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Bolusing with pump and age appropriateness ?

Discussion in 'Parents of Children with Type 1' started by kyles_mom, Jan 9, 2009.

  1. kyles_mom

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    How old was your child when you felt comfortable letting them do their own meal boluses? I realize that every child is different, but would love some feedback so I can kind of get an idea. What things should I look for that will help me to decide when he's ready? Thanks!
     
  2. Sarah Maddie's Mom

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    I suppose we took into account Maddie's age and her math skills and her time pumping. She started pumping at almost 7 and could bolus with supervision from the start, by 9 I would say she was bolusing on her own. But, that's with a lot of back and forth talk of carb ratios and carb counting.:cwds:
     
  3. KellyMama

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    Similar here although Hanna just started pumping recently, she has always done her own boluses. She was dx'd just before her 4th birthday and started doing her own *supervised* shots before the end of the year. Because she had 4+ years of carb counting and shot-giving experience we let her do her own *supervised* shots at school this year (when she went on Levemir/Humalog as opposed to NPH which didn't require a shot at school). She was so responsible with that we didn't hestitate to let her bolus when she got the pump. She is very well-versed in carb counting etc but I still do ALL of that for her. I put a sticky note in her lunch pack. She knows to subtract anything she isn't planning to eat and she calls me from the teacher's cell ph. while bolusing in case she has any pump issues or questions (because I like to know her BG and it's only been since Nov.). ;)

    She is very confident and it really encourages me to see this. She pays more and more attention to labels and can add up her own carbs (then bring the list to us for checking the math which has never been wrong yet) when she's at home so I know by 4th grade she will likely be able to do it entirely on her own. Each kid is different but for us, I think after almost 5 years, Hanna thinks she's a pro. LOL ;) We have also started talking randomly about things like "insulin stacking" aka why you don't bolus for a BG out of range every hour on the hour!! She is trying very hard to grasp all the ins and outs -- I love that she *wants* to do this even though she knows we are content to do it for her as long as she needs.
     
    Last edited: Jan 9, 2009
  4. kel4han

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    Maddison is 8 and terrible with Math, but she also knows when something doesn't look right when she boluses. I think 8 is a bit young to be "trusted" to bolus entirely without a parent re-checking.....but we are working towards this. Maddison tells us what is being bolused (ex. 1.2u) but I wouldn't ever let her bolus herself in class etc. Of course, maturity is a consideration. Maddison has also had Diabetes for 2 years and a pump for a year and a half....we have just recently started to have her bolus. If she doesn't want to do it herself, we do it. She isn't expected to.
     
  5. frizzyrazzy

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    Ian's bolused since day 1 but it's always in an adults presence and always with confirmation before he hits "deliver" - so I'll tell him carbs..he'll confirm bg number and then he'll shout out the total and I'll say yep and he'll hit deliver. In 2 years we've not had one even minor problem with that.

    On the cozmo, you can set up "custom boluses" so I have a lot of those for his normal foods - like normal snack 2cookies and milk is 29g so all he does is hit the menu option for CAM (cookies and milk) and it has the 29g pre-entered. We have the same set up for his normal lunch. One less step.

    But he does not bolus willy nilly - he doesn't take food on his own without asking - it just isn't how we work in our house (no one takes food without askign, even my non-D child) so I don't worry about him bolusing for no reason or bolusing incorrectly. And i would never let him bolus in private etc.

    He doesn't do temp rates or that sort of thing - though he knows how - he's very good learning things like that - and he's learning combos - he first had to learn all the terminology for combos and what it all means and slowly he's getting more comfortable, so that one night he was at my moms and there were having pasta and I left instruction for her to calculate his carbs and then tell him 60/40 for 5 hours. And he knew what to do with that info.
     
  6. MamaChrissa

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    J can bolus himself as well, although only because he is 6 I do not let him do it unsupervised. He knows the carb counts on his regular foods and will always ask before eating anything new. He also always asks before having a snack. He has never ever (knock wood!) made a mistake. He can not do the math, yet, to be totally independent, but he is close. :) I can tell him 105 & 45 and he would respond 1.35 units I will say OK and he delivers it. :)

    He knows the pump is not a toy and to treat it with respect. He has also been pumping for about 21 months now, one week after DX, and manipulating it himself since about 4 months in.
     
  7. momtojess

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    Jessi just recently started bolusing, most the time with adult supervision.

    She has been pumping since she was just a tot, but she is horrible with #s and math. Just in the last few months, I will say somthing like do a normal for .25..and she will repeat it about 10 times as she puts it in. This I am comfortable with her doing with out me looking over her shoulder. If we do an EZcarb, I will tell her what to put, and then she will tell me what it says, before I tell her to go ahead and give that amount.

    I dont have a goal in mind as to when she needs to do it all, we just go at her speed and what she wants to do.
     
  8. KarenRI

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    Nate started bolusing on his own as soon as he began pumping. He was 10 years old. I did oversee what he was doing for the first few weeks, until we had the proper ratios that worked well for him. Since then, he does it on his own. He knows enough to check with me if a suggested dose doesn't seem right to him.
     
