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Opinions on Pumping with Honeymooning 3yo

Discussion in 'Parents of Children with Type 1' started by bamaboyd82, May 16, 2014.

  1. Cookie Monster

    Cookie Monster Approved members

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    Jan 5, 2009
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    Hi Elizabeth,

    I just wanted to add my encouragement along with everyone else's. I have lots I could say but essentially it all boils down to trying him on a pump.

    A couple of pages back someone kindly linked to the blog I wrote about my son. Although he is an extreme example and not really the best to base your son's care on, he does show that age, size, 'real estate', available fat or time since diagnosis are not reasons in themselves to deny a pump.

    The control we achieved with the pump, although far from ideal, was incomparable to anything we could have hoped to achieve by injections.
    The amounts of insulin my son required in the early days were tiny and often involved having him on the lowest basal and still having to turn the pump off for periods when he went too low. By three years old things were better but by no means stable. Young children have lower insulin requirements than older children so the swings you are seeing are not surprising.
    With my son's lack of a pancreas there was no honeymoon yet often his insulin requirement would be around the 0.5 IU/kg/day figure that was mentioned earlier in the thread. But your son's insulin sensitivity shouldn't be a reason for leaving sugars over 300 or 400 without correcting. If you need a pump to help, then you need a pump!

    Yeah, disagree with pretty much everything they are telling you. Pumps are not for everyone, I admit, but to deny access based on 'what ifs' is wrong when the evidence is so strongly in favour of their use in young children. The scientific literature on pumps and young children is sparse and much dates from a decade or so ago but what was clear even then was that pumps helped prevent the severe highs and lows, which is what you are experiencing, even if the overall benefit to glucose control was more sketchy.

    My son has pulled his site maybe two or three times in six years, and it has been pulled by accident a handful other times (once by an inquisitive preschool classmate and a couple of times getting in and out of car seats!). It's really not an issue. He never showed an interest in biting the pump, even through teething. He knows how to unlock it but knows not to, and we have never had an issue with him doing anything wrong with it, like bolusing by mistake (it's only us parents that have done that:redface:).


    Absolutely correct. The idea that diabetes in young children can be treated by simple equations is ridiculous. Our diabetes team have always appreciated that but we have had bad experiences with other health professionals that assume they know the best way to treat him and ignored our advice to their (and our) regret.

    It seems that you knew the answer when you first posted here! I hope the respondents have helped reassure you. Good luck and if you have any questions about diabetes in preschool age children, just ask.
     
  2. Don

    Don Approved members

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    Sep 23, 2010
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    Your post got me wondering why diluted insulin isn't commonly used for very young children. I found this old CWD post. Kinda interesting and clearly a viable, reasonable option if you can find a doc willing to get you started. Pumping is better all around but just something to keep in mind as a backup plan.
     
  3. mmgirls

    mmgirls Approved members

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    We are looking at diluted insulin for pumping for my youngest not on insulin yet. I think the biggest issue is converting or not messing up Dr. orders as there is an added conversion somewhere long the way. Besides that there is no way to make sure that it was diluted properly, but I would think that going to a compounding pharmacy or doing it yourself would alleviate any fear.

    We will be starting on basal only and we are thinking of dilute insulin so that there is more volume going thru that will keep the cannula from occluding due to the natural healing process of the body.
     
  4. kail

    kail Approved members

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    May 18, 2014
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    Hi. I replied yesterday but I don't think the post went through but I apologize if it shows up later.
    We could almost have written this same post as you (OP) as we have most of your same issues except the rigidity of management. My DD 3.5y was diagnosed nearly 6 months ago (this coming sunday to be exact). She is 34 pounds and our TTD of Humalog plus lantus usually ranges between 1.5 and 2.5 units. 1 unit of that is lantus at night. We started out higher at first but worked down to roughly a .5unit to 30gram ratio although if she eats 60 grams (rare) I generally wouldn't give a full unit. We correct (at least in theory) after about 250 by .5 but most of the time I will eek it down to about .25unit correction as best I can and we only correct with meals. If we had paid much attention to the nutritionist we saw at diagnosis, I might have believed that I needed to feed DD a set number of carbs plus protein/fat at each meal and snack (x3) but thankfully our endo knows that it ridiculous and unnecessary. Our basic guidelines that we follow the best we can is that we try to balance carbs with protein, we try to space out the meals and snacks a couple hours (doesn't always happen) and we try to keep the snacks smaller (15 g or less but doesn't always happen). She can sleep as late as she wants and sometimes eats breakfast at 9 or even later but oddly never goes low (<60 ) in am but is usually 75-120. She doesn't always eat enough to be dosed at meals and we also generally subtract .5units if she starts meal before 90 but may not if she eats quite a bit more than 30 grams. I know she spikes up after meals especially if we can't dose her and I hate the strain it must put on her pancreas yet she does come back to normal generally before next meal. I respectfully disagree or at least would advise caution with the above advice to prebolus a 3 year old as many are quite unpredictable and there is nothing worse than trying to get them to eat when you have already given insulin. I've done it accidentally on occasion and it was really stressful. It seems risky as a routine thing. Obviously the pump would open new possibilities. Also, with regard to the overbolus.....that is basically what we are already doing by default. If I dose my DD .5 units for 30 to 40 grams, she will be low in a couple hours if she does not have a snack. Then again she is often low if she goes 3 hours without a snack even with no Humalog on board. Once she went 4-5 days with no Humalog a couple months ago for no real obvious reason hanging around 70-90 most of the time. We are debating the pump all the time though our doctor is not real positive at this point either. Fortunately we are not seeing as high of numbers as you are. Perhaps your insurance would cover lantus as an exception since he is not doing as well on levemir. Or maybe the timing/dose need to be played with. I don't know but I wish you luck and we feel your pain.
     
    Last edited: May 21, 2014

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