You seem to be doing great!!! My doctors have always told me that between 70 and 120 is normal. I used to have a snack between meal all through childhood. I would even have a 9:00pm snack. If his level is higher, then I would say have a free snack but a lot of times doctors plan for their level to drop a bit and that is the reason for midmeal snacks. Having the CGM is amazing and I am glad you have one. I have the Dexcom G6 and yes I have had bad sensors from time to time but Dexcom always sends me replacements if that happens. When the time comes and you decide to get a pump, I started on a Medtronic and just now switched to a Tandem. Both are good companies but I feel like Tandem paired with Dexcom is moving in the right direction. Good luck and you can message me anytime.
Right now, my son doesn’t want to move to a pump. He really isn’t too keen on tubing, having it crimp, etc. We did receive an Omnipod sample so maybe he will move to that someday.
I haven’t really looked into what pump pairings work with Dexcom, but if he starts to show interest, I’ll read and read and read and ask questions here, of course.
With mid meal levels, it just seems that if he goes with a free snack, he’s low-er at mealtime. Experimentation I guess.
I just wanna pop in and say–it’s totally fine if your son isn’t interested in a pump! I’ve been on injections for my entire “diabetes career” purely because I don’t like the idea of having another thing attached to me. It’s 100% possible to have awesome blood sugars without using a pump. It sounds like you’re doing a great job of letting your son make the choices that make him feel most comfortable–kudos to you! Keep up the great work.
Thank you Abby. When we got the Omnipod sample, we just presented it to him as a future option if he wishes. He started with an insulin pen a week or so ago and he’s OK with that.
Maybe down the road if he is giving correction boluses between meals or something like that, maybe he’ll turn to a pump. Until then, we’re all fine with that!
My two main stresses right now are the between meal acceptable ranges, which we’ll discuss with his endo, of course. The other is his limited diet. Getting this kid to try new things is a chore in itself!! 
So after visit with diabetes educator from our new team, it seems we may have been handling snacking incorrectly or not optimally. After reviewing his numbers for the past two weeks she said he was right on target and doing great. He was in range 95% of the time, which she said was super. Then I mentioned the need sometimes for two snacks at night and she said that seems like we are feeding the insulin. I never thought of it that way before. Primarily, I guess because we thought the eating every 4 hours with a snack in between to hold him over was the way to go. At least that is what we left the hospital knowing, but life isn’t always that regimented.
It always seemed that after a meal, the insulin would do its work and he needed a snack to bring his level up to make it to the next meal. He wasn’t snacking because he was hungry necessarily, but just to get to the next meal without a low or falling lower in his range. Maybe that will eventually be the case and I know that things will always change, which seems to be happening a bit now.
Today, for example he at breakfast at 9:30ish this morning. He seemed to peak about an hour later at 164. Almost an hour later he was 125 and he’s remained around that level, a little higher, a little lower, but hasn’t needed a snack.
I guess its a little scary, unexpected or puzzling to see what happens between meals, which we didn’t see before the Dexcom.
The CRNP from our office is supposed to call us to discuss the snacks so I hope that clarifies things for us.
Hope everyone is well! I finally jumped back on the site to see if there were any threads in which I might be able to add something.
As far as our journey, my son has been running a little higher for longer periods of time after lunch and dinner. He’s also experiencing the near lows at bedtime through 1:00 AM ish.
Our new CRNP reduced his Lantus dose from 7 to 5. We also stopped his evening bike ride for a few days to see if exercise was contributing. It most likely was a bit, I guess, but he still experienced the need for nighttime snacks. So, we’re trying a split Lantus dose - 3 @ night and 2 in the morning. It seems to have helped the higher levels during the day, but he still was trending lower again at bedtime. I’m wondering if we split the Lantus up 2 @ nithg and 2 in the morning.
I’m wondering if anyone else has split up their long lasting dose. From what I’ve read, some types of long lasting insulin is better suited to be split, but I didn’t see that applicable to Lantus. Maybe it’s a whatever works situation.
His latest CGM reported some lows, but hopefully those are an easy ‘fix’.
