Honeymooning at School, what to do?

My son was diagnosed over a year ago and will be going into 1st grade in the fall.  He is still honeymooning on a regular basis and I am so scared to send him to school.  It was easier last year, he was only in 1/2 day kindergarten.  Now, I need to write a 504 and describe the honeymoon to the school staff, knowing that he will have lunch and then recess, with the chance for his pancreas to be working after his injection for lunch.  How do you direct the school staff about the honeymoon and that if you give an injection and the pancreas decides to work that day, that for the next 2 hours until the injected insulin peaks, he will need to be tested and given snacks almost every 20-30 minutes.   Also, he would not let the school nurse give him his shots last year, so if he needed one, I would have to go to the school.  I don't mind going to the school, as I don't work right now, but any advice on sending a child that is honeymooning to school would be appreciated. 

Thanks, Mom of RJB

I am not so concerned about the lowered insulin need.  Here is an example of what our honeymoon is:  before lunch his numbers are 250, he eats 50 carbs, his carb ratio is 1/25, so he gets 2 units of fast acting insulin.  Within 5 minutes of his injection he feels low and I check his numbers again and he is 62, so for the next 2 hours, I am fighting the low that will come from the injected insulin until it peaks.  He was low due to his pancreas working for this meal, the injected insulin has not even entered his system yet.  He has 24 hour insulin in his system too, so his low could be significant if not caught.   Has anyone else experienced this. We have this happen at least once a week.  We also have the days where he gets zero fast acting insulin.  So, I do understand the reduced insulin, but it is the episodes of the pancreas producing insulin for a meal that I am concerned about. 

 

it's not uncommon to give infants insulin only after they eat.    there are multiple things going on if he is dropping 200 points within 5 minutes, (including a possible bad meter/bad reading).  analog fast acting doesn't even start to work for 15 minutes - and that's if you manage to get it in a muscle, so there's a physical limit to how much or how fast it can work..

If I observed this in myself, I would not inject before, I would eat and then correct at +1 hour (or thereabouts), for the total difference between target and actual blood sugar, until some clear and repeatable patterns can be seen.    Don't forget that insulin sensitivity drops considerably if I eat and then go run laps at a playground with "insulin on board"...  somtheing to consider.

best of luck to you.

Our son kind of had this problem when he was on shots. He would get his insulin for breakfast and then was usually over 250 at mid morning, but he got a snack then, because if he didn't he would be below 70 at 11. Even with a snack he was usually below 100 which was his low cut-off at the time. Our endo felt it was that his pancreas was working harder or his body needed less at this time as well as the long actings can have slight peaks  This was one of the main reasons we switched to the pump. Our endo feels he is still in his honeymoon but we don't deal with these problems.

COuple of suggestions.

- Try testing after lunch before giving any insulin. If he has dropped while eating, I would not give any insulin then, but would retest in an hour and then just give a correction (as Joe suggested). you might want to take a day or 2 of not giving insulin with meals (or at least not a lunch) and testing every 1-2 hours to see if you can see what his body is naturally doing. You'll want to take really good records including activity.

- One boy I know only took long-acting insulin. He grazed throughout the day and his mom only gave him Novolog if he ate a particularly high carb meal (like spaghetti)

- Do some research on pumps and talk with your endo about it. Our endo really encouraged us, because the pump is so accurate with the small doses our kids need. (Did you know that syringes can be off by 1 unit? Not a big deal if you are giving 10 units, terrible if you are only giving 1!) THe pump will give exactly what you tell it. You can also have different basal rates at different times of day to better match his needs. I know they are not for everyone, but it has helped us so much.

Finally, you really need to talk with your endo about this. If they are not helping you, find a different doctor or a different clinic that will help you figure this out. But I would not make any changes without first checking with your son's doctor and agreeing on a plan for figuring out how to handle this type of situation better. Good luck.

JDVsMOM gives really good advice for insulin dosing in the morning. Another thing that we found helpful to regulate a late morning low was the type of breakfast we'd serve. High protein foods like cheesy scrambled eggs and bacon wouldn't cause a big sugar spike (then crash) like high carb cereal.