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Scientific Sessions Update: Continuous Glucose Monitoring in the Youngest Patients

Discussion in 'Parents of Children with Type 1' started by Alex's Dad, Jun 27, 2011.

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  1. Lisa P.

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    Oh, one thing about the 60 that I didn't address.

    One thing I'm doing lately is avoiding the moving 60s. I suspect I'm nuts on this one, but I've become convince that when we hit 60, 50, or 40 that we start to move back up with or without treatment. I think she has alpha cell involvement at that point. This is good, and it may be good for her. But I read about how many T1s lose their alpha cell capacity after a few years, and there's a niggling worry in the back of my brain that if I make them work too constantly I'm going to "burn them out" sooner. I've never, ever, ever read anything to that effect. I just wonder. So I'd rather avoid her having to kick in her own glucose if I can. That's one reason why I don't want to regularly plan to have her at 60 three times a day (not that you do that, but you see what I mean).:)
     
  2. Lisa P.

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    I'm sure it is very tiring to write out examples like this, but I'll say I think it's extremely helpful.

    Like I say, I like your methods a lot and I think they are different enough they need to be explored and considered by folks, even if they wind up deciding they don't fit their situation.

    But they have to be modified for us. So, when I read examples it helps me make my own plan. I won't bore you, but in reading your post there were about three "keys" I picked up on, I won't do it your way, but I can use them to do it mine!

    (One of the issues is that it is almost impossible for us to look at any time of day as "between" on insulin or food, it all overlaps for us to one degree or another. But we can have more or less overlapping).
     
  3. Lisa P.

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    Yes, and yes to all in your post. I wonder if your plant-based diet makes your body work more like Selahs? Or if the fact that your body works more like Selah's is what makes a plant-based diet best for you? Just a side wonder. . . .:rolleyes:

    I very strongly believe that Darryl's methods need to be adapted to each situation if they are used. I also very, very strongly believe that his out of the box thinking is a very, very useful thing for people to be exposed to. I would not doubt that "diabetes think" has become so entrenched over the decades that it is hard for any of us to think laterally. I know it's hard for me, at least!
     
  4. Lisa P.

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    That's really the only reason I popped in, the OP I believe has a very young child and I just wanted to note that the 100/140 correction method may not work as a straight conversion for little ones. It may also not work for some older kids, I do think each person's diabetes is different, I'm convinced of it!
     
  5. emm142

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    I really don't understand why insulin has a longer action in some people than others. I also don't understand why at 18 I seem to have the I:Cs and basals of someone my age (1:10 I:C and 20U/day basal) but the ISF and BCR of a someone much younger (1U drops BG 100 points, and 1g carb raises my BG 10 points). And I'm definitely not making any insulin of my own. Maybe something to do with diet, I really don't know..
     
  6. Nancy in VA

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    I firmly believe that some people just have easier diabetes to manage than others. I don't care how often I correct, how conservative I am in my treatment of lows and how agressive with highs, I would never be able to maintain a range on Emma between 90-110. Even at 6, 2-4 carbs off at dinner makes a huge difference. The correction factor one day will take her to 100 and the next day to 50. The same meal will take her to 180 one day and 300 the next. During the summer, tubing bubbles cause highs more frequently than winter, regardless of how much we prime and replace.

    I just believe some people are, to use a term many hate, more "brittle" than others and harder to manage than some. I could spend every minute of my day checking and treating and would never have a day to keep Emma in the super tight range others are talking about
     
  7. Darryl

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    We began this at age 8, and she was a very small 8 year old.

    The same method works at 13 as it did at 8, the only difference is she does it on her own now. I imagine it must be different at 4 than at 8, but I can't imagine that the principal of correcting highs and lows is different at any age.
     
  8. Darryl

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    Absolutely. We avoid Dr. visits. We only go once a year not every 3 months as the hospital recommended. We don't believe it's beneficial to go 4x/year as long as her control has been good and the blood test results are good. I think that nothing reminds a child more that they have diabetes than being in doctors offices and hospitals.
     
  9. Darryl

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    The 100/140 could just as easily be 130/190 in another child, but the goal is the same - set a range your comfortable with, and correct when outside that range. The problem with many endo's is that advise to not correct, or to try using the CGM to look for patterns, or anything else that misses the point that highs and lows simply need to be corrected to keep in range. I am glad that my driving teacher was not an endo.

    For all of you with little ones, I do not know much about what you are going through. But when they turn 12, and corrections of 5u and 80u of basal a day become necessary from time to time, that will be a whole other story. I can remember when a 0.1u correction was a big deal... :cwds:
     
  10. Lisa P.

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    Yup. That's what I mean, see and read the principal but it can't be a straight conversion.

    I do think you may be missing a couple of the keys about "other peoples' diabetes" -- like that our humalog lasts five hours. I was just talking to my husband about correcting a 140, and telling him you can do that because you pretty much know that a 140 at hour two means she's going nowhere but up, right? But for us, we could certainly be on our way down already. That's a fundamental difference. I don't know if it's age or individual.
     
