If my blood sugar is on the low side then I will inject after eating, but if I am closer to being high then I will inject before eating.
[/quote]
I do the same thing as you do Jenna.
I was told to do whatever fit my lifestyle. If I know how many carbs are in what I am eating I will do it before, but if I don't I will do it after or in the middle then test two hours later, and adjust if needed. I don't like to have to feed my insulin...you know eat because I injected so most of the time I do it after.