Discussion in 'Parents of Teens' started by truck2ff, Sep 3, 2010.
I like how those numbers are looking!
Excellent work at your end.. :cwds:
Thanks , I hope I can keep him logging so we have a solid week of data to look at. Your calcs seem to be pretty darn good when he eats anywhere close to what he should. He mentioned that he isn't nearly as hungry as he used to be (surprise..) So I probably need to run a few meal senarios with him on his carb-insulin ratio's so he can reduce his insulin on days when he's not as hungry.
I think I'm going to talk to the clinic to see if there is anyway they could get him on Lantus. The Novolin(NPH) peak at lunch time may turn out to be tougher for him to manage when his meal schedule at that time of the day is not very consistent. First things first, though. if he could keep his numbers like this on these two insulins, he's still much better off than he was.
thanks again for all your help.
I have a TON of extra freestyle test strips I can send. I could easily spare 600. Just let me know where to send them. I haven't reduced his strips order like I should have since he started cgm'ing. I kind of like getting the extras then so I can help out those in need.
How can we best help?
It feels good when we can help others that really need it. We are running out of strips all the time, but I have lots of other things I would be more than happy to send. Could you post a "needed" list of items that are still needed? I have tons of individually wrapped ketone strips as well as an extra glucagon kit. If you could post exactly what he needs I would bet that between all of us, you would have it all in your mail box in less than a week!
This is heartwarming to hear that you took the time to care about this young man....I too have a 19 year old. I just left him in Hawaii to go to college for the 1st time. It is extremely hard to be away from him.Fortunately, he has lots of help and knows how to take care of his D. My heart breaks for this young man. At least now he has you as well as a host of caring parents here on CWD.
Thanks so much for the offer. I think we are pretty close to having everything pulled together for now. I may put out a list if something falls through at the local clinic that we think will be able to help him. We should have enough supplies till all of the paperwork is done to get him in their system. thanks again to everyone that has helped out.:cwds:
No problem! Glad to be able to have helped out!
I also could spare Freestyle Test strips - the ones you have to code - a PP poster who is on Omnipod offered a meter I think - I could spare probably 500 to 700 strips - just let me know. I have a teenager and I hope if he ever needs this kind of help he finds someone like you. It is a blessing that you were put in this boys path. You are very special
Thanks Erica, it's amazing how generous everyone has been here at CWD. I have numerous people that are sending meters and strips. I'm hoping to get some of those items in and do an inventory of how long I think all of those supplies will last him. Once I see where we're at and if we can get him set up at the local clinic, I may PM you if we think we'll need more.
I appreciate your offer, but we might be getting close to having enough strips till we get the paperwork at the clinic completed. I'd hate to take you up on your offer if someone else here on CWD may need help as bad as this young man does. I should have a handle on what we have and may need by next week. Thanks so much for offering to help. There are great people here at CWD!!
Thought I'd drop a note to thank everyone for the supplies that have started showing up, it's been a great help. I met him for lunch today to see how he was doing and go over his logs to see if we needed to adjust anything.
Well, the good first. He's taking his insulin....mostly. He missed his dinner dose on Saturday because of a crazy night at work. (Fast food, Sept. 11 with a car show and parade etc..) Fell asleep when he got home from work after midnight and forgot bedtime Novolin-n too. So he was 270 at breakfast on Sunday morning. No missed doses since then and he's tested at meal times and bedtime. His numbers are running from 140's -190's with one that was 263 today before lunch. He said that he ate two egg and bacon sandwiches for breakfast with catsup, so I'm guessing a fat spike in play.
I asked him to do a 4 unit correction before we ate lunch. 1:25 correction factor and his BGL was 263 before lunch. I didn't want to get too carried away since lunch was probably going to be high in fat, too. (Mcdonalds)
The carb counting is still the problem. I think he knows how, he's just not doing it all the time like he should, and he probably thinks that his numbers look alot better than they have for a long time, so why bother.