Lantus is a good candidate for splitting doses many people achieve greater consistency with splitting lantus. Other (non glargine) may not need to be split for example Tresiba. The entire disease of T1 is a “whatever works” situation. Glad to hear from you!
As always, thanks Joe!!
Since getting the Dexcom we, of course, see the fine details of blood sugar levels. I’m still a little confused or concerned about what is ‘good’ between meals. For example… Today his day looked like this… 102 at breakfast, peaked about an hour or so later at 165. He dipped into the high 70s at lunch so he could have probably used a mid morning snack. A little less than an hour after lunch he peaked at 188 (a pretty quick pike). That fairly gradually went down to 92 at dinner. He had a treat of pizza for dinner so about 2 hours later he peaked at 188. About an hour later he was down to 145, then back up again to 178 at around 9 PM. That came down to around 120 when he went to bed. No snack after dinner this evening either.
I know that’s a lot of detail, and I know a lot goes into all of this (type of food, bolus timing, etc), but I just wanted to get the feel of whether this is decent, something to be concerned about, etc. We usually try to give his insulin about 15 minutes before eating. I’ve also read in Think Like a Pancreas that bolus timing can be adjusted based on the glycemic index of food, so there’s that too to consider I guess.
After looking at a Dexcom report, it currently seems that he spikes a bit after lunch sometimes and dinner with extended, elevated periods.
I’m thinking maybe we should swap the lantus dosing to 3 units in the morning and 2 at night. That might help with the after noon, higher levels and maybe he wouldn’t dip so low at night. Don’t worry, I’ll check with his Endo before doing anything.
With all of that said, another main worry is improving his diet. I’ve probably said before that my son is a very picky eater. He usually finds something he likes then continues to eat that until he grows tired of it. Getting him to try better things will be a challenge, but I would really like to help him with foods that will make managing his condition a little easier (if that’s possible).
Honestly @mawa316 his numbers sound pretty good
Don’t forget the purpose of basal insulin is not to lower or raise blood sugar. The idea is it acts as background insulin. Think of it this way. If basal is perfect and he was 125 before lunch, and he skipped lunch, he would be 125 all the way to dinner. If he was above 160 at dinner he needs a bit more basal. 80 at dinner, a little less. Now you’re using lantus so you can’t adjust for 3-4 hour periods but it is what it is unless you get a pump. Basal requirements vary throughout the 24 hours the best I could do on lantus was to overdose a bit so my overnights were as good as possible and snack if I dropped between meals
Pizza takes 4 hours to absorb and if he eats higher fat content with dinner you will usually see that the meal peak is later and longer, in fact pizza takes longer to absorb than Most fast acting insulin so he likely needs 2 shots split of fast acting for pizza.
I think you’re doing great the pre meal numbers are just about perfect. Post meal is a crap shoot if he’s back to where he started at 4 hours post meal the shot was perfect.
Hi @mawa316 and welcome back. You and your son are doing amazingly, and I’ve seen you grow from a scared parent to one who’s continuing to lear and is making reasoned choices and acting on your growing knowledge. I just had to throw that out there and say keep up with the good work, both of you - I should probably say all of you do as to include mom and whoever else is in your family mix.
I know you’re concerned about snacking, perhaps especially the need for something before bed. That’s not necessarily a bad thing. I don’t know if this advice is still out there, but I used to read that it was or would be better for people to eat several small meals throughout the day, rather than the customary 3 big ones. I believe that was suggested as a general rule of thumb for most people and not directed to us, although logic suggests it could hold true for us as well. Meals give a greater variety of nutrients whereas snacks - at least in my world - may focus on one, or even consist of a bit so nutritious filler whose purpose is to simply keep my numbers up.
I’m not saying you should change your son over to 5 or 6 small meals - just starting an analogy that the concept (which BTW I don’t think I’d widely adopted) acknowledges that the human body might - might - just function better if it gets more energy more frequently. Snacks - nutritious ones - feed that energy, so if he needs something now and then it’s not necessarily a bad thing. I quantify using the words “not necessarily” because it’s one thing to eat to keep numbers relatively steady, and another to have to respond to those blasted downward arrows that won’t level out, or to treat lows that keep going lower. I’m using myself as an example: I was getting frequent alerts overnight that I was dropping and expected to fall below 70 in the next 15 minutes. Sometimes stuff just happens, but
- if it happens regularly during a particular timeframe;
- I’m having to take in carbs and calories when I’m not even hungry and don’t even want to eat; and
- I’m putting on unwanted pounds
… then it’s a problem.
