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Does this look like Somogyi?

Discussion in 'Parents of Children with Type 1' started by Theo's dad Joe, Jan 21, 2016.

  1. StacyMM

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    He can still get them. Just set the low snooze to 15 minutes and save the clerks the extra time spent setting alarms.
     
  2. Theo's dad Joe

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    I think he is getting to the point where he can start to have that responsibility. I'd like to have him correct on his own if needed too but it is a lot to learn when and how much.
     
  3. Theo's dad Joe

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    Our target according to the doc is 70-150, but in principal I aim at 100 for 4 hours after eating at each meal. At this point I know that my son is gaining about 8-9 points per gram of carbs. His carb ratio when his basal is set right seems to be about 14 or 15:1. As he looses some honeymoon basal help those tend to go down. In practice I try to be loose with this to reduce impact, and avoid risk.

    I have been aiming then for 100. If he is starting under 100 I will give him an extra gram of carbs for every 8-9 points below, so if he's at 74 at breakfast, I will add about 3 extra grams of carbs to the meal. (This is the backwards way of doing what a pump would do with smaller doses).

    I estimate IOB that after 1 hour there is 70% left, after 2 hours there is 35% left. 2.5 hours there is 25% left, 3 hours 15% left, 3.5 hours 10% left, but I tend to assume that dexcom is 15-20 minutes behind. I assume that the IOB will continue to lower blood sugar by the correction factor. So if he bolused 3.0, then after 2.5 hours I'd assume that there was 25% of 3.0 units (or .75 units left) and that it would correct at the correction factor of about 50 points per unit (or about 35-40 points at that point). So I would subtract that from a meal correction estimate. 40 points is the gain from 4-5 gram of carbs so I'd assume 4.5 grams is covered, or 35-40 points.

    This ALL worked when he was basically giving me a perfect basal from his honeymoon. He would wake up at 70 often even though he only had 1 unit of night time lantus.

    And also I tended to target higher for after breakfast and lunch during school days, about 125, and then fixed it at dinner. Also his correction factors are a little different based on his carb ratios at different meals. Also I did not always target 100. I made a best guess and played it safe and figured that I could wait past a meal and see what happened, but I liked to target 100 at dinner if I was looser at breakfast or lunch.

    I have a question again then since you mentioned the book using insulin.

    As an example, in the table for corrections for 40% basal, they show a TDD of 16, and a correction factor of 100 (which is about what my son has). They suggest that his carb ratio would be 28. Now what is interesting is that Scheiner says that a full grown adult, maybe 140 pounds will usually get about 4 points per gram of carbs. So that actually FITS the model that points corrected would equal points covered. 28 grams would give about 28 x 4=112 points, and so 1 unit would cover about the same amount of points as what it corrects. So there is not a difference in adults-its not considered to be easier to correct than to prevent (except maybe higher highs).

    So a 50 pound KID is supposed to gain 8-9 points per gram of carbs. I don't care if that is true for everyone by it is true for my son now. That would mean that 12 grams of carbs would raise his blood sugar about 100 points, and his correction factor is 100. So why would the equivalence not hold for a kid? If points covered is points corrected for an adult, shouldn't it be true for a kid too?

    I HAVE to say that I am really perplexed and concerned right now though. My son got a correction at dinner because he was 150 at dinner today, that's fine, but now its 2 1/2 hours later and has just gone down minute by minute steadily to 87, still going down. I KNOW he will rise in the next 90 minutes. He ate noodle soup, milk and an orange. Its not like a slow digesting food. I keep hoping that it is due to me covering basal with bolus, and the idea you had, and that when we get his basal right everything will look normal again. I do know that uncovered carbs make him go up normally, definitely within 2 hours. And the hard hitting insulin doesn't make sense, because I was worried about early lows after dinner back in the first 6 weeks post dx. One night I checked him at 1, 2 and 3 hours and then at bed because I suspected he may have been going low first, and he was 75 at 1, 2 and 3 hours, and 170 at 4 hours. I suspected it with certain foods like noodles like he had tonight.

    He's starting to rise now. He ate over 2.5 hours ago. I don't know how we could handle something like celiac. The earliest dexcom records show that he regularly peaked 3 hours after dinner or even ran a flat dinner for 4 hours, and that was with a fraction of the insulin he is taking now, so I am not sure if the insulin rebound idea is true. Breakfasts looked normal back then and lunches didn't even really peak, but dinner after dinner has this peak at 3 or more hours.
     
