I will also tell you how we do breakfast meals. After 3 years, we’ve tried it all…and what works best for us is to, first off, have a higher I:C and basal rates the morning time, for the breakfast meals. With pumps, you can set different bolus rates for different time frames (which you already know since your wife is on a pump right now)…so during the hours of breakfast, we have a higher I:C than the meals for the rest of the day.
On top of this; however, we also do other things if necessary. And I say if necessary because, for us, it’s not needed every day. We don’t restrict Liam’s carbs at all for breakfast or any other meal. He’ll usually have a Eggo waffle (sometimes with syrup on it for the waffles that need it), a cup of milk and an egg (some days the egg). Some days he eats other things, but that’s typically his go-to breakfast.
We consider ourselves “sugar surfers”…we “manage the moments” rather than going by strict I:C’s, timing regimens for meals, etc., Liam can and will eat anytime during the day and we “manage the meal and moment.”
So, depending on the morning meal and how his sugars are behaving, we will do other things to avoid the huge spikes (that are always over 250, but if not treated correctly, can go up to 400 or higher), such as:
Do an extra extended bolus to give him extra insulin over a specific period of time. So, for instance, I may give him an extra full unit with zero up front and everything over 1 hour. We’ve found this helps offset the huge spike that occurs frequently after meals. Because we’re talking about him being high after morning meals (sometimes over 250), the increased unit helps fight that high (the higher the BG, the more insulin it takes to combat the high and bring his BGs back down). As long as you’re paying attention to the trends, you can treat quickly enough.
IF we know that a particular meal regularly wrecks Liam’s BG’s, we’ll also turn on a temp basal. Depending on the meal, we have different temp basal programs created…an especially bad meal that always spikes significantly, we’ll do 95% more basal 1 hour before the meal and we’ll keep that going for between 2 and 4 hours after the meal.
There are so many strategies that people use to combat huge morning spikes. Some go low-carb, some do other things. We choose to just let him be just like his brothers and work on refining his insulin regimen to just make it work. A combination of an extended bolus + temp basal if needed COMBINED WITH vigilance in watching the trends usually works for us. During any given morning meal, we usually go above 200, but rarely above 250 and we come right back…and, if necessary, give another snack. Sugar surfing means reacting to the moment…so if he’s coming down fast, we just correct with carbs. If he’s going up fast, we correct (aggressively) with insulin.