Toddler newly diagnosed with T1DM. Any tips on how to manage meal time bolusing when appetite varies and intake is not consistent?
Welcome to the forum @jsb1234!
Some insulins are supposed to be taken about 15 minutes before eating, at least for adults. Others we would take after we had started so we would know if we would be likely to finish the meal and could dose accordingly. Check with your endo to see if you can dose after he’s started or even finished eating so you can adjust his insulin for the right amount.
PS - I highly recommend you check out the book Think Like a Pancreas by Gary Scheiner. He has Type1 diabetes and works in the field so has a unique personal perspective that is particularly helpful.
hi @jsb1234 welcome to Type Ona Nation. Please check with your endo, but most parents simply inject AFTER your baby eats. This will change in time. good luck!
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@jsb1234 Welcome Jessica to the JDRF Community Forum!
A meal time bolus is is measured and intended to “match” the quantity and glycemic [carbohydrate] content of foods eaten and bring body or blood glucose level back to the target-range about 3 to 4 hours after eating. Now that is a lot of technical jargon that supports what @Joe stated in very few words - wait to see what and how much your toddler actually ate. By waiting until eating is finished, you may see a BG spike in the first hour or so after your child is finished - this is natural and expected so don’t be too alarmed. Hold off on giving a correction bolus and wait 4 hours after the time you injected the bolus.
Essentially, the timing of meal-bolus for a toddler is the same as the timing for adults. I’ve been living with diabetes since the 1950s and I’m not a toddler an I aways have a good appetite yet, if my BG os tending low at meal-time, I hold back on giving a new bolus - Humalog begins working almost immediately in me.
Hey there @jsb1234,
How old is your little one?
My T1D son is 4.5 now. He was diagnosed at 14 months. He was just trying out solid food at the time. He couldn’t talk, much less predict how much he would eat. It’s hard!
The tips that helped us:
From our general pediatrician: “Put him on a schedule.” We were able to do this. We didn’t allow snacking between meals (unless low treatments, of course). He was hungry each time he sat at the table.
From our pediatric endo: He’ll probably eat at least half of what you plan for. Put 50% of the insulin in as a pre-bolus and the rest after you’re sure he’s finished. (this is more realistic if you have a pump, the insulin amounts are so small it’s hard to do for tiny bodies using injections.)
The tips that we thought about but were really hard / didn’t really work:
From my MIL, also Type 1: “He’s going to have to learn to eat everything in his meal. He just has to.” Yikes – that one was hard, because it’s not how we raised our other kid. We do make sure to give carbs for all of his insulin… but there is a little more flexibility & going with the flow that we needed time to learn.
The general advice to wait 4-5 hours after a meal before the next bolus or correction … just isn’t realistic for a toddler. The really little ones eat like every 3 hours! A preschooler might be able to do it.
The schedule is probably what helped us the most. For a long time, he ate at 7:00am, 11:00am, 2:30pm and 6:00pm. I was trying to spread out the insulin and keep as much consistency meal to meal as possible.
Good luck! 
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