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we seem to be stuck in the 220s :-(

Discussion in 'Parents of Teens' started by dqmomof3, Dec 27, 2010.

  1. dqmomof3

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    OK, folks...what to do, what to do. My daughter forgets to bolus. Pure and simple. She checks her bg at least 6 times a day, she corrects when she needs to, but she really does forget to bolus. Her 30 day average bg on the meter is 222 :(. The 14 day average is 194, which is better, but still not good. I do not like these numbers. Her basal is good, I think, but when we look at the graphs it looks like it's way too high because she isn't bolusing.

    DD is a grazer. She rarely eats a meal, really...she snacks all day long, especially if she's home. I think she's having a hard time figuring out the bolus for the snacking, and she doesn't want to go low, so she just doesn't bolus.

    How would you handle this? She is, overall, being responsible with her blood sugar checking and correcting. She doesn't ignore high numbers. We just don't quite have the bolusing thing under control.

    We used to use the MM CGMS, which was really, really useful and kept her A1C in a good range. She developed an allergy to the sensor, though, so we are not able to use it anymore. We are going to purchase the Dexcom in January, so she'll be CGMing again soon.

    Thanks in advance...
     
  2. emm142

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    I think you need something to make her sure of herself with carb counts. If she reliably eats the same food in similar portion sizes, you could make some kind of chart with the food and the carb amounts on it. Me and a D friend of mine at school made one for school meals (based on trial and error, since they don't come with carb counts. It was pretty useful). If you want something that will require more work on your part (although you could do this with her), you could put the snack food in premeasured plastic sandwich bags with the carb count written on them. Or she could just weigh the food on a scale, but that would require more effort on her part.
     
  3. Amy C.

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    What I would do is constantly remind her to bolus. I do this with my son all the time. Did you bolus? is the most repeated statement out of my mouth.
     
  4. dqmomof3

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    LOL, Amy...mine is "did you check your blood sugar?" Maybe since she's gotten that under control, I should switch to, "did you bolus?"
     
  5. wilf

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    What about giving her a couple of slugs of NPH (one at breakfast and one at lunch) or the pump equivalent, to cover grazing through the day?
     
    Last edited: Dec 27, 2010
  6. Our3girls

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    I have to admit there are times we sit down for diner and we all forget until about half waay through and then we can only laugh about it. How about a reward for the day if she stays with in a certain range?

    I like Emmas ideas, we do it (sometimes better then others) pre measure out snacks and label the bag so she knows and it also helps because she sees it so it reminds her to bolus. We also buy the snack size of some snacks she really like and we know are kind on her bg.

    Maybe only let her have 3 meals, 2 snacks and anything else must be free?

    I wish we could allow them to forget about d but unfortunetly we can't so keep up the efforts mom!! ((hugs))
     
  7. frizzyrazzy

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    if she's truly grazing, could you turn her basal up so that it's a bit higher than it should be?
     
  8. wilf

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    That's kind of what I was picturing. Figure out her "grazing rate" of carb intake, and up the basals to provide coverage for that many carbs.
     
  9. kim5798

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    Sometimes we have the same issue, and upping the basals by 10% across the board seems to help. It may not be the best "by the book" way, but if it gets the numbers in range for more of the time, then go with it. Seems like when we start getting better numbers, she pays better attention, then you will need to adjust again.

    You can try it & if it doesn't work, change it back. That is my motto!
     
  10. dqmomof3

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    Good idea. We'll give it a try...up the basals by 10% and see what happens. I'll let you know.

    Thanks for the suggestions...and Emma, good idea too.
     
  11. Marcia

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    This is what we do when at an all day barbeque when Ab grazes all day. As far as your daughter's BG's, if she is grazing all day, her BG never really gets a chance to come all the way back down between snacks.
     
  12. dqmomof3

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    I set her up on a temp basal of 110% for the day. So far, she's in range. And she's been grazing pretty much all day. I am noticing today, too, that she's getting a bit lazy with labels. She usually uses the guessing method, which is fine if you don't have a label, but if you have a label, why not use it? :)
     
  13. wilf

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    - because it's a pain and she wants a vacation - giving the "grazing basal" may provide that.. :cwds:
     
  14. kim5798

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    totally relate. It kills me when she eats chips or crackers out of the bag & I KNOW she is not really counting them. Then puts in carbs that I know cannot be accurate. I am always saying, "what is wrong with measuring them out or counting them out in a dish?" She just wants to eat like any other person could.
     
  15. emm142

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    When she is older, carb estimation will be a regular part of her daily life. Weighing every bit of food eaten just ISN'T feasible in the long term, and honestly when I start weighing every bite of food I eat, I can tell that it is distorting my impression of food (I've also read many times that girls with T1D are already more likely than the average girl to develop eating disorders).

    If she is way off with her carb guesses, then maybe you need to work on her ability to estimate, and sometimes the best way to do that is to weigh the food a few times. But honestly, I think it's a very useful tool to be able to confidently estimate carb portions.
     
  16. dqmomof3

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    I agree completely, Em. We bought a Salter scale and probably haven't used the thing ten times. That worked well for us for 2 years...the last year the A1C has been creeping up, up, up. I think I am going to tell her to bolus for 10 grams more than what she thinks she's eating and see what happens, plus increase the basal by 10%. Maybe between the two of those, we'll get some better numbers.
     
  17. wilf

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    Could be she needs 20% more basal during grazing hours - don't be stingy. Let her numbers guide you. :cwds:
     
  18. dqmomof3

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    Amazing how that little fear of lows still creeps in there in my dosing decisions. You would think three years in, I'd be a little less conservative with those decisions.

    Thanks, Wilf...and all!
     
  19. mariaweber

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    It's sounds like we've had some similar issues. We have found that bumping up Sofie's basal rates has helped tremendously. Fear of lows was definitely an issue, but it's a lot easier to fix a shallow low than it is to bring down a stubborn high. Sofie is on a 60/40 (approx.) basal to bolus ratio and it has covered off the "grazing" issues very well.
     
  20. frizzyrazzy

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    I know Ian is still younger, but even still, has has an uncanny ability to know how many carbs things have and how much insulin he's going to need. It's weird - it's like all these years they just absorb and absorb. So perhaps her 'estimations' are closer than you think ;) (that said, I'd freak if all of a sudden I had to turn Ian loose and let him do it on his own LOL)
     

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