I need some suggestions. My 8 year old daughter always runs high after breakfast and I can't seem to adjust anything to get it down. She usually eats at 7:30 in the morning, about 45 carbs (usually toast, waffle or cereal with milk and fruit) I try to get some protein in as well like sausage or peanut butter. Her pre-breakfast numbers run 90-140 usually. We dose for her carbs 20 minutes prior to her eating, she eats and then goes to school. Almost every day she calls me around 10:00 to tell me her CGM is alarming for a high and that her finger stick bs is 250-300+.
Her breakfast I:C ratio is 1:13. I have tried going to 1:12 and then she goes low.
I think her basal rate is okay because on the weekend when she sleeps in (sometimes until 10:00) her numbers are fine.
I tried cutting the carbs in her breakfast and only allowing her 15-20 g but she was still high.
When I have toast, I choose whole grain bread since most other breads raise the blood sugar level much faster. My bread has only 8 carbs per slice. That helps too. I never eat waffles and cereals since they will always raise blood sugar so fast. Milk is bad too, but whole milk that contains the fat is not bad. Fruit is good, especially berries. Strawberries with zero carb whipped cream from a spray can is excellent. All berries are good choices. Peanut butter works slowly so that is good too. My typical breakfast consists of one slice of the low carb, whole grain bread, two eggs, meat (bacon or sausage or ham), and some fruit (small apple or orange or berries). That is usually a 25-30 carb breakfast for me and I do not have a very high blood sugar level at two hours after eating. I don't know if that would work for a child like it does for me, but that is all I know to suggest.
I also struggle with high bs post breakfast but there isn't anything that I've found to work. I usually eat cereal with banana in it, and mostly I will go high afterward but sometimes I will be normal even though I did the same exact thing. so it really does not make sense to me and I cannot figure out something that always works.
I guess injection site matters a lot. If you inject on the thigh, the action will be very slow. For me, cereal and milk are bad for breakfast. I usually have high results if eat that.
I also struggle with high bs post breakfast but there isn't anything that I've found to work. I usually eat cereal with banana in it, and mostly I will go high afterward but sometimes I will be normal even though I did the same exact thing. so it really does not make sense to me and I cannot figure out something that always works.
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I guess the number of hours you sleep affects your post breakfast bs. For me, if i sleep less, I will go hypo after the breakfast even if I eat the same usual food and inject the same amount on the same site.
Bananas are very high on the glycemic index, which means the carbs in bananas convert to glucose very fast, and raise the blood sugar fast, causing a high spike an hour after you eat them. You are lucky if they don't affect you that way.
I guess the number of hours you sleep affects your post breakfast bs. For me, if i sleep less, I will go hypo after the breakfast even if I eat the same usual food and inject the same amount on the same site.
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Yea that could definitely be the affecting factor, because if I wake up at 7-8am and I am working a normal work day then my bs are good and usually actually go low by lunch time. however if I sleep until 10 or after, then my blood sugar is high after bf.
Richard- its actually funny that you say it is the worse thing I could eat, because that is what I had for bf in the hospital after being diagnosed which is why I continue to eat it for breakfast. I was given rice krispies, juice, fruit and maybe something else..I don't really remember. so ever since then I will usually eat rice krispies with banana for bf. After two years of that almost every morning though, I got pretty sick of it. So I was eating honey nut cheerioes for a while, but lately I have been trying high protein cereals because thats what my cde recommended. It doesn't seem to help the after bf highs, and actually because of all the protein and fiber it keeps my bs higher longer!
I agree with Vered about the bananas. While it is important for people with Diabetes to be wary of foods that metabolize quickly, it is also very important to remember that what kills most diabetics, (and non-diabetics for that matter) is heart disease. So suggesting "sausage and bacon and eggs" are better foods for a person with diabetes than a banana doesn't make sense. Healthy foods that supply a plethora of vitamins and nutrients such as bananas that enter the blood stream quickly can be accompanied by healthy fats and proteins (egg white omlette with avacado or guacamole). This will help to slow the sugar absorption. You might also try a dual bolus if you have a pump. Also, it seems to me that if the problem were a high-glycemic food, the blood sugar would spike soon after eating the food, not hours later. I would talk to a nutritionist who specializes in diabetes. I also have noticed these odd spikes, and I'm on a low-carb diet, (usually less than 15g per meal.)
