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Terrible Sugars, Pump Issues

Discussion in 'Parents of Children with Type 1' started by Annie1378, Sep 18, 2013.

  1. Annie1378

    Annie1378 Approved members

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    My 10-year-old daughter has been having such a hard time with her sugars lately. She is using a lot more insulin than she used to, and at the same time her sugars are a lot higher. It seems like almost every night after supper, they rise into the 300+range, no matter what we do, and then I spend half the night trying to get them back down again! Also, she has a ton of scar tissue on her tummy, but she cries whenever we have to change the site, and says it hurts a lot, and whenever I put it in her arm or leg, she says it hurts even more, and then it always seems to come out by itself in about half a day. She won't even consider her rear end. She also is having an issue, I think, with snacking when we're not looking and then not bolusing. Between these three issues, I am kind of at my wit's end here. She has had diabetes since she was 4, and we all know (including her) how to count carbs, and bolus, etc. I don't really know why she doesn't want to do it. Sometimes she cries just because I have to give her a bolus. She says it hurts when the insulin goes in. She actually prefers shots, but we're afraid that will be totally inconvenient for school. And everyone always says the pump gives such better control. She's been on the pump since she was 7. Better control with the pump is definitely not our consistent experience though. Do you think she's just burnt out? What can we do?
     
  2. Christopher

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    Sorry you are struggling. I am sure the pump experts will chime in with good advice. As far as injections, why are you so sure it will be inconvenient with her school? Are you not getting good cooperation from the school now? Have you tried doing MDI at school? Do you have a 504 or a medical plan in place? Sometimes the fear of something is much worse than the actual reality. Your experience is telling you that you do not have good control with a pump. Your daughter feels more comfortable with shots, so why not give it a try?

    Danielle was dx at 8 and has been on MDI since then and with a little planning we have not had any problems doing MDI at school.

    Good luck
     
    Last edited: Sep 18, 2013
  3. Amy C.

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    My son was on shots from 3 until 12. We never had a problem with the school. I say give it a try. Pumping is not the only way to get insulin into the body. Some find that using a pen is really convenient.
     
  4. Sarah Maddie's Mom

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    If she's got scar tissue and is unwilling to try new sites them you may have no choice but to take a break from the pump...

    That said, have you been increasing her basal rates to help cope with the highs? You may be seeing evening and overnight hormone surges which require more insulin.

    10 is hard. They aren't always in your pocket, but they often aren't ready for independence. I'd call a family meeting and discuss how you can work together to improve her bgs. Calmly talk through the need to rotate sites, cover all snacks, and work together to solve the problems that have cropped up.

    Good luck :cwds:
     
  5. kiwikid

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    My 12 year old is also using a lot more insulin with higher bg's... Our highest basal rate is now 1.6 units per hour from 4pm until 10pm and we are going to have to increase more. I think its just a diifficult time of day with raging hormones... All your other issues we are facing too.. I nag nag nag about bolusing for food.. Do you have the pump bolus speed set to slow? Can you do two boluses of half the amount each to try and cut down pain? We swapped from Humalog to Novolog which helped with stinging.. GoodLuck
     
  6. Megnyc

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    Sorry you are dealing with this.

    Would you be willing to try EMLA or LMX4 for the next few site changes to see if she is willing to try new sites? The cream numbs the skin basically 100% and she will not feel the site change. You can numb it and then have her poke it with a lancet to see that she won't feel anything! EMLA needs an rx but LMX4 can be ordered from the pharmacy or amazon. I personally prefer LMX4 (I feel like it works a bit faster) but in my experience it is cheaper to get EMLA through insurance at the pharmacy.

    In terms of sites falling off a small dab of skin tac or mastisol before you insert the site should take care of that.

    For the painful bolus issue what you can do is extend the bolus over 30 minutes so the insulin goes in slowly (called square wave if you have a medtronic pump). Ideally, you would give a decent amount up front though to avoid a big spike from food. It may also help to try different sites or infusion sets. I really like the lower back as an area for sites.
     
  7. nebby3

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    My dd is 11, dx at 19 months old. She pumped for five yrs and then wanted nothing more to do with it so she's been on shots again for five years. I was a huge fan of the pump and hated to see it go but it's her b?dy and her choice. And our control had only improved (which probably has more to do with her age than anything).
     