    Last edited: Jan 26, 2016
  4. Sarah Maddie's Mom

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    I understand that you think you are doing the best for your child but reading your posts I really have to wonder how lousy this micromanagement must be for him. A wise poster once wrote, "My kid has diabetes, but it's the least interesting thing about him." Something to consider.
     
  5. Theo's dad Joe

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    My son is not micromanaged at all. You have no idea what you are talking about or the direction that this thread has gone. I described how I would determine his dose in an idealized way. I use it as a framework for making the best estimate at how much insulin to give him. I give my son breakfast that he wants and the best dose I can. I pack the lunch that he wants that is balanced and have them give him the best dose at school that I can. I give him many choices for dinner and make the best guess I can. I wrote that I DON'T in practice try to hit a perfect number, but I am thinking about how I would dose with a pump since a major component of this thread is about how a pump will let us be more flexible doing family things. Since you have been "reading my posts" tell me which post numbers you read before posting this ignorance. What micromanagement are you talking about? Yes, if he comes to breakfast at 75 instead of 95 I may give him a little bigger piece of banana. If that is micromanagement then I am guilty but it is a way to not have him end up having to leave class and have his day impacted.

    He has had to leave class and get extra carbs at school due to a low 3 times in a year because I always err on what is going to prevent him from being impacted rather than trying to get the perfect blood sugar. We can't get his basal right at this particular difficult time so I gave him less insulin at breakfast knowing that he would be over 150 at lunch because I didn't want diabetes to affect him in that way. I wanted him to be able to be in class, and correct later. I corrected at lunch and at dinner knowing that I could have gotten "better" numbers if I had not been loose in following the trends and my underlying thought process about what his dose needs to be.


    I The entire goal of my approach is to minimize the impact. Fewer lows, fewer corrections, run higher than the target in practice, get to go through every darn day of school without having to do anything D-related but get his lunch shot and eat lunch. Other than that he doesn't think about diabetes.

    The entire last 12 pages of this thread is about very difficult and troubling patterns that have developed with my son's blood sugar after meals. He is using very large boluses but going low at midnight with baby levels of basal. He is going LOWER than his pre-meal numbers for 1-2 HOURS after a meal before finally rising out of range late. I am concerned about absorption issues and other autoimmune issues.

    All he has had to do regarding D today is get three shots and eat three balanced healthy meals of his choosing (from an non-infinite list of options), and as much as he wanted, (if not a little more). If he wants a snack, he knows he can ask any time. I was asked a question and gave a detailed answer about my thought process in figuring out the best insulin dose for him because we are going to our next appt in two weeks and it appears that using a pump might allow us to not have to wake him up in the middle of the night to consume carbs, and not have him end up in the office at school 1 hour after lunch because for some reason his blood sugar drops for an hour before it rises at school. That is the opposite of micromanaging. It is avoiding letting diabetes affect him.

    My son's blood sugar is 105 and flat 4 hours after dinner, the HIGHEST it has gotten since dinner. he went down to 85 over 2 hours and then up to this point. Based on the last two weeks I don't know if he can go to bed at that number without plunging to the 50s at midnight, or if he will soar with a snack before bed. I know that anything goes, but this is not about good blood sugar, this is about troubling potentially abnormal physiological trends.
     
    Last edited: Jan 26, 2016
  6. DiabetesMama

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    I think a pump would help you because when you do see these patterns, you can adjust his basal amounts to that particular time of day. I think it would help you out a lot. It was a game changer for us! I also like the fact that I usually don' t have to give him juice in the middle of the night, I just do a temp basal for an hour or two and let him come up naturally instead of a sharp spike then level off. I think it would relieve alot of your problems. Pumps don't fix everything and they are some work too, but the benefits far out weight the negatives. I would have a serious discussion with your endo. Does your son want a pump at all? Is he open to the idea? That should be the first decision. But if he's onboard, I say go for it! Take care and try to rest a bit. Hugs!
     
  7. Theo's dad Joe

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    I asked my son if he's be open to learning about a pump with me, and then doing a pumping class that they offer at the clinic and meeting some other kids. He said we can do that. He doesn't like to meet other kids "just because they have diabetes" because he doesn't want to be a "kid with diabetes". He's only 9. Then we will try it out. It also will let him bolus for something that we just decide to get on an impulse (as I don't pack insulin on a trip if we don't plan to eat). Unless and until his day and night time basal needs become more uniform (after the honeymoon) the pump basal options are going to keep us out of dangerous patterns. I am still hoping that it turns out that the patterns are the result of having basal needs that vary a lot due to a now un-reliable honeymoon.

