@ClaudnDaye, in response to your question:
Is there such a thing (for a toddler) as an exact bolus?
Well, I would say in theory, yes? Maybe?
But in practice, for us, there is maybe one day out of seven where we don’t need to give any follow-up microbolus and he just winds up magically at 110 at the 3- or 4-hour mark. It’s frustrating because that’s how it’s supposed to work…right? And I keep thinking I’m doing something wrong when I have to microbolus. Plus, once he’s in kindergarten we’d like him to be less of a hassle for the school nurse – just a lunch bolus, not middle-of-the-day boluses. But we just can’t get it to work with the same results.
But the way I think of it is that the insulin has a certain duration of action, a time when it’s most and least active. This is based on the insulin’s chemistry and the site where it’s in your son’s body, how well it’s working, etc. In order for you to achieve a meal where your son doesn’t spike too much 1 hour to 90 minutes after the meal, then slowly drifts down to his target four hours later, you’d need that insulin curve of action to perfectly match your son’s digestion and production of glucose from a meal. First off that’s going to vary based on mysterious inner workings in his body. And second off, for us, we’ve found our son seems to digest foods really slowly. So we always need to give him a little bit of a bump two hours after breakfast. If we don’t he’ll slowly rise up before his next meal. We’ve tested and his basals are right, so raising basal isn’t the “technically correct” solution because a higher basal means he is locked into eating at set times. Those little bumps are basically the best option for us. And if we raise the I:C too much, he goes low after the meal, we have to give him some fast-acting carbs, and then he goes high anyways… So to me that’s a sign we can’t really get much closer without those extra little bumps.
For those who have very spiky responses to food, the way most people try to “match up” the insulin duration of action with the body’s glucose production is to do the prebolus… sometimes 30 or 45 minutes in advance. If you’re willing to risk it, you can try one time when your son is, say, running high (like 180-200), prebolus 45 minutes in advance and only feed him when he’s dropping really quickly (like 140 double arrows down or something) and see if he still spikes or if he goes low from the I:C. If, after the prebolus he is still spiking up a decent amount, It may be that your I:C is too weak. If, on the other hand, his I:C is causing him to go very low when insulin is at its peak action (insulin has it’s most potent blood-sugar lowering power about 1-hour after administration) , that’s an indication that really you may just have a kiddo who needs a little bit more of a prebolus than ours does. Then you have to make the mental tradeoff-- do you want the increased risk of lows in exchange for fewer spikes that a prebolus entails? 4 times out of 5, for us the answer is no, but for others that may be different. If he’s like our son, in this experiment he may go low, then go high, meaning that his food is outlasting his insulin and that the ideal matchup between the insulin duration of action and our son’s blood sugar production is with less of a prebolus.
Also keep in mind that he will spike sometimes. At least, I have found no way with a toddler to prevent all spikes. Our son spikes to nearly 200 about once a day. I could prevent some of those spikes if I stopped all my work and followed him around all day ready to pounce on the slightest rise, but sometimes I have other things to do and have to let those rises occur. Honestly, if my son spikes up to 200 briefly, even though it’s way out of our current target range, I’m not too concerned if he starts immediately dropping down. If he’s spent less than 20 minutes above 150, it’s not going to affect his A1C too much.
