Lunch numbers

So I am curious if this happens for anyone else...Zackery is your typical happy, jolly, somewhat obnoxious four year old - with type one diabetes.  Since he was diagnosed his numbers have never really been in the so called "normal" range.  If I can get him to stay below 200 it's a great day.  But for quite some time now his lunch time numbers are up there.  The highest I've seen it go is probably just about 500.  Sometimes I wonder if I have a weird kid, no matter his range of number,  be he below 70 or skyrocketing he acts the same.  Rarely ever any different.  Anyway,  at his lunch time he is 99% of the time over 300.  We don't understand it and our dr doesn't seem too concerned.  *btw, I've looked into pediatric endos for our area and the closest is San Antonio where we go anyway  for those I've talked to before*  

I just wanted to know if anyone else has gone through this or thinks I seriously need to switch drs.  We have done a complete range of snacks each for one week apiece to come up with a theory and it is always the same.  *the in between time after breakfast and before lunch*

 

Oh and just as a crazy venting parent,  screw terrible twos four is where they REALLY push your buttons.  Then again,  his little sister is two and claims she is a Diva Princess.  She plays the part very well.  Lol  Oh and my 7 month old *7 weeks preemie* is teething AND managed to really get a grip on this rolling thing.   Lol. 

I know it's Monday but I hope everyone has a good day.  Little man is finally dozing.  This momma is pooped.  :)  

I ♥ my T1D son.   I wouldn't have him any other way. 

I would look at switching doctors. If his sugar is constantly high I think that his carb correction baseline needs to change. My son was diagnosed about 4 weeks ago and he is having wild swings and right now is usually low. I have been talking with some nurse friends who say that environmental factors play a big role and that certain foods effect each person differently.

Hey Jennifer,

  Is San Marcos too far for you? There appears to be a practice there. http://www.pedendotx.com/. Also, it appears that you have a few other options in San Antonio since you're making the drive anyways. www.healthgrades.com/.../san-antonio.

  The 500 at lunch sounds like maybe the timing of the long lasting dose or the breakfast carb ratio needs adjustment. My 4 year old gets 7 units of levemir in the morning and a 1u:16g ratio for breakfast. The levemir (long lasting) should be based on a body size and weight calculation so it should be close. The ratio depends on the kid. I'm just giving you a comparison point. We have our own challenges with this routine but he rarely tops 300. Mainly in the high 100s/low 200s by lunchtime. You can always have him run around a lot after breakfast. :)

Tim

If his numbers are consistently that high and your doctor doesn't seem too concerned then I would definitely look at switching doctors. It sounds like whatever long-acting insulin he is taking (my son takes Lantus), and even possibly his carb/insulin ratio, needs to be changed (especially his breakfast dose). Consistently being high is not good for his overall health, especially in the long run. Our son was in the 400s when he was diagnosed. Our pediatric endo keeps a constant watch on our son's blood sugar readings. If he  goes over 180 (or under 80) for more than a few days, whether it be when he wakes up or when he eats a meal, then we have to send his readings into his nurses so they can make the necessary adjustments. I don't know how far away from San Antonio you are (you mention having to drive) but I would definitely recommend having your son moved over to the Children's Hospital there and let them take over his diabetes. There are no pediatric endocrinologists in our area either. Our son's pediatrician (who first diagnosed him) sent him immediately to Birmingham, which is over 2 hours away, instead of to an adult endo here. It's troublesome at times but I wouldn't send him anywhere else.

I agree with everyone else’s thoughts about finding an endo who is concerned with those over 300 blood sugars… The way our peds endo described it to me, those high blood sugars aren’t necessarily doing the same damage they will after puberty hits, but if the average sugar is so high all the time then it prohibits proper growth. And wow, do I feel you on the pushing buttons, though my little girl is only 3 lol. We’ve been battling large ketones all weekend/today along with a cough/cold, despite a bolus of IV fluids on Saturday, and she wants to debate and barter with me on every sip of water!!! Or any other fluid, or anytime I ask her to pee when she doesn’t want to… Blargh. Good luck with all these challenges!