    If he doesn't want to, I am getting used to the odd patterns created by MDI, and I am coming to accept "good" numbers that give us more freedom in the day.

    also with the irregularities at night I believe due to basal, I have only slept about 3 or 4 nights in the last two weeks. It makes it harder for me to be a dad in the day time.

    I welcome your prayers.
     
  8. mmgirls

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    I wonder if some of the advanced features of Nightscout / CGM in the cloud would help you sleep at night better. We Nightscout at school, been using it about 18 months before the "share receiver" came out. I only use it to in it basic form but if there are so many other features regarding alarms thresholds and snoozing and "predicted" glucose levels based upon IOB. It goes so far as to also track FOB "food on board". While I have some of the features turned on we do not use them but will be looking into more of them in March/April to see what could help my soon to be middle schooler.

    here is the webpage http://www.nightscout.info/

    Her is the Facebook page if you do that: https://www.facebook.com/groups/cgminthecloud/
     
  9. DiabetesMama

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    Glad to hear that he is open to a pump. That is such a mature attitude that he doesn't want to meet other kids ," JUST because they have diabetes too". That shows that he doesn't want to be labeled or grouped together with people just because of the disease they share. I think that's an indication of how strong his personality is, that's great. He is confident with making friends for the right reasons, because they are friends. So often I found myself trying to find other kids with type 1 for my son to hang out with, but he is better off with just regular kids who he is actually friends with. I think the last thing that kids want to think about is what makes them different or similar, they just want to be buddies. I am glad that you all might get a pump because with a pump and CGM onboard, I felt more confident in how I took care of him and I was able to sleep better. Please let us know what you all decide about getting a pump. It will be awesome! Keep us posted!
     
  10. MomofSweetOne

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    I'd recommend calling each pump rep and meeting with them individually. We found doing so far superior to the hospital pump class, which we were also required to attend. Hospitals sometimes have their preferred pump for whatever reason. At our hospital class, the CDE really pushed Animas, which my daughter had zero interest in once she wore it. She felt every bolus infuse and didn't like the pain. She knew from experience that Medtronic didn't have the same sensation for her. Things like this is why actual trials are so important. The kids wear their choice for the next four years, and they shouldn't be subject to hospital politics! Now to be fair, our current endo (different from prior) told us that she was completely comfortable with my daughter wanting the t-slim this time around, in general, she's recommending the Omnipod because the meter is linked (actually self-contained) and kids don't have to disconnect for sports. She said she sees so many cases where basals aren't bolused when disconnected that it really affects A1Cs. So there are reasons sometimes behind their recommendations, but hopefully they consider each family and their needs in their decisions. It used to be that Medtronic's data was so far superior to others for doctor access that many endos recommended it. I think that is lessening now.

    My daughter did NOT want to pump. We went through a period at about 10 months where her basal halved and she went completely off all meal time insulin. She never spiked over 120 postprandial, either. I was up feeding lows every two hours for two weeks, and I decided I wanted/needed a cgm because I just couldn't do it any more. I wasn't sleeping between checks, wondering if I'd given her enough carbs to keep her safe. She agreed to trial the cgm. The Medtronic rep wanted to know if she'd also trial a pump. The look on her face was the same look she'd get when she found out asparagus was on the dinner menus. I begged her to just humor him and trial it, but that she absolutely didn't have to get one. Our first meeting with him was mostly him interacting with her, not me, about how the pump worked. (I'd already read enough I knew what he was presenting.) She was fascinated, but it took her about two weeks of weighing the options before she decided she wanted to switch. At the same time, puberty struck with a vengeance and we were no longer able to keep her feeling good. If her nights were stable, she had to feed the insulin all day. When a kid who is constantly hungry is tired of food, there's a major problem. If I had her stable during the day, then she climbed all night...and I was up correcting upper 200s repeatedly. When she started the pump, her nighttime basal was double her daytime needs. Now her highest needs are 5 a.m. - 12 p.m.

    Her big concern was the tubing. She didn't want a pump to affect her life. She wanted to climb trees freely. Having other kids pull the tubing out was a big concern (and the ONLY time that has happened was during her Medtronic trial!) Now she has both the Omnipod and T-slim, and she prefers tubing. She likes having "Panc" attached to her and being able to bolus without looking or having to go get the PDM. I will NEVER forget the smile on her face as she bolused for an apple as we left pump-start. Her first carbs in over a year without a shot.

