My 8 yr old son is newly diagnosed type 1 and we were told to dose before, but I can't be sure my son will always eat the whole meal so we have been waiting until after. Is there a reason to dose before? He eats his meals so quickly...there is really only a 10 minute difference at most. (We haven't had our diabetes ed class yet...thank for the help!)
unfortunately prebolusing is pretty important. The reason is that even "fast-acting" insulin acts considerably slower than most foods. So if you son was say 200 right before a meal and you let him eat and then bolused him 10 min after he would probably be well into the 300s for some time before coming down. Of course it's hard with kids who don't always finish. I think the best strategy is to bolus 15 minutes before (assuming he's not say below 120), then if he doesn't eat everything give him something to round it out, like 1/3 cup of juice or some goldfish. If he really can't be coerced into eating or drinking anything else then you probably have to bolus afterwards, but it does have a pretty significant impact on A1cs. It's also a lot easier with the pump. Then you can prebolus for as much as you want (2/3 of the meal) then give him the rest afterwards.
Good luck and take care.
Bruce
We give my son his shot after his meal unless his sugar is high then I give it before he eats. Since he is a picky eater and does not always eat his whole meal the doctor said this was fine. He is also a SLOW eater and gets distracted due to his ADHD so we wait at least even halfway through the meal and then give his shot.
Speak to his doctor since you should not have to "eat" to feed his insulin.
Good luck!
Thank you, both, for the quick reply! Each of your answers makes sense. We are at the beginning, of what feels like it will be, a very long honeymoon period. I am starting to understand why our diabetes nurse keeps telling us 'Everyone's diabetes is different". We are going through a period of extreme lows right now (following 2 weeks of highs). Still adjusting insulin...not that that always helps. We recognized his diabetes early (according to endocrinologist) so his pancreas is kicking in full force at times....very scary. Just trying to minimize these lows by matching carbs as best I can right now. Will I ever sleep again!?!
Now I am glad the group diabetic education was delayed a month so I could see the issues I need help with...I am full of questions:)
Thanks again!
everyone goes through this and it's important (and hard!) not to blame yourself for his numbers being low or high. T1D is famous for it's inexplicable variability, so you to try to cut yourself a break and realize you are in it for the long hall. If you decide that bolusing after the meal works better for you in the short-term then you should go with that. Finding a manageable lifestyle is critical and seems impossible in the early days, but you will get there. Our son was diagnosed 2.5 years ago when he was 7 and it seemed like our world had ended, but we did come through it to a better place where every once in a while things feel under control. The pump has been a huge plus for us and gives you all kinds of flexibility that you don't have with shots, unless you are prepared to do a lot of them, which of course most kids won't tolerate. It is something you can look forward to if it works for you. Our son just had an 8 pancake breakfast! About 6 more than he usually has (and than we had prebolused him for). We just kept giving him insulin as the meal went along. Not ideal, but not really anything we could do about it. He'll go up then come down. In the end you consult with other people, docs and nurses, but you have to decide what works for you and your family.
It will get easier!
Bruce
Hi again,
I agree with Bruce that it is different for every one and for those using a pump vs mdi. My son is 11 diagnosed at age 8 and I was 31 when diagnosed. I am on a Mimimed pump but my son has not transitioned to the pump yet so we do multiple daily injections. It does get easier but I can tell you being a Type 1 and having a child with Type 1 are completely different. Of course, many things such as illness, stress, lack of sleep, activity, change in routine, prepuberty/puberty, hormones, etc... will all have an impact on blood sugars so please try not to stress yourself.
I am not sure if you won't ever have interrupted nights but things will get easier. When my son's sugars are lower at midnite than usual I will set my alarm for 3am to recheck him. Since my dad and older brother were also Type one my dear mom hardly slept through the night but she was great and took great care of them both.
You will do great and just know all you can do is your best. My dad and brother are still going strong having lived with diabetes for 72 years (my dad) and 34 years for my brother. Sadly my mom who was healthy and not a diabetic passed away last year due to undiagnosed heart disease.
It is amazing what a parent is capable of for the sake of their child! We are all superheroes in our own right!
Good luck,
Jodi
Sometimes I'm sure Jimmy (8) will eat his whole meal, so I bolus before - only to discover that he doesn't eat the whole thing... So, I've worked out to hive him coverage for 1/2 his food first - then the rest after he finishes. But, he's on the pump, so it's easier to do that. With shots, a before and after coverage would have not worked... Hope this helps!