Still trying to get him to do that and remember it's important to adjust his fast acting at breakfast and dinner if he's eating more or less than the carb target we're shooting for at those meals. I bumped his bedtime Novolin-N from 5 units to 6 units because he's starting out most days around 170-190 when he does mostly what he should for that day. I don't want to go too far till he gets better at tracking his carbs.
I set him up with new log sheets that should make taking notes on food more convienient. I hope he uses it. It would help me get a better handle on what he's doing even if he forgets to count his carbs I can get an idea if he tells me what he ate at those meals. He's still OK with meeting once a week to go over his numbers for the time being. He's almost got all of his documentation and paperwork together to apply at the local clinic for assistance, so we're still going forward. :cwds: Thanks again everyone.
You're doing a great job. This cannot be easy for him, so any step he takes forward, no matter how small, is one step closer to being healthier.
I have to remind myself that he's been wandering around on the verge of DKA for months. The fact that he's testing most of the time and taking his insulin, for the most part, is a good thing. The fact that he's still willing to meet with me and talk about how things are going is a positive, also.
I'm hoping he'll start to feel more comfortable making his own corrections. I think the lows really scare him, so he's reluctant to correct himself when he's high at mealtimes. I don't think he's ever really done it before so it probably makes him nervous. I imagine his previous management was such a shot in the dark that he never knew what to expect and without regular BGL testing or eating habits, his lows probably did seem to come out of nowhere.
Baby steps I guess.:cwds:
I'm really liking these numbers. It seems to be going very well, though it is just early days. The challenge is to encourage and inspire him to develop and ingrain good habits, because that ultimately is what will carry him forward.
I think you are doing excellent support work here. Thanks again! :cwds:
Maybe have him try half corrections, and build up some experience with those.. :cwds:
I'll see how he does this week and maybe suggest that next week if he's still reluctant to try it. thanks again for the help.
You are all very good people!
Is it possible he will have trouble with his eyes after being high for so long. Perhaps you could warn him that if things start going blurry - it is temporary - and because of the high sugar levels previously. There is a build up on the lens and this flakes off when you get back into normal range. It only lasts a month or less - but if he is not expecting it he might worry about losing his sight! Forewarned is forearmed.
I got him in for an eye exam a couple weeks ago, his eyes were horrible then and they got him set up with glasses. I'll ask him if he's "seeing" any difference. He said the glasses helped alot, he didn't realize how bad his eyes were. i wonder if he'll even notice considering how blurry things were before?
Thanks again to everyone that has sent strips, meter, lancets and syringes. He's in pretty good shape for quite awhile now and he just needs to round up a copy of his tax return and I think we'll be able to get him into the clinic so he can address his supplies long term.
He stopped by the enginehouse today to go over his logs. A few general issues before we get into a discussion of numbers: He had a birthday (20yrs) party and barbecue at his aunts place on 9/18. Had some sort of a fight a few days later with family. He's working alot of late afternoon thru late night shifts at the fast food restaurant, so he's not eating dinner till 9:30 at night or later on most occasions. He's writing down most of the food he's eating, but only really counting the carbs at one or two meals a day. He's missing meals at work sometimes and his manager is evidently too dumb to realize he needs to eat and check while working (unless it's a scheduled break) and he is afraid to say anything for fear of retribution. He's still missing some injections and he's still not correcting his higher numbers(we addressed that some more today). A summary of his numbers is as follows:
9/16 : Tested BGL @ all 3 meals-230/160/202, counted approp. carbs at 2 meals, wrote down description of food. Took insulin per regimen w/no correction.
9/17 : Tested BGL @ all 3 meals-185/85/105, counted approp. carbs at 1 meals, wrote down description of food. Took insulin per regimen w/no correction.
9/18 : Birthday, Tested BGL @ breakfast & bed-97/--/308, counted approp. carbs at 1 meals, wrote down he ate alot. Took insulin per regimen w/no correction.