    Her tubing constantly shows. She doesn't try to hide it at all. Remember "Where's Waldo?" Pump tubing sights have become a joke around here when we look at photographs. She was away for the weekend, and yesterday she was looking at photos of the event. She started laughing, as one photo of another kid had her sitting in the background. Only her jeans...and her tubing...showed. It's nice to laugh at it; in the beginning, seeing a pump that screamed "my kid has a chronic illness" was hard. Now I see it as something that allows her to eat a bit more freely and allows us to set her basals better.

    I enjoy the mental stimulation your posts provide. D is a drudge, but the analyzing is interesting. I think I've been in a state of burn-out, plus we had other health issues masking changes. Do be careful of burn-out. Your son's numbers are so good; take time to enjoy those betas while a few remain. The job will get more and more challenging as the years go on, and especially as puberty hits. My mental image of puberty was a rollercoaster ride with me hanging on to the back car by my fingertips to avoid flying off completely. It's beyond crazy, and temp basals were my best strategy to control.

    As far as parental micromanagement, it is a fine line. In our case, after we took all the T1U classes, I decided to see how close I could get my daughter's A1C to a 6.0 safely as recommended for pregnancy. I just wanted to see what kind of a challenge it would be for her someday. Crazy, I know, but it is what started it. Now, to give you perspective on how D has changed and how quickly, my daughter was diagnosed 5.5 years ago. She was only the 2nd child on a cgm full-time at the hospital we were going to, and we didn't cgm the first year. Her A1Cs were coming in at 6.8 and 6.9 consistently, and our endo wasn't comfortable with them that low. She wanted a 7.0 at the absolute minimum. I didn't say anything to my daughter or the endo about wanting a 6.0. I wasn't going to do anything I wasn't comfortable with; if lows increased, I would quit. I just started analyzing data more carefully. After a while of that, my daughter informed me, "I know what you're doing, Mom. You're trying to get tight levels like in the T1U class." I asked her if it bothered her. "Are you kidding? I FEEL better!" That said, I'm realizing that her settings need a lot of tweaking, that burnout has been a factor for me, and that I'd still like to get that elusive 6.0. We do analysis together these days, and she's coming up with great insights that I've missed. T1D parenting is an incredible juggling act of health, attempting normalacy, and handing over the baton. How we and our kids approach and view it is different for each family. Darryl used to get a lot of heat here for how he and Leah managed. I admire them, but I don't think I personally could handle that many D alarms all the time. But it was working for them, and while I have yet to read Sugar Surfing, it sounds similar to their system.
     
  11. MomofSweetOne

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    I agree with you in part. My daughter isn't interested in being friends with others just because they have T1D as well, but she also benefits from having friends who share T1D AND common interests as well. She's taking an English class whose topic this week is "discourse communities" and analyzing different forms of communication within those communities. She told me Snapchat is the best for T1D because she can snap a photo of her cgm that communicates tons to her friends without eating up her phone memory. Thanksgiving day texts were flying as she reached out to her friends who were also dealing with the lonely stress of carb counting, occlusion highs, gluten-free, etc. Just as we're here for support, they also need it in their worlds. Helping them find their community is important, but that community will be different for each. My daughter has never gone to D camp as a camper. Her battle cry at diagnosis was that she was returning to where she had gone before, that D was not going to take that from her. However, she has volunteered as a counselor at D camp for the younger kids several summers and values that time with the kids and the T1D moms who started it. She's also involved in another T1D community with those of a common passion, and I hear almost daily how much she misses being with them.

    We recently participated in a research study about teens and their management. There were questions about how many people with T1D they knew, etc. We were stunned when we started naming people to get a number. We came up with 15 friends and about 40 acquaintances beyond that. I believe those relationships and the support they provide contribute significantly to her wellbeing.
     
    Last edited: Jan 27, 2016
  12. Theo's dad Joe

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    thanks. I have been curious about food on board. Do you know how it works? The reason is that I have research associates who specialize in blood sugar management in human performance. They tell me that nobody digests and completely absorbs a full mixed carb, protein, fat meal within 4 hours-plus management of what the liver does afterwards. I wonder if there are some assumptions about how fast people, especially kids absorb food. Most people will not be rising from a pure glucose test after 2 hours, but mixed meals have been shown to provide glucose for 4-5 hours even in adult athletes.

    Again the primary issue with lows is not related to food on board because he tend to be low in the first hour after lunch only, but the reason for that is my main area of concern. I am going to do one last summary post of the possible explanations in case anyone might help me sort it out.
     