Hi there! My son is 10 and was diagnosed on March 21st, 2012, and we are still, in honeymoon phase. I caught his "D" early as well. When my son is at school he has to give his injection "after" lunch, due to them have recess first and we dont want him taking a hundred trips to the nurse everyday. There are alot of times I will inject after he eats, just depends on what he's eating. For us, anytime he eats pasta, we inject after due to how long it takes for the pasta to show up. If he eats cereal for breakfast, oh he's getting an inject before he eats. My son doesn't like to eat "alot" all at once so for me, when I give him his plate, he checks his blood sugar and begins to eat. By the time he's halfway through I can pretty much gauge how much more he will eat and give the injection during eating. I understand that the best way is to inject prior to eating, however, we are just about 1 year in, still in honeymoon and sometimes its just easier this way. His A1C was taken 4 days ago and he was 7.2, so he's perfect. Everyone's "D" is different, you just have to find a way that works best for you and your family.
Hi Christy, I am curious as you mentioned that your son gets his shot after lunch, does this mean there is a nurse on staff to give his shot. I live in Montreal, Quebec and there is NO nurse at my son's school and his school really does NOTHING for him except allow him to check his blood sugar and I have even had problems with this.
I have met with the school (principal, teacher, social worker, school pschologist, etc) and tried to tell them about his routine and gave them papers on his protocol and yet we still encounter resistance.
I have not returned to my part time job (I was on sick leave when my son was diagnosed) since I have to bring him home at lunch to feed him and give his shot and be close to school in case of an emergency since NO ONE has been trained to help him.
Many times he has come home with a low blood sugar after school and I worry that one day something serious will happen.
Good luck with your son.
Jodi
Jodi-
Can you get advice from your doctor? It sounds like his insulin needs to be adjusted if he's having lows at the same time every day.
Why isn't your son doing his own shots? My school had a nurse when I was a kid but she never would have given me shots. That was up to me.
I know it's different for everyone, but most kids have the dexterity and understanding to give shots on their own by age 6. I wouldn't let a young child decide on his/her own dose, but they are capable of administering a set dose or of getting direction from you over the phone and giving the shot.
You could also speak to his doctor about skipping the lunch shot and eating a lower carb lunch. It would cause a slightly higher blood sugar until his dinner shot and might help him avoid the afternoon low.
Another option to deal with the afternoon low is for him to have a snack at school. I kept a box of graham crackers at the office for my whole time in elementary school and would come by at 10am and 2pm to have a graham cracker and milk. It would be ideal if your son could have a snack in class, but that can be disruptive to the other kids.
It's normal to worry about lows, but they shouldn't be a problem if he can sense his low blood sugars. Make sure he always carries sugar or snacks in his backpack and tests when he gets home. Lows will happen but as long as he has sugar around he should be able to help himself. He's probably more capable than you think. When I was a kid I wouldn't worry about lows when my mom was around because she could help me. But when I was alone or with people who didn't know how to treat my diabetes I was quick to sense and treat lows.
My teachers always knew I had diabetes and should be allowed to eat if needed and they should give me sugar if I started acting weird. Give the teacher glucose tablets or gel in case it's needed. Your son will be able to treat 99% of low blood sugars on his own.
I'm also a big fan of insulin pumps. I did shots for 25 years and had constant highs and lows. Pumps still take time to manage and you have to count carbohydrates and bolus for each meal, but I have much fewer lows with a pump.
Take care. Jenna
Jodi,
Not sure how it works where you live, but her in the United States we have something called a 504 plan. If we have one of those the school HAS to do things for him and he's allowed to do whatever he needs to for his diabetes whenever he needs to. Also, we can have them hire an aide to be with him throughout the day and on field trips. Maybe you can look into something like that. It's really nice to have since it protects your child while in school. We haven't had to get one yet. My son will be going to kindergarten in the fall and so far the school is telling me that they will do whatever they need to do for him and not to worry.
Hope this helps :)
Kelly
HI All:
Thanks so much for your comments. Very helpful! I take a little bit away from every post. We are working our way through our issues and have switched to dosing 15 minutes before meals now that we know he is sticking to the same meal types, which seems to help control his levels better. I like Christy's suggestion on waiting until after the meal for pasta....that would help address our same issue of late blood sugar rise.
We are now having issues with finding care for the summer. While schools have to follow the 504 plan, day camps don't have to. I, unfortunately, have to work in order to keep our benefits so finding a camp is a necessity and we live in a rural area so choices are limited. We have been spoiled at our school by an aide that keeps track of all the diabetics in the school. My son does all the work, but the aide keeps him on time, checks his dose before he injects and texts me his glucose levels at lunch or whenever he needs to check his sugar. She also makes sure he eats all his lunch or if he does not, makes sure the insulin is covered. I am now just trying to find a camp that would be willing to work with me, so Jodi, I feel your pain. I made a promising connection today, so I just need to find out if the person that directs the camp is open to me educating them on a T1 diabetic's needs. I am hoping a little upfront education and work will result in a great summer for my son! I hope you can find a similar resource at your school...I think people really do want to help but might be afraid or basically need to be asked very directly to help.