  9. GaPeach

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    Very similar here. Melissa was dx'd at 8 1/2 and began pumping at 10. SHe has always been actively involved with carb counting and dose calculation. The transition to pump bolus and corrections was awesome.
     
  10. saxmaniac

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    I don't view it as an all-or-nothing thing. Alex is 5. Now that he can read a little, and knows his numbers up to 100, he can bolus himself. Carb counting is still a little too heavy for a 5yo. So we tell him the carbs, and he does the rest, while we supervise. As he gets older, he'll do more and more of it.
     
  11. kyles_mom

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    Thanks for all the responses. Part of the reason that I'm asking is because I talked to the school nurse yesterday (she can be a pain, whole nother story) and she made it seem like they expect him to do his own boluses right away. By that I mean (well I assume) that would entail him 'pushing the button'. I send his lunch with the carb count every day. She is not on his campus full time, she has 3 other schools to attend. There is a health clerk there for the most part. He does his own shots at school right now, and the health clerk just verifies the amt in the pen before he does the injection. So I guess she would just verify that he's bolusing the right amount based on his BG and amount of carbs in that days lunch but not administering it. Does this sound about right?
     
  12. haffgus

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    I send a small slip of paper to school each day that my daughter keeps in her pump pack. I write on this paper the number of carbs in her snack and in her lunch. There is space for my daughter to put the BG reading before snack and before lunch as well as the number of units given (via pump). The nurse verifies the information Erica puts into her pump by looking over her shoulder and makes sure Erica presses "ACT" which delivers the insulin. The nurse also documents the BG and number of units given in her own records. When Erica gets home, I review her slip and record for my own records what her BG was at snack time and lunch time.

    Erica has been entering her own carbs and bolusing on her own since the beginning (I assist in counting - especially meals). I used to have her tell me the number of units before she pressed "ACT" but we haven't done that for the past year. We only had one problem within the past year when I told her to bolus 75 carbs for pancakes and she thought I said 25. Of course she was very high later! You may have your child bolus more freely during the day, but be more watchful for snacks in the evening (check the bolus history). As a mistake in bolusing on pre-bedtime snacks wouldn't be caught until morning (unless you do nighttime testing).
     
  13. 2type1s

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    Zoe has done all of her own boluses since the first day (with parent supervision) she got her pump (almost exactly a year ago, she was 8.5). She now counts her carbs, adds things ups, and enters it in the "carb smart" function in her pump (calculates carbs+BG+IOB) and gives her the correct dose. If she is away from home, she'll call and ask for assurance. If she doesn't know a count, she looks it up in her pump menu. Yesterday she was staying with a new after school friend (who is a nurse) and she called with her BG (which was a little high) told me what she had eaten and I could hear Zoe saying "35" in the background...she was right! She does not make any changes in her basal rates, unless she is running really high, then she knows how to do a temp basal of 10/20%
     
  14. frizzyrazzy

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    That sounds reasonable, especially if he's been doing his own shots with supervision, he'll have no trouble with doing a bolus with supervision. I would simply ask that the health aide verify each number he puts in - carbs/bg/and then total insulin.
     
  15. Tigerlilly's mom

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    Basically this is what Tyler did/does. I send in a note with the number of carbs in his lunch, on MDI the nurse would figure out the correction (if any) and then Tyler would dial up dose, nurse would verify, then Tyler would give it to himself. Now Tyler tests, tells nurse bg number, number of carbs and then tells her how many units he is getting for the bolus. I am not sure if she looks over his shoulder, but I know that he says the numbers outloud for her. It has been working out well for them.

    Good luck with your transistion.
     
  16. jules12

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    This is what we do too - Josh has been pushing the buttons since we went on the pump - I now let him dose for snacks, etc but he asks first. Learning the buttons helps too when he is at a friends house because I can walk him through it over the phone and know he is pushing the right things.
     
  17. Diana

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    My son is the only one who operates his pump at school. He started when he was 5. The nurse and aid double check the numbers he puts in, but he has always been the one driving. He even programs the temp basals by himself (and then the nurse/aid double checks the home screen to make sure it's right).

    It certainly helps get around the "only a nurse can administer insulin" problem.
     
  18. kyles_mom

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    Thanks for all of your responses. It looks like it won't be a huge hurdle like I had originally thought :D
     
  19. DylansMum

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    Dylan is pretty good at bolusing himself, and good with his carb counting, he has been doing his bolusing by himself on the pump pretty much from the start with the supervision of the school receptionist when he is at school, and me or my husband at home.
     
  20. bkfkmc

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    Braden started pumping at 6. He immediately started bolusing on his own and I would tell him the carbs and double check. As his math has gotten better, he can add carbs now and bolus accordingly. He usually yells out the bolus amount just so I can make sure it sounds like a correct number and I say "go". I don't visually check what he did. He still doesn't guess carbs if it is something that isn't labeled or weighed on the Salter scale. Although he has guessed a few times and did fairly well, I still don't trust his guesses yet. He is 8 now.
     

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