  13. MomofSweetOne

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    If we don't dose for fat and protein, we definitely see a rise in BG at the four hour mark, depending on the food. Yesterday's breakfast was yougurt and banana/cranberry/almond flour muffins. The carb dose was 61 g. The fat protein dose was an additional 12 units over 8 hours. Her basal needs range from 1.35 to .9, so the fat and protein more than doubled the insulin she needed in those hours.

    I really think your son's pancreas is causing the initial lower numbers by releasing insulin in addition to the injected insulin. Aren't there two insulin responses by the body, an instantaneous one and then follow up? It sounds like his instantaneous response is still strong!
     
  14. DiabetesMama

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    MomofSweetOne- I should have worded that differently, I guess. Sorry, it was early and I hadn't had my coffee yet. :tongue: What I meant was that it's good that he doesn't want to be friends with others with type 1 just because they have type 1, but they are a great resource to have as friends too. I am not downing those relationships at all because it would offer a different aspect to their friendship, knowing that they are both going through the same things. I am glad that he wants to have friends to have friends, just not because they have type 1. We met just one girl in our area that had type 1 and my son was so excited to meet another type 1, but she HATED type 1, so she didn't even want to talk about it. He was confused and kind of hurt that she didn't want to talk or bond over their common experiences. So until we can run into another type 1 kid in out area that doesn't mind sharing their condition, he will just have to settle for the "regular" kids at church. I wish I could find a local group around here that we could hang out with and kind of get to know some other kids with type 1. The closest group with the Diabetes organization, (which I have conveniently forgotten their name) is so far for us to drive to, that we just haven't made any connections yet. But anyway, I just wanted to clarify that I didn't think that it was a bad idea for him to have type 1 friends, just that it's a good sign that he isn't hanging on the fact either. A true friendship will cross ALL barriers, no matter what.
     
  15. Theo's dad Joe

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    I THINK that this is the fundamental issue though I want to rule out 2-3 other things, and I guess if I can do that, that is what I will be left at.

    So what you are saying, and that makes sense, is that he still gets help at the start of the meal (and either by his remaining first response, or even just still having amylin to slow things down. Non-Ds stomach will actually reflexively hold and release food depending on whether blood sugar is higher or lower).

    PLUS let me add that I am probably bolusing "hard" for the meal given a pretty consistent higher fat content, and that is making up for not having insulin to handle that fat down the line.

    If I take his prebolus drop (to usually 75-90) which may include a correction, which has him bottoming out as much as an hour after prebolus, and then a peak 2 hours after than, and then failure to turn over the blood sugar and bring it back down by 4 hours, then the prebolus and possible correction at the next meal, his blood sugar graphs basically look normal, just skewed an hour down the line relative to the bolus and meal.

    So he used to have enough help to finish off the fat and protein 4 hours down the line, but his pancreas is getting depleted on the first response, and then not helping or handling the fat anymore (although if he eats at that point he gets the same 1 hour drop after prebolus pattern. So maybe its just that I am trying to handle fat and carbs all upfront and it is just leading to overbolusing for carbs to deal with the eventual rise from fat.

    There are a few issues with that. One is that we tend to see a similar pattern if he eats less fat and protein at a given meal. another is that he doesn't ever rise beyond 4 hours after dinner. He may be at his peak at that point sometimes, but he is always drifting down at 4 hours. Same for breakfast. After lunch he may drift up a little between 4 and 5 hours. When he had a stronger honeymoon, or when I was able to raise basal, he would turn over the lunch curve and be lower and not rising at 4 hours.

    But I am SURE that I will have to be able to bolus for fat down the line. Again right now if I take the current pattern-up to an hour down, 1-2 hours rise, and hour flat, and then if I added half a unit at about 2.5 hours his graph would probably look pretty normal.

    The fat issue scares me as well, because my son does NOT rise 4 hours after dinner, yet he eats significant fat with dinner. That may mean that his basal is already set to balance the fat at dinner. At this point with 5 units of morning Lantus, he does NOT head low during the day off of basal. He is pretty flat 4+ hours after breakfast (though recently higher than ideal), he drifts UP slightly between 4-5 hours after dinner, and he drifts down slightly from 4 hours after dinner to midnight or 1 am, and then is coming back up 20-30 points between 1:00 and 7:00 when he gets the next Lantus shot.

    So for some reason he seems to be more sensitive to Lantus from 8:00 pm to 1:00 am and even having the expected "peak" probably coming around lunch time, he has a down drift from 12-17 hours out. Hard to tell how much is his own pancreas, but its not got enough to keep him from rising from 1:00 to 7:00. That could also be a switch in hormone patterns from bedtime to dawn phenomenon that happens when puberty starts.


