My son is five and was diagnosed at 17 months. What struck me in the hospital and has stayed with me is that I never want to have fights over food with him. So I have always given him his insulin either during the meal or right after he is done. This way I know what he is eating and I am correcting him right. One time in the hospital when he was first diagnosed I gave him insulin before he ate and he decided not to eat at all. I chased him around the hospital with apple juice and chocolate milk for 45 minutes. I told the nurse that was ridiculous and that there had to be a better way to do things! She wasn't the one who told me to not fight it was the nutritionist. And now, Niklas eats very well and almost his whole meal every time (for a five year old that is amazing!) My personal philosophy is that if you have a power struggle with food, you are going to turn food into the enemy and you really don't want that with any child, especially a diabetic one!
well my mom lets do my insuln after dinner for like one week and not for like the next two. she told me it could be bad because if you dont take your insuln for your sugar then your sugar can go high while your eatting and sometimes if your sugar is already high before you eat then it will go even higher.
We still do it after the meal because my son is so young. I never no how much he will eat. I do know that at some point they want us to change. I cannot even imagine how hard it will be. I still fight with my three year old at feeding times. She will tell me what she wants to eat and I get it ready and she then changes her mind. I would not even know where to start with that. So, I hope Ayden is a better decision maker when it comes to his food.
The pre or post bolus choice is dependent on several things and I use both. The foods that breakdown slowly can be managed with a post bolus or using a split bolus. If the food breaks down fast in most cases the pre bolus will work best.
The other factors include background insulin, time of day, pre-meal BG, meal access timing, hours since last bolus and other factors.
[quote user="Travis"]
Physicians don't live in your shoes nor do they deal with the gray areas that complicate life. While insulin before you eat would allow the insulin to counteract the rise in BG at the most efficient level, the question is whether it is worth the risk if something goes wrong.
For example, what happens if I take insulin, go to Chili's, but wait...they're packed and we have to wait 30 minutes before we're seated. Well then, we have a problem. Especially with quick acting insulin like Novalog, this can be a real problem.
In the end, you are the one physically giving the insulin, right? Not the physician. So you have to make a decision that you feel is the best for your situation with their advice in mind.
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I agree 100% Travis. We are in charge of the circumstance at that precise time. I hate when I bolus and undereat--the low is so much worse than eating my fill and then bolus.
We were told that while it is ideal to give the insulin before the meal, and that eventually that will be the goal, it is hard to predict what young children will eat so that we can give it after. If his is a good number we will do it after (or at least during- after supper but before dessert or if he's had lunch but wants more, etc), but he knows that if he is high he gets it first. Also, if he checks his sugar while i am cooking because he has something he wants to eat (like a treat he had to bring home for later) I will let him eat that if his number is good but then give the insulin before the meal.
Usually we have the opposite problem that he wants to eat more, not less (he has ended up with 2 needles at some meals cause he is still 'starving'). Though if we have given it before and he doesn't particularly like his supper he will use it to his advantage to get the carbs he wants instead (the old if you don't finish your supper you are not having dessert or anything else until bedtime just doesn't work when you have given 3 units of insulin:).
One time at a restaurant we ordered and gave insulin while we waited (and counted in ice cream for the way home). his food took A VERY LONG time to come! all of our food was long, but i think they forgot his cause everyone else had finished eating and we had to ask about his like 3 times after food started arriving. Finally it came, he ate all his spaghetti, garlic toast and chocolate milk (luckily the chocolate milk was earlier or the story would have been worse). we stopped for ice cream on the way home and the minute we walked in the door he looked in the fridge and cried that he was low. I was thinking that there was no way given what he just ate- i thought he just wanted to eat, but checked him anyway and he was 3.1. I guess the food hadn't got there yet, but the insulin sure did. he was high the next morning after everyting had eventually gone into his system (and we had treated the low and given extra carbs at bedtime as he was still under a bit). so unless he is high we don't give insulin right after ordering uless it is fast food.
I just wanted to say thanks for this and the other thread about the timing of insulin. For the longest time (years, we're talking) I was taking insulin immediately before eating, because I figured I'd never really know exactly what I was eating until the food was in front of me. I've had T1 for 24 years now, and I guess after a while I forgot the whole "insulin timed before the meal" thing. I've been trying to get my A1C down to a respectable number - 7.8 a couple months ago, and that's the best I'd seen in a while - and after reading these threads, it was like someone turned the lights on for me. Oh yeah, duh, I need to be taking insulin sooner before eating. Being on a CGM helped me realize it too... I had no idea I was spiking so high after meals... I just knew I'd be in the 200's a couple hours later, and have to correct, correct, correct to get back down. So... thanks dudes. :)
[quote user="kcbscrapper"]
We dose befor the meal, and if he doesnt want to finish what he said he would eat he has to drink juice to make up the difference. The other benefit is we prepare the insullin befor saying Grace- my son likes the idea that his shot is blessed.
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I thought I was the only person who mixed prayer and insulin.Many times in the begining of this d world,I would pray before insulin was given -still do at times :)
[quote user="ajax"]
I bolus before I eat unless I am on call, but since I work as an EMT, sometimes I have to leave in the middle of a meal - and I really don't want to go low while I'm trying to take vitals! So when I'm on call, I try to bolus after I finish. A lot of times, I forget, though.
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Ajax,I think it is wonderful that you are an EMT.I will never forget the two that moved us from the emergeny room here,to the larger hospital an hour or so away.They were kind and calm and did their best to help us.You could tell that it was not just a job to them.They invested a part of themselves into their work.I have no idea what it would have been like without that calm,in control ,caring manner they had. :)
Our endo leaves it up to us but she does suggest to bolus for the correction before eating if your testing after eating just to get some insulin into the system. My son has no problem eating what is on his plate and more if I would let him -
We used to bolus after meals but found the numbers started to spike. Now we work hard on trying to give before meals.
Have you considered bolusing for the correction and then adding a few extra units to compesate for the meal. Example - she has 60 carbs on her plate but give her 2 units with correction - you can adjust after you see how much she has eaten.
My son is also a diabetic, and he came up with was that he will dose half before the meal and then again depending on what he eats BUT she needs to be comfortable with that. If she doesn't understand that she needs to eat everything than this is perfect, but if she is against getting shots then consider just "tricking her into like a 3/4 dose with the big meals knowing she wont eat everthing.
well yeah the 'healthy way' is to give insulin before so that it has started working and covers the 'peaks' that the carbs in the food cause. My doctor told me that ideally i should be bolusing 15 minutes before eating so that the insulin has plenty of time to start working but that's even less realistic than your situation.
I cant honestly say i've had this issue with a kid but have you thought of giving the insulin before the meal and then if she hasn't eaten enough giving her a soda or juice to cover the rest? or a sweet treat? because, really, there's ALWAYS room for dessert right? ;)
It depends how early he wants you to inject I guess.
When I was first diagnosed, I used to wait until I ate everything to give my bolus. My endo told me that me doing that is giving my BG too much time to get high...once it's high for awhile it gets harder to get down...that's when you end up trying to overcompensate for the high and crash into the 20's or 30's...was a fun first couple months I'll tell you what.
I see your issue though with kids you don't know how much to give. You can always give less than you intend in the event that she doesn't finish all her food and if she does you could give a correction shot to make up for the extra carbs? At least that way she isn't going to go low if she doesn't finish her food...
the more i think about this, the more i can't wait to get ezekiel a pump! then we could get his supper, bolus before he eats it, and bolus again if he wanted seconds or dessert.