  8. obtainedmist

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    It sounds like burnout to me...especially the snacking without bolusing. That's probably your worst enemy right now as far as bg's go! Any delivery method will be unsucessful if the insulin isn't getting there at all! Does your clinic have a list of psychologists who deal with kids and chronic disease issues? I would consider scheduling an appointment to try to sort out all the issues your daughter might be dealing with right now. Ten is a difficult age anyway, just on the cusp of teenhood!
     
  9. missmakaliasmomma

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    We started the school year out on the pump, then switched to mdi a week later. It was a pretty smooth transition. However, my daughter has a 1:1 nurse so I'm sure it makes it much easier in our situation. The regular school nurse though gives shots to another diabetic. Doesn't seem to be a problem.

    She probably needs a break. That's a lot of years of scar tissue.

    She also is probably going through puberty of some sort and that could be why they're rising also.

    If she prefers shots, why is she on the pump, jw?
     
  10. hawkeyegirl

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    Okay, there are a lot of things going on here.

    1. If she is going into the 300s after supper and corrections don't work, I think you probably have a basal problem. I would raise her basal two hours before her BG starts going up and see if that helps.

    2. Scar tissue. There is no reason she should have scar tissue after just 3 years of pumping. My son has pumped for almost 6 years, using his tummy exclusively, and he has no scar tissue. We are very careful about site rotation. That being said, get some numbing creme and start using different sites until her tummy heals. Get some tape to keep sites on if you're having trouble, or try different kinds of sites.

    3. Snacking without bolusing. If this is happening, you're going to need to keep an eye on her and make sure that she boluses for snacks. I don't know how big your house is, but I definitely know when one of my kids is into the food. I don't know how much D care your daughter does herself, but it sounds like it's time to take it all back over. She sounds stressed and burnt out.

    4. If she really wants to go back to MDI, let her. I suspect it will make the snacking without bolusing worse, because it's a heck of a lot more convenient to bolus with the pump, but we'll see. The biggest problem is that she can lie to you about bolusing and you won't know until you see a nice 350 on the meter later. Still, if pumping is making her that unhappy, it's worth a shot.

    Best of luck to you.
     
  11. TheLegoRef

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    We went through a few months where we were seeing highs and getting frustrated with pumping, but after a few changes, it got much better.

    I would see what you can do about getting her to switch sites. I talked to my son for about a year before he tried his arms, and he doesn't mind them at all. We use the emla cream, but we didn't used to. It has made site changes easier for him. We use arms, stomach, bottom, legs. So my son has an 8 site rotation schedule lol! But he would overuse his stomach, not rotating very well on the stomach area, so we had to increase site areas. Sometimes something kids fight against ends up being not so bad. :)

    What sites are you using? Straight in like quicksets/mios? Or angled ones like silhouettes? What is the length of the needle? My son was given 9mm quicksets in the beginning, and we switched to 6mm, then after a year we switched to 13mm silhouettes, now we use 9mm mios and 13mm silhouettes. I think it just takes some playing around to find what is comfy and what works. Ask for samples from the company (in our case Medtronic).

    Do you tape down your sites? We started taping down the sites with tegaderm or IV3000, or even waterproof sports tape if we're on the go, and that also helped with our struggles. Hardly no site issues now.
     
  12. quiltinmom

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    To me, a little inconvenience at school seems a good trade for better quality of life the rest of the time. You can always take a break from the pump and see what happens. It doesn't matter what "works for everyone." What matters is your dd. if she doesn't do well with pumping its okay to switch to mdi. She is old enough to be a part of the decision making on this one, IMO. Ask her what she thinks would work.

    It has been our experience that insulin needs take big jumps and everyhting changes, then stay stable for a while (months). Sometimes the jumps are scary at first (he hit 1 u/hr basal recently which was a little weird at first but it evened his numbers out a lot).

    As for eating and not dosing...it is important to find out if she's doing it on purpose to spite you or if she truly is just forgetting. It's hard to see how they can just forget after so many years of having d, but for my son, I think he very rarely, if ever, intentionally skips his insulin. So how to handle that part of it depends on the why of all of it. Sometimes when something is "too easy" (pushing a few buttons vs. taking a shot) it actually makes it easier to forget to do it.

    A little patience goes a long way when kids aren't doing the d things you know they know they should be doing. Not that I follow my own advice though! :rolleyes:

    Sorry you're having a rough time. Hope things are looking better for you since the day of your post. Hugs. Keep us posted. :)
     

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