    One thing I will mention is that if I were to follow a pattern of bolusing, having drops but not lows, then late rises, and small correction at 4 hours (which would theoretically work over the next 4) then we could still get effectively management with a higher fat diet that gives a blood sugar pattern that is "manageable" with only 3 boluses. It would eventually require perhaps a final correction at bed. It might not be perfect, but it still could be "good".

    I am also interested a little in how the fat raises blood sugar. Again only a small piece of triglyceride can become glucose, and free fatty acids can't at all, but I think that the fat is basically getting the liver to release glucose later, or creating a degree of resistance to normal basal in 4-8 hour period after eating them. It probably SHOULD be bolused for in an extended way so that basal retains its clarity of meaning for practical management.

    I am also surprised that the VERY low carb group, like Bernstein do not note any rise in blood sugar from eating extra fat. They DO however tend to use regular insulin, and they tend to develop low carb ratios over time, usually they say 8:1 standard, but I've known some very low carb crowd who over the years have crept up to needing 2:1. Maybe others just get by with extra basal and the fact that they pretty much eat 70% fat every day, so the consistency lets them handle the fat with the basal.
     
    Last edited: Jan 27, 2016
  16. Theo's dad Joe

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    Can someone just give me a list of pumps so I can start to investigate them? My son is small. he can't really handle a lot of hardware on him.
    I don't want to detatch for things like PE class, I don't know if that is a problem. People mentioned sports. Do you detatch when swimming if its just playing around? I've been told that people wear theirs in water some time.


    The first thing we need to be able to do is get variable basals right and be able to shut off basal and then build bolus patterns.
     
  17. Michelle'sMom

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    I gave you a list of pump companies when you posted the question about getting the Rx.
     
  18. Theo's dad Joe

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    The basic explanations that I am left with for my son's patterns are as follows:

    1) The fat content of his diet is problematic with a single bolus of fast acting insulin. He used to clear off the late blood sugar from fat and protein by himself, but that is going away. He is basically overbolused for the carbs in his meal (at about 10:1 carb ratio over the course of the day) that basically knocks the blood sugar down early so that it doesn't go too high by the end of 4 hours. His pancreas may also help at the start of a meal, but not help with basal 2-4 hours after a meal because it gets depleted.

    (issues, 1 similar patterns with low fat meals, if his pancreas is depleted 2-4 hours after a meal then why does he have such a fast response and drop at the next meal. On the other hand his carb ratio starts to look more normal given that he is bolusing for fat as well. Also he always dropped early even when he was only needing 1 unit per 30-40 grams, and he showed late rises after dinner even when he was getting smaller boluses, and even when he ate less fat. There may be a hormone related blood sugar rise around bedtime or 7:00 pm before puberty. Also he does not rise beyond about 4 hours after a meal. He is starting to go lower 4 hours after dinner and breakfast is usually flat at 4 hours, never rising after 4 hours even if higher fat. In theory he should go low at night after a lower fat meal, but that does not seem to fit into the pattern.

    2) He is getting a large dose basically because his honeymoon does not allow us to give him enough basal without unexpected lows at this time so we are covering day time basal with bolus. As he loses more of his honeymoon and his basal goes up the curves may look more normal. Raising basal HAS made the graphs more normal in terms of coming down at 4 hours in the past, and eliminating late rises after lunch and dinner. He may be in an in-between stage where his pancreas is helping more for 2-3 days and then not helping as much. Some days he does not drop early now, and those days he tends to need corrections, so he may be losing his first response.

    3) Reaction to large fast insulin dose-the dose needed to stay in range at 4 hours is so fast and strong that it makes the body reacts, maybe the liver tries to get rid of insulin because levels are high, and then levels have been lowered by 2-4 hours out. Or maybe the body counter-regulates the high insulin levels even though he is not going low.

    4) Celiac, allergy. Maybe he absorbs slow, but has late rises from inflammation.

    5) Injection site leading to troubling patterns, low early, but waning effect, and possibly becoming resistant at the site of injection (the arm). Except that we use legs for dinner. Not lunch because at school. Seems to stay lower longer after dinner.
     
    Last edited: Jan 27, 2016
  19. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
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    got it, post 93.
     
  20. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
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    Yes, there is documentation on the site regarding digestion/ absorption. I only know from people asking question about set up. But I will look
     

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