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Help, Pump Broke! Sugar is HIGH!!

Discussion in 'Parents of Children with Type 1' started by Mom2Michael, May 15, 2010.

  1. Mom2Michael

    Mom2Michael Approved members

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    I just got off the phone with MM and they are sending a replacement pump that will be here Monday morning, but in the meantime I have to go back to giving him injections. It's only been 5 months since we've done it but right now my mind is total mush... been messing with this pump for 3 hours! I just checked him and he's 596!!! I can't remember how much humalog to give him or how to figure out how much. I do have his ratio's but he's not going to eat anything for a while. Ok, I need to settle down I know but can someone help me so I can get his level down for now until hubby gets home from work and can take some of this stress.
     
  2. HBMom

    HBMom Approved members

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    Do you have Lantus on hand? If not you will need to get some, because he will need that for his basal until you can get the replacement pump. Can you at least give him a correction for the 596 to start moving his blood sugar down?
     
  3. Big Hair Momma

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    What's his correction factor and target? With that info we can help you calculate the amount of insulin needed to bring down the BG.
     
  4. emm142

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    Okay, do you remember his ISF? What is his target BG? Don't panic!
     
  5. PAULEEN

    PAULEEN Approved members

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    Do you have his last report of settings from care link? First thing, have you called your Endo? Our pump died Yesterday too! My son is away camping and doing shots for a few days...
    If you have your son's settings from the pump I can help
     
  6. PAULEEN

    PAULEEN Approved members

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    You should also check him for ketones. If he doesn't have any then :

    Take his High BG minus his target and divide that by his sensitivity...
     
  7. Mom2Michael

    Mom2Michael Approved members

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    I have both his lantus and humalog. The darn pump wiped out everything so I had to call the doc to get the information.
    Basal
    Midnight - .5
    3am - . 6
    7am - .5

    Ratio's
    Midnight 1:20
    7am 1:17
    11am 1:20
    4pm 1:22
    6pm 1:20

    Target is
    80-100
    100-120

    Sensitivity is 70

    I checked him for ketones and they are trace so he's drinking a bottle of water now and I gave him 4 units of humalog.
     
  8. Ellen

    Ellen Senior Member

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    Please phone your pediatric endocrinologist for guidance. Also see if the MiniMed rep in your area has a backup pump you may borrow. I can also ask via Twitter if you don't have a Twitter account.
     
  9. Sarah Maddie's Mom

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    Yes, call the endo.I'm always a total idiot when we have to go back on shots :eek: I always need guidance and it's a good reminder for me to jot down her latest rates - I haven't done that in ages:cwds:
     
  10. emm142

    emm142 Approved members

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    Okay, he is 596 and you want him to be 120, so you want him to drop around 470 pts.

    470 divided by 70, your sensitivity, is 6.7, so I'd give him 6.5 to 7 units..

    I see you only gave 4. Was that because you are worried about him dropping too fast? If he has not been getting basal insulin for a while, he might be more insulin resistant than usual.

    ETA: His total daily basal dose is 12.4, so I'd say a starting dose of 12 units lantus would be conservative, but this depends on whether he was more or less sensitive to lantus than he is to pumping rapid insulin. My endo has always told me to just stick with the same ratios on MDI as with pumping.

    Of course, all of this is just what I would do. I'm not an endo, by any means. (;
     
  11. HBMom

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    FYI - it takes a while (a few hours, I think?) for the Lantus to kick in - it does not work immediately.
     
  12. Ellen

    Ellen Senior Member

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    Respectfully, I don't think we should be advising how much insulin anyone should give their child.
     
  13. Mom2Michael

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    I'm going to call in the morning, I hate to bother the doctor again since she's the on call one and I'm sure has alot to deal with at the hospital.
    For tonight I think I'll be the nightowl and just check him every couple of hours.

    I only gave him 4 because he's outside playing and yeah I'm afraid of a drop. I figure I'll check him in 2 hours and dose again if needed.

    Thank you for the offer to try to find a pump we can borrow Ellen but they said his will be here Monday morning before 10:30 AM and maybe this is good that we get reeducated on doing shots. I know I'm not sending him to school on Monday and I'm using that as a bribe to keep him from complaining the rest of the weekend.
    I hadn't realized how spoiled we've become on the pump. Maybe now he'll stop giving me a hard time about site changes too.

    Anyone have a spare bottle wine? :D
     
  14. wilf

    wilf Approved members

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    This is really well thought through - I would have suggested much the same thing.

    Your son needs a fair bit of insulin - 4 units won't be near enough to do the trick.
     
  15. emm142

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    It sounds like you have everything completely under control. :cwds:
     
  16. wilf

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    I guess I would disagree. We'll all doing the same sorts of calculations on a daily basis - it's not rocket science, but it is something where outside advice from someone who knows the ropes can be really helpful.
     
  17. frizzyrazzy

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    well you don't know how this particular child reacts to having both lantus/novolog in his system. Some kids need a big reduction in insulin when this happens and some need a huge increase. YDMV as we all know.
     
  18. Ellen

    Ellen Senior Member

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    I would rely on my gut instinct combined with the professional advice from my pediatric endocrinologist and team. That would include making a second phone call today. In fact I'm surprised the endo didn't think to give you advice knowing the pump failed.

    I would personally not take insulin dose advice off a message board, even knowing how well intentioned people are or the knowledge they have of their child's diabetes. Each child reacts differently. A child who has not had any Lantus for many months may have an unanticipated peak by getting a whopper dose of X number of units of Lantus all at once rather than splitting the dose. And I believe it's not a 1:1 ratio when going from basal units in the pump to basal units of Lantus.

    I am not one to give specific insulin dose advice either.

    (My son would rather not have to use long acting insulin as he went on the pump 15+ yrs ago and hasn't had long acting in his system since - but we've been lucky having started out with Disetronic and always having a back-up pump. We still keep a prescription of Lantus in the 'fridge never having used it - it just gets replaced as it expires. )
     
  19. Mom2Michael

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    Thanks everyone!
    If things get too out of control I'm not against putting his tushie into the car and making a quickie trip to the ER to get things sorted. I will definitely be their first call tomorrow at 7am. :)
     
  20. wilf

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    YDMV indeed.. :rolleyes:

    I guess we could just all chant "call the endo for advice" and hope that that meets the needs of the OP. But I prefer not to.. :cwds:

    We know that at 1:45 pm he was 545, and that his pump had not been working for an indeterminate number of hours before that.

    He would have had almost no insulin in his system, aside from the 4 units he got at 2 pm.

    I feel quite confident in saying that he needs more insulin than just the 4 unit correction. At his basal rates of around 0.5 units per hour, he'll go through 1.5 units just to cover his basal needs for the next 3 hours. And the remaining 2.5 units at an ISF of 70 are not going to do much to budge the 545. Moreover heavy exercise at blood sugars that high is not advisable until they've come down a bit.

    Anywhere from 6 to 12 units of Lantus should be given right away (depending on whether the OP wants to one dose to cover basal needs, or give a second one later) - it will take about 6 hours before the Lantus even start working.
     

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