Getting ratios right

First off I would like to thank everyone for the responses on my other questions they are all helping a lot with this transformation, so another question… I know newly diagnosed children it is rough the first year, but I am trying so hard to work with her Endo team in finding ratios that don’t either shoot her up high or bring her too low (even if this is possible to keep her normal). Like they changed her ratio for breakfast 1:30 because she was having a low before lunch, now I have tried it yesterday and it shot her levels to 475 I’m not sure because she ate at home and she was rising then when she got to school she ate again :woman_facepalming: and that’s why. But today she ate about a hour ago and she is already over 300 and rapidly rising. I am just frustrated and overwhelmed because I am afraid this is hurting her and is going to hurt her in the long run when she gets older. Any input would be grateful! Am I doing something wrong? Is her Endo team doing everything they can?

Hello @Dee314 - you sound very fed up of it all and who can blame you when you’re trying your best clearly. Out of interest did your daughter have exactly the same breakfast on both days? And is your routine today the same as it was yesterday? I know it probably sounds a bit geeky but even the slightest things can muck up blood sugars. And dont we all know it :slight_smile: Keep me posted, happy to help if I can. Sally

Pretty much yes, she ate the same thing as yesterday and even ate her protein before anything else, we try and live on the same routine as much as possible, just on school days she eats a little earlier. She is steady at 322 which is better than 475 but I’m uncomfortable with her being over 300

Hi @Dee314 I agree with @Scrumpyjack65 and want to add that ANY activity can have profound differences in insulin requirements and to a lesser extent so can stress.

The exact same 2 units with a snack can either have no effect (sitting at a computer and stressing over work) or can drop me over 150 mg/dl (mild to moderate activity). Diabetes is definitely not easy and definitely not “oh it’s a sandwich so that’s 3 units” (period) Everything depends on everything and over time you will develop a new sense and how activity acts as a huge variable. Newer pumps with auto mode can be helpful if you find yourself lost after a year of this but it’s my opinion that your brain is vastly better than any CGM + pump will ever be.

To be clear, perhaps you should have a “home” pattern and a “school” pump pattern in your pump. I urge you to work with a CDE at least for a little while until you get comfortable with all the settings and all the variables that affect blood sugar. Good luck.

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If your child is on a Dexcom CGM, I would recommend working with the school to add the nurse and/or other staff members as followers. This way, they can get notified if your child is going high or low. Our nurse became our best friend after this! We were on a group text with my wife, and she would contact us and ask if we were OK with a correction bolus. It’s important to have a support system at school. We can’t do this alone!

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Her school nurse is awesome and has become a friend as well because we need to communicate so much but her levels she is even confused on why one day they are ok and one day they aren’t. Still getting high readings after breakfast. Rest of the day she is good. So tomorrow going to drop the ratio again and see how that goes.

Hi, if the majority of her excursions are happening after breakfast … many children are tremendously insulin-resistant in the morning / breakfast period. For example, my son’s breakfast carb correction is approximately twice as “strong” as his carb corrections during the remainder of the day and evening. Now, I’m not telling you to double up her factor, that is for your doctor to decide. But insulin-resistance in the morning is a question that you might like to pose to your doctor. I have often found that if I can get breakfast “right”, then the rest of the day pretty much falls into place. If breakfast leaves my son high afterwards, then I look forward to (not really)… spending the rest of the day chasing his numbers.

I think your idea R @RMcM about getting your son’s day off, BGL wise, on a good footing in the morning greatly helps him to stat more in range during the rest of the day. Over many decades of tyring to get this insulin thing figured out, I’ve found breakfast to be the easiest in that I usually eat at home and can get an exact carbohydrate count.
When you say “carb corrections” in this posting, I’m assuming “insulin:carbohydrate ratio” as opposed to “correction or sensitivity factor” used to bring a high glucose level back into range.

It is not only children who need more insulin in the morning to cover carbohydrates than at other times of day; my carb ratio gives me twice the insulin in the morning than in the evening. This is caused by the body being designed to release certain “wake up” to get us active at our expected wake-up time - it also happens to you. There is much written here, and in JDRF resources tab, under various topic lines; search for " dawn phenomenon".

Thanks for clarifying – yes, by carb correction, I did mean insulin: carbohydrate ratio.

Dee, you have described an interesting phenomenon that happens to a lot of Type Ones, as you’ve already heard: insulin resistance in the morning necessitating a higher insulin to carb ratio. I deal with this as well. I don’t think you’re doing anything wrong… sometimes you can do everything right and still have blood sugars all over the place. It’s okay, in fact it is totally normal, to feel frustrated and overwhelmed. Yes, unrelentingly high blood sugars over a period of time can cause nasty complications, but it sounds like that’s happening to your daughter primarily in the morning, while the rest of the day her blood sugars are closer to normal. I know it sounds ridiculous, but try not to worry so much. Years ago, when I was in my 20’s and experiencing blood sugars in the 400s or 500s for a few hours several times a week my endocrinologist reminded me that those few hours were like a blip; a temporary deviation from a general trend. Those blips happen to everyone taking exogenous insulin. Do the best you can most of the time. Achieving good blood sugar control ALL of the time is impossible. I do hope this helps.

Hi! I’m so sorry - diabetes is so frustrating. I’m glad you have people willing to help!

Timing is another key factor - the com helps so much with this too! I typically prebolus my meals by 20 minutes … and sometimes I wait a little more until I see the dots going down. Usually carbs from meals hit faster than any Bolus. I strongly recommend Juicebox podcasts - http://www.ardensday.com/juicebox-podcast - I’ve been T1D for 30 years, just started listening in June - lowest A1Cs ever and substantially much more time in BG range. Yee haw!

Pre-bolus is critical.
We don’t restrict carbs, but we do encourage lower carb breakfast before school (only 2x/wk) and it helps reduce the variability.

Chia seed pudding with unsweetened almond milk is pretty great. Just bolus for any yummy stuff you add to it. No prebolus needed unless it’s super sweet.

Otherwise, I second the Juicebox Podcast and prebolus timing.