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Sliding scale/carb counting

Discussion in 'Parents of Children with Type 1' started by kvnc, Mar 26, 2014.

  1. kvnc

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    My daughter was diagnosed 4 weeks ago. Her follow up appt was one week after diagnosis. They have my daughter on a sliding scale. Her school nurse wanted to know what her carb/insulin ratio is. The endo said we are not ready for that yet - see you in 3 months. Since my daughter is in a honeymoon phase is a carb/insulin ratio too difficult to sort out? I feel like I've been left hanging by the endo for the next 3 months.
     
  2. nebby3

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    It's not too hard to figure out in the honeymoon. Doctors just think they need to start you out slow with minimal thinking on your part. A sliding scale is really an insulin:carb ratio and correction factor lumped together. Do you have any way to give extra carbs if he eats more? Can you call them, daily if need be, and her help? This early on they should be available to you at all times.
     
  3. sszyszkiewicz

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    You have the insulin/carb ratio in the sliding scale. Its built into the sliding scale. So for example if the sliding scale says give 1 unit of insulin if the carbs are between 10 and 19, then the carb/insulin ratio is 10 to 1. 1 unit of insulin for every 10 carbs. Everyone has their ratio, and it changes as they grow.

    If you post the first few sliding scale entries we can tell you the carb/insulin ratio and the correction factor.

    Also if you give the school nurse a copy of the piece of paper they gave you she will have what she needs.

    At diagnosis did they provide you any training? We are newly diagnosed as well, and we went through several classes over the course of three days. it was like 10 hours of training altogether before they threw us out of the hospital and said "You can do it".

    Regardless, welcome to CWD....sorry you have to be here but it is a good place to be.
     
  4. andiej

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    Hi and welcome. My 10 year old son was diagnosed just 3 months ago. We were taught about carb counting in the first month and he is in his honeymoon period. I think much of it depends on when they can fit you in to explain. I see no good reason for waiting. However when i did the carb counting course there was a 15 year old boy there with his father and he had been diagnosed for 1 year but I think that was their choice rather than the endo team.
     
  5. kvnc

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    Well, they gave me a insulin/carb ratio -- .5 unit for every 30g of carbs
     
  6. sszyszkiewicz

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    there you have it then :)

    did they tell you your correction factor? For example my sons correction factor is 75, meaning 1 unit of insulin will drop his glucose by 75 points. Lets say his glucose measures 250, and my target is 100. I would subtract like so: 250-100=150. Then I would divide 150 by 75 (150/75) which is 2 units. About 2 hours later I would hope be would around 100. Its not an exact science mind you, but it gets you close.

    Another example. Lets say his glucose is 200 and my target is 100. I subtract like I did before (200-100=100). I divide 100 by 75, which is 1 and something extra. I would only give a single unit. We were taught to drop the "something extra".

    Hope thsi helps!
     
  7. Sarah Maddie's Mom

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    At that ratio you'll certainly want to look into 1/2 u marked syringes. They can be hard to find but if you have a decent pharmacist you should be able to get them within a day. You also might want to consider talking to your endo about diluted insulin... It's not easy to give 3/4 of a unit or 1.25 and at that low a ratio you'll have to be micro dosing.
     
  8. mmgirls

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    NDC/HRI # 08290-3249-10
    324910

    BD insulin syringes with the BD Ultra-fine needle 1/2 unit marking

    capacity: 3/10 ml (doses up to 30 units)
    length: 6mm (15/64")
    gauge: 31G
     
  9. wilf

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    The question is, how are her numbers?

    If she is honeymooning and everything is going well with the sliding scale, why push to change things?
     
  10. mmgirls

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    Its great that they did it to the 1/2unit, I know many nurses that don't do doses in the 1/2 units because the Dr. orders don't state half units or because parents don't provide 1/2unit syringes.
     
  11. kvnc

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    I don't know what a correction factor is. I swear they sent us home from the hospital clueless. I'm reading other posts on here in "d-talk" and it's still a foreign language to me. We use a insulin pen that has an increment of 1/2 units.
     
  12. mmgirls

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    You might not need a correction factor yet, you child maybe honeymooning (your child is still making good amounts of insulin) and only needs mealtime inulin to keep from spike too high.
     
  13. wilf

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    What are her numbers like?
     
  14. sszyszkiewicz

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    I am sorry that you did not get what you need! If your doctor is not terribly responsive it may be a good idea to find another doctor. You as primary caregiver need to know.

    After diagnosis they didnt let us out of the hospital without training (this was Children's Hospital of Philadelphia). We actually had to take a multiple choice test! if you did not get that, perhaps reach out to the American Diabetes Association and see if they have local chapters that can get you the training you need. Perhaps others on the board can help with training resources.

    I found this....see what is close.

    http://professional.diabetes.org/erp_zip_search.aspx
     
    Last edited: Apr 3, 2014
  15. MomofSweetOne

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    A correction factor (or sometimes called an Insulin Sensitivity Factor or ISF) is how much 1 unit of insulin will drop the BG without food being involved (and assuming basal is correctly adjusted). They vary greatly. I've seen ISF here of 1:350 and much smaller. My daughter's is currently 1:70. It's not unusual for the ISF to be different during the day and at night. ISF can be tricky in a newly diagnosed child because their own betas typically help to bring BGs down during the night.

    The carb ratio only covers food that they eat. Most of the time, doses are calculated using both. We weren't taught this at diagnosis; I read it in Think Like A Pancreas about two months in. Ideally, if everything is adjusted correctly: basal, bolus, ISF, then your child will come to a specified target when their insulin wears off. However, everything else like exercise, emotions, hormones, also play into it.

    If your child were at 210, and you only dose for carbs, then, in theory when the insulin wears off, they should come back to 210. But, that's out of range and why the ISF is important. The dose should be calculated to cover carbs and bring them to the intended target (say 120?). If their BG is below target, then some insulin should be taken OFF to keep them from going low.

    The pumps do all this for you. The ISF, carb ratios, insulin duration, are all saved in the pump. When you type in the BG and carb count, it tells the dose. Obviously, we tweak for exercise, etc. that the pump doesn't know about, but the pump doing the calculation work saves quite a bit of time at mealtimes.
     
  16. wilf

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    You said in your original post that all they gave you was a sliding scale, and that your school nurse wanted a carb/insulin ratio and that your endo hadn't told you and you'd been left hanging.

    That's not consistent with this subsequent post. Turns out they gave you a carb ratio after all.

    So what exactly is the point of this thread?
     
  17. wilf

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    You don't know what a Correction Factor is yet, because you don't need one yet.

    Given your daughter's carb ratio and doing some basic math, my sense is she's getting well under 10 units total a day. In other words, she is honeymooning big-time. Her body is still producing much of the insulin it needs, and you are just to give insulin at meals to help cover carbs.

    You haven't been given a Correction Factor because at this point a correction of blood sugars would probably be dangerous, as it would cause unwanted lows.

    You need to get yourself a good reference textbook. I can highly recommend "Type 1 Diabetes" by Ragnar Hanas. It will help with the learning you're needing to do right now.

    In the meantime, if you let us know how many units of insulin a day your daughter is getting and how her numbers have been then we'll have a better sense of where she's at and what advice might be useful. :)
     
  18. Melissata

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    Seemed to me like they might have called to get that information after first posting. Your posts seem a bit harsh to me for an overwhelmed newly diagnosed parent. If you don't have the patience for it, maybe let someone else answer.
     

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