Managing Breakfast

My son was diagnosed on August 5th with T1D and I am new to this site (he is six years old). We are very much in the learning stages of managing his diabetes and I know he is honeymooning, so that adds to the complexity of figuring out how insulin works. I also know this is a blessing because I feel like he is walking around with a little safety net right now.

I am having a very difficult time managing breakfast.
He is consistently high and doesn’t recover before school snack (which is uncovered), which then sends him higher. I have tried eggs for breakfast, cheerios cereal, cut out the O.J… I feel like, even if I give him something that spikes him, he should come down in less than 4 hours, but usually it takes all morning to recover from breakfast. We have to dose after he eats because his eating is so unpredictable.

He takes Humalog to cover meals and Lantus to cover him at night. He doesn’t take very much insulin…only a 1:45 carb ratio, which results in a 1/2 or 1 unit dose most times. He doesn’t usually eat many carbs.

I feel like anything in the 200’s is good for us and that he is, more often than not, in that range.

Does anyone have any advice in tightening up his numbers without sending him into a need to eat 2 hours after a meal to prevent a low? We use a Dexcom and his arrows are usually up or down but not level very much. What am I doing wrong?

Have you talked with your endocrinologist yet about the possibility of dawn phenomenon? For most people, especially kids, the body starts kicking out hormones like cortisol and growth hormone during the early hours of the morning, then subsides around mid-morning. These extra hormones cause BG to rise, which may explain why he starts out high in the morning. If he is using a pump, you can adjust the basal rates during the early AM to compensate for this, or if he’s on shots it might help to adjust the time you administer his long-acting insulin dose.

You’re on the right track by sticking with a low-carb breakfast that focuses on eggs, meat, and/or veggies. I like to do up a bunch of scrambled eggs, cheese, and veggies over the weekend and portion it out into little tupperwares that I can just take out and heat up. So yummy. If he likes yogurt, the sugar-free Greek yogurts are a nice alternative, too, or just a few cubes of fruit (berries are the lowest-carb and you can sprinkle a little Splenda to sweeten them up).

I agree with angivan- I need more insulin first thing in the morning. I use a 1:10 ratio for breakfast vs a 1:15 for the rest of the day.

My daughter also needs more insulin in the AM… also I sometimes morning snacks are not needed. So maybe if your child is hungry- which happens when they “high” instead of giving something with carbs, that will just keep em high, give something that is free- carb. It will help satisfy and will give you peace of mind as well. Also we have cut out juice completely- unless needed of course. However there is 0 carb juices that taste great that you mix that taste like real with thing, grape, apple, orange etc. You seem to be on the right track. We were also diagnosed in Aug, what we have found is that breakfast is always challenging possibly because she loves her fruits & oatmeal. But hey its ok, adjustments CAN be made for what works best for your child! Your doing great. Angiven couldn’t have explained it better.

Definitely talk to an endo or diabetes educator, but from my experience I think they’ll tell you to increase the Lantus dose at night. An increased Humalog:carb ratio at breakfast might also help. When I was a kid I took NPH three times a day as my basal insulin, a fast acting insulin to cover meals (eventually became Humalog, I don’t remember what it was when I was really little), and Regular at breakfast to cover my lunch (I didn’t take insulin while at school). Maybe a not-so-fast-acting insulin, like Regular, would help to cover your son’s mid-morning snack? I also wasn’t allowed to sleep past 9 am because my blood sugar would get higher and higher the later I waited to take my insulin.