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IOB and morning snacks

Discussion in 'Parents of Children with Type 1' started by susanlindstrom16, Sep 9, 2015.

  1. susanlindstrom16

    susanlindstrom16 Approved members

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    Second day of school for my second grader and all is well for the most part. Thanks to everyone who gave me the advice to keep things simple with the bus driver- The county nurse had a quick conversation with the drivers and they have already been through some basic training previously, so they are aware of the situations that may come up with diabetes. So nothing much had to be done on our part.

    My question today has to do with snacks and pump settings. It may or may not be specific to Animas ping. She has the latest lunch of the day (12:55), so they have a mid morning snack at 10:30. Breakfast was at a little before 7am and she was 154 and got 4.1 units. Snack was at 10:30 and she was 118 and the nurse says the pump said to give 0 units for a 24 carb granola bar. If she were at home I would have given approx 1 unit to cover depending on activity. I don't usually do the bolus calculator for snacks but now I have to figure out why the pump would say that because her orders for the school say to use the pump's bolus calculator for dosage.

    What should I look into changing so that it will tell them to cover the carbs at snack? There should be a way right? Duration of Insulin Action? I forget what it is set at but I still find it confusing that the pump would say not to dose for 24 carbs 3.5 hours after breakfast. She was 231 at lunch so she definitely needed something.

    Thanks for any help! Hope back to school is going well for everyone! :smile:
     
  2. jenm999

    jenm999 Approved members

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    You are right. Something is not correct here.

    On the tslim, our former pump, a carb only bolus always gets the full amount unless BG is under 70, then it gives a reverse correction (but does not factor in IOB). IOB, no matter the source, is subtracted from all correction boluses.

    I recently discovered that the omnipod bolus calculator, which we now uses, also takes into account MEAL IOB, and subtracts that even from a carb only bolus if it calculates that the full carb bolus would result in a low. Kind of like a reverse correction. I haven't decided yet if I think this is a good idea. Anyone on the Omnipod FB page probably saw my long thread about this on Monday.

    I'm not familiar with the Ping but have been thinking about this a lot the last few days, and I think the only way your nurse could be correct is if the DIA is set to like 6 hours - and most are set to 3 (we are at 3.5 after some Dex observations and experimenting, and have seen fewer lows - he seems to peak at 2:45 after eating and then comes down for another 45 minutes or so before leveling off). OR, if you have reverse correction set to something like 180, which I doubt you do. 24 carbs is a lot to get w/o a bolus and my kiddo would be through the roof by lunch.

    I'm betting she entered BG and not carbs by mistake since 118 is a perfect BG. Can you look at the history when your daughter gets home?
     
  3. dshull

    dshull Approved members

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    I would check on the pump and see how long your insulin duration is listed. Don't have the pump in front of me, but I think it's in the advanced settings area? This tells the pump how long to calculate insulin on board (IOB). We have ours set for 3.5 hours, and by 2.5 hours in, it would definitely give insulin for a snack. You can always tell the pump to do what you want it to do, but I understand that will a school nurse it's easiest to tell them to do what the pump says.

    Also - someone could have typed the numbers in wrong. Good luck!

     
  4. quiltinmom

    quiltinmom Approved members

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    Another thing to look at would be her I:C ratio at that time. If it is set really high, maybe that's why? Although it still should have given her something, even a very small fraction of a unit. Even with iob, a pump should give insulin for carbs.

    Honestly, my guess is user error. Unless your pump is malfunctioning. Nurse is new at this too...don't be too hard on her. :). Maybe you can experiment with it over the weekend.

    Good luck!
     
  5. susanlindstrom16

    susanlindstrom16 Approved members

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    I think you guys are probably right that it was just some kind of error, although the DIA was set at 4 hours, which I changed to 3. I was just so used to pretty much ignoring any IOB lingering after 3 hours but I think this was good so I get the most accurate info in the pump.

    Today at snack she was 140 and got 1.7 units for the same snack. That makes more sense to me so hopefully this is all worked out as much as anything can be.

    I was saying to my husband last night, its just so hard because we are used to making so many decisions depending on the circumstances of the day, activity, and other considerations, and each day is different. With school, the want a formula, if X, than do Y. I totally understand why it has to be that way but its so hard!!! lol
     
  6. dianas

    dianas Approved members

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    Since it's the beginning of the school year could the nurse have misread the pump? I would imagine it would be easy to mistake the 0 that comes up before you manually enter the bolus dose. When I was on the Ping I've done that myself a time or two when I was in a hurry especially right after I had just switched from Medtronic where the bolus dose is auto populated in the field.
     

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