It is said that breakfast is the most important meal of the day. One of diabetes’ little jokes seems to be making the most important meal of the day the most challenging for many of those living with diabetes, Caleb being one of them.
I think back to the short time that Caleb was on injection therapy and I would drop him off at preschool in the morning and check his blood sugar and see mid 200s about two hours after breakfast only for him to be below 100 at lunchtime after also eating a mid-morning snack. During my daily calls with his doctor the response I remember and remember strongly disliking was, “well that’s diabetes”.
It became my mission to tackle breakfast. For years now, I have been applying my own technique to this time of day and it’s evolved to something that I think I can somewhat confidently say we may possibly have some sort of handle on. At least until tomorrow when it all goes kablooey because I was silly enough to think such a thought and bold enough to write it down and share it.
Nevertheless, I will proceed.
I am a fan of the super bolus and its theory. Big fan. For a long time now, in some way, shape or form, I have been frontloading Caleb’s insulin at breakfast time to get it working in advance to avoid a peak after eating while also shutting it off on the backend to avoid a crash.
It started with his basal. This was way before we started using DexCom and I was able to see between the dots. My goal was simply to get him in range 2 hours after he ate. Caleb, and all my kids, woke up early and predictably in the morning (they still do). Scheduling breakfast was not only easy, it was pretty much forced upon me. So I would schedule his basal to be a little higher than his actual basal need about an hour before he woke up. I would bolus upon eating and not too long after that my phone would alarm with the melodious tones of Caleb’s voice saying, “zero basal please, zero basal please” and I would shut down his basal for two hours.
I’m imagining some of you thinking me crazy at this point. I’m sure it sounds a little nuts. It really wasn’t. It was just routine and the routine worked.
The outcome: Caleb would be in range at the 2 hour postprandial mark and the tail of insulin from the disproportionately large bolus that he needed to cover carbs at breakfast would take the place of the basal insulin mid morning. Because I turned off the basal delivery, Caleb’s bg stayed in range – no dangerous drop from the large breakfast bolus tail of insulin.
There has been evolution of this over time. Most recently, I have something much closer, although not exact, to a true super bolus. It’s the same theory – move the insulin up to avoid the early peak and the later low. Move it – don’t add it.
These days, the kids are a little older and not as demanding about eating as soon as they wake up so I don’t schedule the basal like I used to. Typically everyone wakes and begins their “getting reading” routine. Shortly thereafter Caleb is bolused for the expected carbs he will eat, but I add a little more and then reduce his basal a little too. About fifteen minutes later we eat.
The picture of the DexCom receiver depicts one such day. He woke up at 82, had a little peak from breakfast and ended at 106. (The gaps in the line are because I was holding the receiver at church and Caleb is in choir and at times separated from me.)
Though not always this pretty, more times than not it is, or at least close.
Until tomorrow of course….