Hey Tim - San Marcos is a longer drive for sure.

Oh man, I’m on my phone I didn’t know my “enter” button was actually the Enter button. Lol. He takes 3 units of Lantus at night and Novolog during the day. It’s 1 unit per 15 carbs, 2 for 30 carbs. No more than 40 carbs per meal including the drink and 15 carbs per snack. This is how it has been since the beginning. We really need to be stronger advocates for him. I think even with it coming up on three years that we’re still in a bit of denial. *i.e. Pretty much just do as we’re told. There’s so much stuff jumbled in my brain that I want to say but I can’t get it all straight right now. Maybe later. Thanks everyone.

I would look to get another opinion.  Are you dealing with a group practice or an individual.   I do think that sometimes the physician group setting allows them to learn from each other as well.  My daughter is 4 as well and she actually just went on the Omni Pod 2 weeks ago and so far I can say it seems to be making such a difference in her numbers.  Of course she seems to be coming down with something, sore throat and all, so I'm sure that will throw us off course a bit.  I used to keep a spreadsheet with her numbers and send them into her nurse at least once a month and she would review the trends and make adjustments to her doses.  Found that to be helpful.

And on the 4 is the new terrible 2, I couldn't agree more.  And her being my oldest its difficult sometimes to know if the T1D is magnifying it all (which I'm sure it is to some degree), or if this is the new normal.  My 3 year old believes she is a princess as well, last night she got out the microphone to sing along with the ACM awards and had all the posing down.

Wishing you an easier tomorrow!

-Kelly

Have you looked into a blood ketone meter.  We just got one when we started the pump and wow does it make it easier to check, especially with a toddler.  

KellyB, how much did your blood ketone meter end up costing you?  It WOULD be so much easier than trying to make a toddler pee!

All I know is that we I guess are “assigned” this dr which is the one that saw him when he was diagnosed. We technically only see him once a year. The rest of the time we see one nurse practitioner. (I think that’s what you call them.) If only our family dr was a pedi endo. She is awesome.

Jennifer, Assuming your son is around 40 lbs, the recommended basal dosage is 3u-8u (convert weight to kg x (.15-.40)). There's a nice chart in the book Think Like a Pancreas (highly recommended) about the calculation. So right now you are on the low end of the scale. Depending on what time you are giving it as night, it could be on the downside of it's effectiveness. It would be interesting to see what a larger basal dose would do to the lunch number. It might drive him lower in the night though. These are the games that get played when changing dosages.

He's 37lbs so yeah. I've thought about doing that but always worried what the effects would be.  See? Still learning.  :)  Thanks - I'll look for that book this weekend.

My son is 10 and if his blood sugars are above 200 we have the terrible 10's(lol).  I always can tell whether he is high or not just by the way he acts.  And I say ok lets test and see if we need an extra bolus.  I tell his Drs its like Dr Jekyl,  Mr Hyde(lol).  He finally got on the Minimed about 9 months ago and the Drs adjust his insulin whenever we go back for our 3 months visits.  Or if there is major issues I just call one of the nurses or the NP and they will tell me how to adjust it over the phone because our Drs are 1 1/2 hours away.  I really love the support that I get from them and I only pray that he will still have something like that when he gets older.

My son is 10 and if his blood sugars are above 200 we have the terrible 10's(lol).  I always can tell whether he is high or not just by the way he acts.  And I say ok lets test and see if we need an extra bolus.  I tell his Drs its like Dr Jekyl,  Mr Hyde(lol).  He finally got on the Minimed about 9 months ago and the Drs adjust his insulin whenever we go back for our 3 months visits.  Or if there is major issues I just call one of the nurses or the NP and they will tell me how to adjust it over the phone because our Drs are 1 1/2 hours away.  I really love the support that I get from them and I only pray that he will still have something like that when he gets older.