How much "freedom" to give for independent bolusing and corrections?

[mph]

Nick is 10 and has had D for 4 years (pump for 2.5 yrs and CGMS for over 1.5yrs).

He has started to judge his carbs and bolus independently.

I think it has more to do with not wanting to feel "different" so he does it kind of quietly if other people are around.

His maximum bolus is set at a reasonable amount to avoid accidental overbolusing.
His CGMS alarms are set at reasonable limits to let him know if he needs carbs or insulin.

BUT he is also now wanting to do his own corrections as well without necessarily using the Bolus Wizard feature on his pump. I have used the Easy Bolus set at .2 to give tiny corrections if he goes over his range (when checking wasn't an easy option and his CGMS was reading above 150 or so). So this is what he is used to and likes because he does not have to stop what he is doing to wash and check....especially if other people are around.

Is it wise to keep his Easy Bolus set low and allow him to use it with limitations...or do I require that he wash and check and use the Bolus Wizard which will make "corrections" bothersome and he might be likely to not do any corrections or view his D negatively (he has NEVER complained about it yet....but I hate to mess with that)? I'm kinda liking his "maturity" about all this.

TIA for any "been there done that" input.

[meg9901]

Can't say I've BTDT yet. But I have a 10-YO and if she wanted to and was capable, I would let her do what you described. I think you're on the right track. I like the approach of a small increment for EZ bolus. Especially if he already has the increments down.. knows how much to deliver for how much over target... and is tracking IOB.

At this point, I think my DD is capable, but uninterested. Hopefully this will change with time for us. Best of luck to you! Let us know how it works!?

[Sarah Maddie's Mom]

Oy, corrections....

Maddie corrects before giving herself a meal bolus if needed, but to be honest ... there is so much grazing going on, especially now that she's out of school and on a goofy schedule, that while she sometimes does between meal corrections, I find that it's still part of the abstract learning process of pumping to help her think through correction and IoB and exercise and all that.

So, short version ... I'm steering her toward making complex correction decisions, but for the most part she just corrects for tested bgs prior to meals when she boluses.

Hope that makes sense.

[kiwiliz]

Why don't you want him to use the bolus wizard? It does all the calculations about iob for them! Trust me - they get lazy once the teen stuff kicks in - you have to make it as easy as possible for them. I just hope she will do a correction when she does her carb - and sometimes - she has forgotten to bolus! (Ok confession - 5 times in one week!) I had to treat it like not doing homework. No bolus - grounded - day for day! Hope that makes you feel better - my kid is worse than yours! LOL

[Gracie'sMom]

My dd turns 10 in two months, was diagnosed over 2 years ago. She does most of her own carb counting and bolusing (when I make dinner, I count the carbs for her, but often she is home with her older brother and does it 100% independently). But, I do not let her ever correct her BG without checking first. We do the entire wash hands and check and the bolus wizard thing, then she texts me the # of units it recommends and I confirm how much she should deliver. However, for the most part, she doesn't care too much. It doesn't seem to bother her like it does other kids, to be a little different. I tend to be on the tougher side, whether my kids like it or not if there is a health or safety consequence, they need to do it the right way. I would explain it and come up with a reward system for him doing it the correct way . . . but that's me. I guess it depends on how resistant he is and what your parenting style is.

[mph]

Originally Posted by Gracie'sMom

I tend to be on the tougher side, whether my kids like it or not if there is a health or safety consequence, they need to do it the right way. I would explain it and come up with a reward system for him doing it the correct way . . . but that's me. I guess it depends on how resistant he is and what your parenting style is.

I'm looking at the reality that he will need to make a LOT of independent on-the-spot decisions with his D as he matures. We ALL know that D does not follow nice little guidelines and is a 24/7 job. It takes plenty of thinking skills.

The Bolus Wizard is only as good as the settings "I" put into it....so I can make the same calculations in my head and I want to teach HIM that same skill in small increments.

I consider the "right way" as the way in which he CAN manage corrections without having to rely on the Bolus Wizard.....in case he NEEDS to use an injection for whatever reason.

