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Daughter grazing on the pump...need some advice

Discussion in 'Parents of Teens' started by obtainedmist, Dec 27, 2010.

  1. obtainedmist

    obtainedmist Approved members

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    Hi all,
    My daughter was diagnosed 7/10 and within 3 months was on the pump. The MDI were really hard for her because she's a snacker. I worry, though, that because she snacks while on the pump that she's always kind of chasing a bit of a high. When she is at school, she's much more level because she's in class and occupied. On the weekends or holidays (like right now) she's eating often and I'm just worried about the impact on her future health. She exercises almost every day and is at a wonderful weight...but I worry about complications in the future.

    We were never really given guidelines about frequency of eating other than waiting 10-30 min. before eating based on what her bg # was. My gut feeling is that she should try to wait at least 3 hours between eating...but I also realize that quality of life is important too. I just don't know if I should make an issue of this with a H.S. senior...or if in the long run, it isn't that important. I'd love to hear any responses from parents who have been dealing with this much longer than I.

    Thanks so much!
     
  2. Nancy in VA

    Nancy in VA Approved members

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    Have you had a post-diagnosis A1C done yet? Once you see that, you might be able to see whether the grazing and the "constant highs" are really having an impact or not? If she's running in the 8s, you may want to address it. If she's in the 6s or 7s, I would probably leave it alone
     
  3. obtainedmist

    obtainedmist Approved members

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    Thanks for the reply, Nancy!

    We are going in for her 3 month check mid-February...so we'll see how it goes then. I just don't want to nag her because I'm worried and she is doing a fabulous job of always bolusing, etc. I just can't keep from worrying about the highs...and the holiday season has kind of pushed me over the edge! :)
     
  4. emm142

    emm142 Approved members

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    I don't think you can push this too much with an 18 year old, since it's pretty much up to her at this point what she does with her care.

    However, she might not be aware about certain tricks that make it possible to graze on a pump without going high all the time. These are some things I have done:

    1) Set a long square wave bolus, for example 50g carbs over 3 hours. As long as you eat the amount of carbs fairly steadily over that amount of time, the insulin absorbs really well since it's dripping in really slowly, and it just matches the food really nicely and calms down snacking highs a bit.

    2) Overbolus for a snack a little after. So if you want 20g now and 10g in an hour, you could bolus for 30g now and eat 20g now and 10g in an hour. Bear in mind that this only works if the insulin peak matches the food peaks correctly. It will work if she usually has an immediate spike from food, but it's one of those things that you need to watch closely, especially the first few times.

    3) Prebolus more if the spikes are big. Sometimes I need a 10-15 minute prebolus to handle the spike, especially from a high carb snack.
     
  5. JeremysDad

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    Jeremy snacks a lot too. Being on the pump allows him to press a button to bolus for his snacking and his BG levels are still so much better than when he was MDI. His A1c should show but he is not due for an A1c test until March.

    We are currently working to get Jeremy to snack less but its an uphill battle. At least with regards to D, his snacking and covered carbs are not affecting his BG readings which is a good thing. Health-wise, that's another story!!
     
  6. obtainedmist

    obtainedmist Approved members

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    Molly's A1C went from 13.9 in July (just diagnosed) to 9 2 months later to 6.4 right before she went on the pump...so she was doing well with the MDI. However, when she regained the 35 pounds she lost (she was an exchange student in Italy for a semester and wasn't sure what was going on) her hormones kicked in and it seemed she couldn't adjust her lantus enough to get her morning numbers out of the 200's. The pump was a savior for that! I am a bit worried about her A1C coming up in Feb., though. It seems that her #'s are higher recently because she doesn't give herself time between snacking to get it down to range. I hope I'm not worrying needlessly.

    Thanks for all the comments! It really does help to know that other parents have traveled this road before me and I appreciate the enormous work that goes into it all, especially with the parents with the little ones! My husband and are getting involved with the local JDRF chapter as a way to try to give back for all the help we've received. Happy New Year to all!!! :)
     
  7. kiwiliz

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    Molly is probably honeymooning now - so her insulin needs will go up as she comes out of that. You would have probably found it difficult to manage regardless of whether she was grazing or not. If you find she is highish and still wanting to eat you can always do a temp basal increase for an hour or two. Even 150% - just play around till you find the right amount.

    I think you will find the grazing eventually scales back. You could try and persuade her not to so she doesn't get cavities.;)
     
  8. MrsBadshoe

    MrsBadshoe Super Moderator

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    Like the previous poster stated the honeymoon phase will make it difficult pump or not. As the mom of 2 Type 1 teens I say let them graze and make adjustments with the pump. The fact that my son is able to eat like a normal kid has made him be one with his diabetes. It may not work with all kids but he is the poster child of perfect teen control and being zen with his T1. Being zen is much more important then the total control for me.

    She's 18, be there to support her in her decisions and don't make it about the numbers. If they go up, don't judge let her try to talk through how she can work through getting them under control for the next A1C.
     
  9. Sarah Maddie's Mom

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    Emma, those are great tips. ;)
     
  10. obtainedmist

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    Thanks all for the great responses! I just had to "chill" a bit (as my daughter tells me:)). I relayed all the information to her about upping the basal or including an extra 10 or so carbs in the initial bolus to cover what would come next. She's good at trial and adjustment...so I just wanted to give her some strategies! I think the problem with me is that I was so involved with the micro management of all this for the first few months...it's been hard sometimes to pull back and feel comfortable even when I know she's a big girl! I am just SO thankful that this happened now and not right before she headed off to college.

    So, Happy New Year to eveyone and hope it's a sweet one! ;)
     

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