{Our Story} I’m Not Worried

by Leighann on May 30, 2012

On a Monday morning I dropped Q at her school and was en route to my son’s school when my phone rang, the caller ID revealing it was Q’s classroom teacher.

I had literally dropped her off not fifteen minutes before. When we turned onto the street behind the school where parents can slow down and shove their child out (AKA car line), I had asked Q what her CGM said. High 200’s with two arrows up. Thank you, pancake breakfast.

So that her CGM alarmed a quarter of an hour later alerting a blood sugar above 300, I was not in the least bit surprised. Or worried.

But it’s in our 504 plan that we be called with high or low blood sugars, so the teacher was absolutely correct to call.

I told her it was just her breakfast spiking and that if she was still in the 300’s when the nurse checks her at 9:30 am, we’ll deal with it.

9:30 came and went and the phone didn’t ring.

At her last endo appointment I showed the doctor two and a half weeks of CGM graphs indicating a quick spike and even quicker drop, which often resulted in lows usually minutes before the nurse’s mid-morning check.

(And this is not medical advice, but) the doctor suggested we consistently pre-bolus for breakfast and reduce her morning basal rate. She said the insulin was peaking after the carbs and the basal was pulling her too far down.

So we have been pre-bolusing and I can see on the CGM graphs that the spike is less. She still sometimes has those lows when things aren’t matched up well and she still occasionally gets a spike, like this day. But I can definitely see an improvement.

CGM Graph

Perfect overnight blood sugar.

CGM Graph

Kabam! Post- oatmeal blood sugar spike. A finger stick when the CGM said 327 actually revealed that she was 213. So the spike isn't quite as crazy as the CGM would have us believe or she was already on the way back down. That's why we always treat based on a fingerstick, not the CGM reading.

(These two graphs were not the school morning I describe above, but you can see how a perfectly good blood sugar can spike dramatically. She actually went low after this meal because as the insulin peaked she was outside roller blading.)

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{ 2 comments… read them below or add one }

1 Denise aka Mom of Bean May 30, 2012 at 4:06 pm

We’ve found that pre-bolusing for breakfast is a MUST for Bean. No matter what it is, but especially when it’s a carb fest like pancakes or a muffin or toast even!
What also has worked for us (because increasing her i:c would have her really low, I actually backed it off a carb or two) is to crank her basal a good twice as much for an hour to hour and a half right when she eats. She still sees a bit of a spike, OK a big one (like 100-150 points), but its way better than the over 200 point spike she would see with a massive plunge.
But, as always, everyone’s D is different and what works for one doesn’t always work for another….or the same one on a different day for that matter!!
🙂

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2 Leighann May 31, 2012 at 7:39 am

Great tips! Our endo also suggested we increase her basal right before then back it off. I haven’t made that change yet because I wanted to see what would happen with the first change.

That darn breakfast spike…so many things working against T1D’s first thing in the morning!

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