Good Luck!
Hi Jodi,
Yes, his school has a nurse and we have a 504 plan in place that the school has to adhere to. I do not know about the laws in Montreal as I am in the US. However, you may want to check with your childs Endo to see if they can guide you on how to handle the school. My son's blood sugars are all over the board at times. Just the other day during band, his blood sugar dropped to 54. He went to the nurse got some juice and started to come up. Is your son able to take his meter with him to school? Does he reckognize his highs or lows? I have actually put a meter in my son's backpack as a precaution for if the school ever goes into lock down, he also has a tube of glucose tabs with him as well. I always tell him, if you are feeling low, pop a glucose tab in your mouth, go to the nurse and check. Even if he gets it mixed up and he is "high" and he eats a glucose tab, to me, Id rather him go high for a bit and correct later, then to have him go low and drop on the floor. Do you know what the laws are in your area for children with Diabetes at schools?
Hi Jodi,
I did some Googling and found your JDRF in Canda (Junior Diabetes Research Foundation) and provided their info below. You may want to reach out to them as they will know all the laws and what your school can and cannot do. They can also assist you in setting up someone to come to the school and assist with training and such. Please reach out to them as soon as you can they are a HUGE resource. Also, they have a "toolkit" to help you with the schools as well. This is what I used when my son was first diagnosed. I provided the link that will take you to the toolkit page as well. I hope this helps, I know it did for me. Let me know how it goes please.
www.jdrf.ca/.../school-resource-toolkit-request-form
JDRF National Support Office
2550 Victoria Park
Avenue, Suite 800
Toronto, ON M2J 5A9
TF: 1.877.CURE.533
Tel: 647.789.2000
Fax: 416.491.2111
E: general@jdrf.ca
Hi Jodi,
I found a found a document from the Canadian Diabetes Association. Its called "Standards of Care for Students with Type 1 Diabetes in School" Hope this helps too. You may want to print it off and take it to the school as well.
Hi Christy,
Thank you for the info. Unfortunately, there is NO 504 plan in Quebec and even though my son is coded with an organic impairment (type1diabetes) the school can do what it wants with the extra funding. The school is not obligated to provide a nurse and training and giving my son a shot has to be done on a "voluntary " basis. I have called every agency and they all confirm this no matter how much I argue that the money is earmarked for my son (technically).
I have brought much documentation to the school ( our province did develop a protocol for kids with Type 1 in Quebec schools but again everything is listed as a "suggestion " or "voluntary"). So anyone in Quebec is basically on their own.
So, my son does not go on outings with the school and I bring him home at lunch so I can give his shot as well as find out how his morning went and to ask if there are any issues especially on gym day which is 3x per week.
You would not believe what we have to put up with...one example is when his gym class went to the park to go snow shoeing and he reminded his gym teacher to take his meter(it is kept in the office) and Swedish berries in case of low and the gym teacher said that he did not need to bring it! They were heading to the park which is not on school grounds and he always needs to ake his meter and berries. I know put berries in his jacket pocket for emergencies and tell him when in doubt just take some berries if he cannot check.
Luckily, we have a new principal this year who I called right away and told him this was unacceptable and he agreed and spoke to the gym teacher ( who has done other things as well but too much to tell in this note).
This is why I was curious as it seems evey one in the USA has access to a nurse at their school so the laws regarding this are better in the USA.
All I can say is thank goodness my son was 8 at DX and not 5 starting kindergarten. I know a few moms who ended up homeschooling because of the lack of care at school.
Thanks Christy,
I am in contact with them but the principal in years past refused to allow a nurse to come in to train! I kid you not! Now the new principal s much better and did have a small training session in September but he is new so at the beginning of the year he was not open to anything since he needed to get to knowvthe files. We met in October and since then things are running as smooth as possible but teachers still do what thet think is best so I have to keep on top when they do something like make my son wat to check his sugar because they are in the middle of lesson.
I appreciate your help.
Thanks again.
Jodi
Hi Edie,
No 504 plan in Quebec and while the school does get some funding for my son it is to their discretion on how to use that money so it is not used for my son. I have called around and this is legal! So I remain a one mommy warrior protecting my charge :-)
The school does know I will NOT take any crap and I involved the principal right away when an issue arises.
Thanks again.
Jodi