I guess we are all different. I avoid the foods at breakfast that have high glycemic values. They make my BG rise to above 200 in only one hour. If I eat food with LOW glycemic values I am fine. If you don't get those highs one hour after eating, then you are OK. I am glad you can eat them. I wish I could, but I feel so sick when I go that high, and it is unhealthy for me. I stay in the range 70-130 about 95% of the time and my body is just not used to high numbers. I have no complications after 65 years of type 1, so I must be doing something right. Lol!
I'd love to figure out how to get more fruit into Sarah's diet. So far the only fruit we can deal with without crazy high bloodsugar is pears. I let her eat 1/2 pear along with a serving of peanut butter, and she stays level. I've let her have 1/2 banana several times, but even then she usually ends up spiking a bit. And apples are just as bad. She's never liked berries or citrus, so haven't tried those. When in season she always takes 7oz of watermelon in her lunch and that isn't an issue as long as she has protein (which she always does).
I've struggled with the same thing and have just recently got it under control. Theres a few things to consider here:
The basal - From my experience, the fact that her numbers are fine when she wakes up after sleeping in (did I understand this properly?) does not mean her basal is correct. The morning basal really needs to cover someones dawn phenomenon, which doesn't usually occur until someone actually wakes up. This is why, on weekends when I sleep in, I don't start my basal increase to cover the dawn phenomenon until later. I think you should conduct a basal test (have her not eat breakfast, and monitor BG to see if it rises without any carb intake) on an actual school day. This will account for the stress of waking up for school, which could play a role, and also waking up at her usual time. I understand she probably wont appreciate it, but it's a good way to rule this out.
The GI - Personally, I definitely can't eat most toast, waffles, or cereals for breakfast without spiking similar to your daughter. What has worked for me is switching from whole grain bread, which is medium GI, to pumpernickel rye bread, which is low GI. I also have it with natural peanut butter, slowing digestion without adding sugar (processed peanut butter can actually have a decent amount of sugar). Besides toast I also have a stir-fry with beans, which works great, but obviously I don't know if that's practical for you and your daughter.
The I:C ratio - after the BG spiking, does her sugar eventually return back to normal without any additional insulin? If not, there is an insulin deficit, and this could either be from an insufficient basal rate or I:C ratio. If she does return back to a healthy BG without extra insulin, it sounds like the food she is eating is too high GI, but if not, more insulin in the form of basal, bolus, or both is needed. Once you know the basal is set properly, you can conduct a bolus test by having her eat an amount of carb that you've made sure to count precisely. Wait until all of the bolus is out of her system, and then do the math to figure out the correct I:C ratio. For example, if she was 180 after the breakfast bolus had left her system (i.e. 5 hours after breakfast), and her correction factor is, say, 54 mg/dl per unit of insulin, you can assume she needed 1 more unit for breakfast (meaning she would finish at 126 mg/dl rather than 180). If her original I:C ratio was 1 unit for every 20 grams, and she had 60 grams for breakfast (meaning you would have bolused 3 units), you can calculate her new I:C ratio as 4 units:60 grams of carbs, or, 1 unit : 15 g carb.
I really hope this helps, and please ask if me if you have any questions about what I've written.
[quote user="Dylan"]The basal - From my experience, the fact that her numbers are fine when she wakes up after sleeping in (did I understand this properly?) does not mean her basal is correct. The morning basal really needs to cover someones dawn phenomenon, which doesn't usually occur until someone actually wakes up.[/quote]
Dylan- Thanks. I think I will try having her skip a school day breakfast and see what happens. It never dawned on me that she may need more basal in the morning on school days. Her bs does eventually get down to a reasonable number by lunch time so I think her I:C ratio is okay. If it weren't for her starting to use a CGM, we wouldn't have caught this pattern as quick as we did.
Thanks to everyone for your advise and help. We may need to try some other foods for breakfast. Don't need to worry about the banana debate though because she doesn't like them!
I definitely agree with Richard! I always avoid bananas-they make my blood sugars rise extremely fast and stay at a high range for a long time. I don't even remember the last time I had one now-my blood sugars were never good when I ate them, so I just completely avoid them. I think just looking at them makes my blood sugar go up lol!