Otherwise, occasional snacks for the joy of eating, or because you’re a little hungry, or because they tide you over to the next meal - are all fine. No need we shouldn’t enjoy food as much as anybody else.
If he’s a finicky eater who knows - you may have a young chef in the making! Some of the competitors and pros on shows such as Chopped got into food because they out a loved one have health conditions. As long as he’s getting the nutrients he needs I think that’s the most important thing. However, if you’re bothered by his overnight numbers and feel he would do better with a basal adjustment rather than snacks, that’s still of course a reasonable consideration. I just wouldn’t want you to think snacks are a bad thing.
Thanks Joe and Dorie!
When we came home from the hospital, the routine was meal, snack, meal, snack, meal, snack. Sometimes he needed more than one snack a night to get to a good level then that pretty much persisted throughout the night.
However, he was eating meals to feed his insulin, which the Endo said is not or should not be necessary. You should be able to get from one meal to another without snacking if your insulin dosages were correct.
If he’s actually hungry between meals, he will have a snack though we try to or have been choosing the snack based on his sugar level at the time. If on the higher side for him, he’ll grab a free snack, if not, maybe a 10-15 gram snack is chosen.
@mawa316 there is no correct or incorrect way here. Most younger t1’s can use the calories so feeding insulin is not a bad strategy if he needs to gain weight. The endocrinologist’s philosophy is right, you don’t WANT to HAVE to feed the insulin but it’s lantus you’ll have to compromise in one way or another. Since many if not most of us need higher basal rates at night you are either ok between meals and you will rise at night or you are ok at night and drop between meals. There are reasons for and against either strategy.
And it’s not just Lantus, all injected long lasting insulin will have this limitation. You have to decide if the convenience of a long acting shot is preferred versus the accuracy and ability to spot or temporarily modify the basal delivered by pump. Again no one answer is right for everyone.
Thanks Joe. I’ll have to reread that a few times to digest it all.
Aside from all of that, I guess the question is what is a good ‘target’ level for in between meals, 150, 170ish, etc. I know that can all be impacted by bolus timing, type of food, etc, but I’m just wondering to ascertain if a fast acting dose was too little/too much.
Also, this morning we gave the 2 units of long lasting then his meal bolus (Endo said its OK to take near same time). He was at 101 at 9:35 AM then spiked to 201 at 10:50. So, I’m wondering what happened there. How long does it take for the additional Lantus to kick in?
@mawa316 Lantus begins to work very quickly, but a shot of 2U or 3U represents an absorption rate of 0.083 units per hour to 0.125 units per hour. This is not enough insulin to combat a bit of morning resistance or a meal. Typically you bolus x units of fast acting insulin for y grams of carbs. This ratio of x:y is your carb ratio. so my average ratio is 1 unit for 12 grams of carbs - for a sandwich of 48 grams of carbs, i would need 4 units of fast acting. This shot takes 15-20 minutes to start working, peaks at about an hour and continues to work for 4 hours total.
compared to a basal rate of 0.085 units per hour… 4 units represents a huge short term insulin dose (and that’s why it’s called “bolus”)
so if FAST insulin takes 4 hours to absorb and work, you’d think that starting a 8 AM you eat with bolus, and 4 hours later (lunch) is when you sugar stops dropping and you should be back at normal blood sugar. In other words, from 8:30 till 11:30, your blood sugar will be higher than normal. By the way - “Normal” is 70 mg/dl to 100 mg/dl
does that sound like it sucks? Yes? It’s because it does. but we can’t get faster and shorter acting insulin. When I started my diabetic career, “Regular” stunk even worse than today’s fast acting.