We're talking about correction boluses of 0.2 with an ISF of 100 so that means 20 point drops. Surely he can make good judgments with 20 point drops. I'd probably set a limit of no corrections unless sensor is reading over 180 and he would be targeting 140 for safety reasons. We can tighten it up as he shows ability.

He is not the least bit resistant to being told what to do. He is a very sweet and compliant boy who is with me nearly 24/7 so I can always check his pump to see how his decisions are working out.

I want him to NOT resent his D!!! Forcing him to wash and check for a .2 correction is just asking for resentment even in a very compliant child. I want to give him a small leeway to independently manage his D - in small increments.

Letting him carb count can be considered a HUGE leeway........it's easy to be way off with some foods (homemade food especially)! So I do have him at least tell me what he bolused for a MEAL.


"I" don't always use the Bolus Wizard when correcting. When we are in the grocery store and his senor alarms HIGH 300 for whatever reason (it happens even with tight ranges) I am not going to send him into the men's rest room alone to wash and check. I check the trend on the graph and if this has been a good sensor (and most are), I make an on-the-spot mental calculation of the correction needed and manual bolus a conservative amount and we quickly finish shopping. We check his bg when home or at the nearest clean sink. I find wipes, hand sanitizers, and such give unreliable readings.

I've done this all along with great results and have orally communicated my thought processes to Nick (talking to myself aloud), so he has been hearing "how" to make these decisions for 2 years!

I was just wondering how others handle a child's willingness to take an active role in THEIR D.

[kimmcannally]

I'm just thrilled that my son finally bolused himself for a snack instead of eating without insulin! For him, that is a HUGE step forward. He is with me almost 24/7 during the summer but I work 5 hours daily during the school year. I want him to bolus himself when he eats a snack while I am gone.
I hope he will continue to do this now that he has started!

[hawkeyegirl]

Well, I think some people are talking about apples when you're talking about oranges. I don't have any problem with a 10 year old bolusing and correcting largely independently, especially if the parent has determined that they are good carb-counters, and understand the basic math behind pump calculations.

But what you're asking about is whether you should teach him to use the CGM readings to correct without a confirming BG check. I will admit that there are times where it is impracticable for me to check BG where I will use a CGM reading to give a correction. But I always follow up with an actual BG check in the next half hour or so, and I only do it if I have confidence in that particular sensor. I also mentally consider IOB, since the manual bolus will not.

I think that's a lot of thinking for a 10 year old boy, and I'd particularly worry that he would not follow through with a confirmatory BG check within a reasonable period of time. Within the parameters that you describe, I don't think it's likely to lead to a particularly unsafe situation, but I could see a 10 year old becoming more and more casual with it, and eventually giving larger and larger (or more frequent than prudent) correction boluses without checking.

So while I'm not horrified by the notion, neither am I particularly thrilled by it, especially at his age. I am much more aggressive with Jack's care than I will teach him to be until he is an older teen, at the earliest.

[Ivan's Mum]

Originally Posted by mph

I was just wondering how others handle a child's willingness to take an active role in THEIR D.

Embrace, applaud, support. When they make great decisions congratulate them, when they make bad ones, talk about how they could have done differently. We don't have a CGMS but van will do his corrections, especially if he's eating cake! he will also wait for a rise in BG and then double corrections etc. I'm 80% happy about him reading carbs but he can still muck it up.

Could you not set some kind of meter/pump alarm to remind him to recheck after correcting and then when the beeper goes, he has to do a real finger prick to be sure all is on track. We use no alarms on our pump but I'm sure there's some in there.... somewhere I know van has twiddled with his meter because one of them starts beeping and it always seems to be some time after a high reading on a finger prick. Pumps must have the same post correction.

My son gets a kick out of the confidence that comes with his growning independence. Sure, if doesn't get it right all the time (and of late plain old doesn't do anything when he's out) but it's all about getting the balance right for you and your boy.

Good luck

[sam1nat2]

We have learned, because we didn't listen, that you don't give corrections based on a CGMS!!
Yes, if they appear to be in range and want to bolus for food, then fine. But why can't he test his blood and do a correction?

We also use them MM pump and I am not sure about what sort of corrections he is using. We always input the bg when it is high to do a correction. I like that the pump does the thinking for me