9/19 : Tested BGL @ breakfast & lunch-256/186/--, didin't count carbs, Took morn. insulin per regimen w/no correction. Worked late didn't eat dinner and went to bed after work w/o taking dinner or bedtime insulin.
9/20 : Tested BGL @ all 3 meals-290/160/205, counted approp. carbs at 1 meals, wrote down description of all food. Took insulin per regimen w/no correction.
9/21 : Tested BGL @ 2 meals-168/--/186, no carb counting and did not eat breakfast, wrote down description of all food. Took insulin per regimen w/no correction.
9/22: family problem, no insulin, no testing, no logging.
9/23: Met with him before dinner (no dinner test done yet) Tested BGL @ 2 meals-205/165/???, counted carbs at both meals, wrote down description of all food. Took insulin per regimen w/no correction so far today.
So there you have it. A little discouraging, but at least he's still willing to meet with me. Discussed the meal situatuation at work and testing. Set a goal to test 3 times a day this next week even if he isn't counting carbs. Handed off some more one-touch strips and lancets, which made him smile(he likes that meter) and let him know that the strips came from all over the country from people that have never met him and don't know him, but are living with D everyday in one way or another and wish him the best and want him to succeed. Maybe a little corny, but wanted him to know that other people are out there that actually care.
Thanks again, guys. I just got home from an overtime shift and I'm heading back in again tomorrow early, so I'm gettin cleaned up and going to bed. I may not be able to catch up on any questions or comments till later tomorrow. :cwds:
You know, for a twice daily regimen using Humalog and NPH and with all the complicating factors, these are not bad numbers at all.
This regimen will certainly be working much better for him than the previous one. It would be nice if the numbers were a little better, but they could be far far worse. He is doing well, and deserves positive feedback for the work he's putting into this.. :cwds:
Is he still on this regimen:
Breakfast (100 g carbs)
- 20 Humalog, 30 NPH
Lunch (80 g carbs)
- covered by breakfast NPH
Supper (120 g carbs)
- 20 Humalog, 5 NPH
- 6 NPH
- carb ratio of 1:5 breakfast, 1:6 supper
- correction factor of 1:25 (1 unit dropping him 25 points)
If he is still at these amounts, I would adjust it slightly based on what we're seeing - moving to a carb ratio of 1:5 for both breakfast and supper. This would have him going into the overnights with a slightly lower number, and could help bring those waking numbers down. I'm reluctant to mess with the NPH, as it seems to be doing pretty well in terms of providing steady basal coverage.
The other thing I'd ask him about is whether he's prebolusing for meals. If he's not it may seem like a real pain in the butt, but after the changes he's already made this more than anything else will help with his overall numbers and A1Cs. 15 minutes would be the place to start.
But the bottom line is he's doing way better than he was, thanks to your intervention. Commend him. And please accept a pat on the back from all of us for your excellent work with this young man.. :cwds:
Wilf- You have the correct regimen stated. After I got home and had a chance to look over his numbers closer I came to the same conclusion. They could be much worse considering his situation...personal, work, and otherwise. The regimen is definately better than his previous one. I'll get with him to adjust his carb ratio and try to get him to prebolus. I'm assuming you want him to prebolus before meals regardless of what type of food he's eating.
We're going to try to get him in to the lab for an A1C test so we can get a baseline for how he's doing. I told him when we finished with his logs that even though we had some hit or miss days his numbers really didn't look too bad and to just keep chugging along. Continue to do as much as you can but don't get too bent out of shape if some days go bad. I told him the goal is to get him to a point where his care becomes something he does out of habit and we're not gonna get to that point overnight. Tomorrow's another day and we move on from there. Thanks again, Wilf.
If you can't get him to a lab for the A1c, you can do a home test. The bayer test results are immediately available. The kit comes with two tests. The Relion test at Walmart is cheaper ($8). But it has to be mailed in and you get your results online.
ETA: The Bayer test is usually 27.75 at Amazon, and it's on sale for $22.99 at Walgreens online. That's for two sealed tests. Thought that might be cheaper than a lab.
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