If you don’t need the carbs for fast energy, many diabetics choose to eat very low carb. the peaks are less and you are in range much longer or a much higher percent of your day. I eat higher carbs when I am planning on being active, so I can cut the top of my peak with activity. I also shoot for near perfect overnight blood sugar because it’s a big part of my 24 hours and i know during the day it’s a bit of a peak-and-valley looking thing.
sorry for the long post.
Thanks Joe.
He did take fasting insulin to cover his breakfast this morning as well. Eventually dosages will change there as well, I know, but my immediate concern was with his lows right about bedtime to 12:30 AM or so, which is why the Lantus doses have been changing.
Before we started doing that, his levels were pretty good throughout the day, but his peaks into the low 200s have become more frequent since monkeying with Lantus.
Aside from the highs he usually seems to be back near normal range at the next mealtime. He came back to 117 at lunch time.
I know this is going to be tough to really figure out, like why the peak in the 200s today. Was changing Lantus doses involved, did we calculate his food and dose incorrectly, does his figured dose need changing (things are changing with the disease itself). Which of course leads to more questions like when do you know when dosing of fast acting needs to change. I’m guessing that comes with experience, but until then the endo will guide us.
It’s just something I so urgently want to learn and master for him, but mastering this isn’t possible I guess.
Thanks again for all of the support!!
Anytime @mawa316. The way I tell if fast acting shot was right is if I am roughly no more than 50 mg/dl higher than my sugar was before I started eating and if it comes back to normal at +4 hours. That’s it.
Getting basal right is a series of skipping meals and seeing if blood sugar is rising or falling. I prefer to get the basal as good as possible then checking bolus.
Then you can figure sensitivity which is how much your blood sugar drops with 1 unit but basal must be pretty good to get that right.
And no there is no mastering. It’s more like being an experienced artist.
So the next big hurdle is the return to school. I’m thankful that this hit us right at the end of last school year so we had the summer to adjust. My thought’s are with those not ‘fortunate’ enough share the same fate.
Anyway, its back to school time and the next hurdle will be getting from breakfast (7:30ish AM) to lunch (1:00ish PM). It hopefully isn’t too bad as he’s going back to a hybrid model and will only be in school for 2 days.
Today was the actual first day, but he was home (in school Wed & Thurs). We are following his morning, school schedule to see how things will shake out. Today he needed two snacks to bridge the above mentioned gap. I’m not sure if that is normal or if an adjustment needs to be made to his insulin doses. I’ve notified his Endo team, of course, but wanted to see what others thought.
With diabetes we’ve learned to be flexible, as you have discovered. I believe you mentioned previously that you didn’t want him to need to “feed his insulin” - at least not frequently. With time you’ll see if this is a regular need (which I studied it will be) and if you should make changes to his regimen. One regimen change could be having a breakfast that “sticks to him longer” to tide him over to lunch - his nutritionist could make some suggestions and it might expand his food repertoire. Thankfully as you said earlier, you’ve had the summer to become familiar with what to do, what to ask, and how to handle things that may happen, so keep up the good work!
Thanks Dorie!
That’s the next thing to learn more about - diet and which foods act longer than others, etc.
Once we get past the multiple snacks at bedtime to prevent lows, I’ll tackle his diet more aggressively.
Hey @mawa316, if you are familiar with the candy Sweet-Tarts that come in rolls about 9 inches long, they are a great rescue. I used them when I taught at a community college and had a dorky schedule.
The roll has 27 tablets in it. Using a finger nail divide the roll into three 9 tablet sections or about 15 grams of carbohydrate. Get some ziplock baggies to keep the sections clean and in a pocket or back pack. Use these for rescues for you son.
Part two is a protein/carbohydrate bar like the Zone Perfect bars made by Abbott. They are a balanced mix.
Part three for school, is to make sure his school is aware of his diabetes and it is in his IEP/504. The school nurse should be made aware, taught to read his CGM and maybe on Dexcom Share or Sugarmate. One of these would give more people ‘eyes on’ your son so he could take action before crashing.
Finally, there is something I learned when I entered the health care industry more than 40 years ago. Treat the patient not the numbers. What does your son say.
@joe & @wadawabbit, thanks for teaching me.