  11. joan

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    I hope I did not imply that the principle of correcting correcting highs and lows was different based on age. You correct a high and correct a low no matter what age, pretty much common sense at this point. My point was that the way you correct is different when dealing with a young child.

    Correcting whether high or low is different once you can rationalize with the child. Not necessarily 4 vs 13, but 4 vs an age that you can reason with more easily. You may ask your daughter if her bs is 180, "what are you going to do in the next hour, read or go for a run?" that will affect the amt of insulin she might get if she were going to correct. Maybe my son was different, but at 4 that was not a question I would ask so that 180 would be fine, he may sit and watch TV or decide to run around for an hour I had no clue. And lets say I did correct because i thought he was going to watch Tv and he decided to go outside and play it might be tough to get him to eat if he went low. I would have to worry more about him going low and possibly have to feed him and possibly spoil his appetite for lets say dinner. That would mess up the evening. On the other end if he were 65 I might give some sugar incase he decided to be active but when older that might not be necessay.
     
  12. Lisa P.

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    I sincerely and deeply believe that's true.
     
  13. Alex's Dad

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    This 3 quotes are the reason I'm posting, I don't want to derail the conversation. But our case is similar to what Lisa and Joan are talking about, my daughter is 2.5 years old and is very sensitive to insulin and carbs as are a lot of kids at that age. We don't have cgm or pump and correcting a 140 is not an option right now, I understand that people have plans that work for them, but it won't work for my child but I'm thinking about the newly dxd parent that comes here and reads that correcting a 140 is the best way of keeping a low a1c and they try it and make a huge mistake.:(. I don't know maybe I'm taking it too literally too:cwds:
     
  14. joan

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    I'm thinking about the newly dxd parent that comes here and reads that correcting a 140 is the best way of keeping a low a1c and they try it and make a huge mistake.:(. I don't know maybe I'm taking it too literally too:cwds:[/QUOTE]

    I totally agree
     
  15. Darryl

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    This thread is about using a CGM though... having said that, the mention of the 140 target was in response to someone mentioning the 6% A1C range, not a suggestion that 6% A1C should be everyone's goal.

    If using a pump, a correction of 0.05u is routine. Even at an ISF of 300:1, a 0.05u correction is only a 15 point drop in BG - IMO not too risky to completely rule out if the CGM says BG is stable or rising at 140, or 160, or whatever low target you are comfortable with.

    The point here is not the actual target levels, the point is that correcting outside the target levels is the key to success with a CGM. If you have a CGM but don't correct outside your target range, you can't expect much.
     
  16. Lisa P.

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    That's true, and something I hadn't considered in my own responses.

    Had a really interesting day with my trial run. Don't want my responses to come off as argumentative at all so I'm going to leave off at this point, I still feel that caution needs to be exercised about misunderstanding, perhaps, but that the use of the CGM in this manner has a lot to recommend it for some.

    As for the OP, sorry I helped derail but I do think much of this is relevant, the folks who ran that study I think oversimplified and kind of undercut their own success with the approach they took to having the kids use the CGM, it seems to me. As you can see from this thread, there's a lot of ways to approach the technology. Thanks for bringing the topic up for discussion!
     
  17. Lisa P.

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    That's interesting. I never would have thought of this aspect of things. Huh.
     
  18. Ali

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    Lisa, I am sure you do think of all this at some level, it is probably just a very automatic reaction. This aspect of care is frankly a complicating factor of all T1s no matter what the age. What do you do when your hike is twice as strenuous as anticipated, what if you get cramps 15 minutes into a planned exercise routine and have to stop, what about that stress, as the T1 parent, when your child suddenly has a tantrum or is sick and you need to run them to the Dr. It does get easier for all T1s as they age in terms of control of food and exercise. But the hormones, stress, unexpected events (work, family issues) in day to day life, stay the same. As an adult all I can say is you as parents are already so far advanced in your care compared to my first 30 years that your kids are really lucky and well along the way to great management as adults.:cwds:Ali
     
  19. wilf

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    Interesting. Something I will talk about with my spouse.. :cwds:
     
  20. Lisa P.

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    I try to think about how to eventually get us to a place where the care is sustainable when she's self-sufficient.

    But the details of how it's going to be when she's older sometimes surprise me. Seriously, I never thought of the scenario described by Joan, where an older kid would have to make those judgments for herself about how to tweak things based on life. It really kind of throws me, thinking of Selah herself adjusting whether she'll take an extra few carbs or etc. based on what her day is like. I can picture her bolusing herself, counting carbs, inserting a pump site, but for some reason the idea of her saying, "well, I'd better watch out for highs because I'm ovulating this week" just really freaks me out! :p For some reason, suddenly that feels like it's asking too much of her. :( Almost a tipping point.
     

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