Is this stacking?

I agree, we should have corrected at breakfast.

Our last needle bent at lunch and I had to go home, we don't usually wait more than 10 min after a meal.

I will just try harder tomorrow

 

I agree. The right before meal numbers were the most important for you to have today. And the 2 unit correction came too close behind a meal. Your Endo said three hours. Some people have to wait 4 hours after a meal to correct on MDI. It depends how long insulin keeps working in your child.

The lunch ratio probably is too much, but it's hard to be certain because you don't have a premeal number.

The 400+ number after breakfast was more from the 293 you never corrected than it was related to breakfast and the ratio you used.

You actually used a 1:25 for breakfast because of the carb count. You might want to try that again.

It's best to dose before meals, but yes it is age dependent, as well as child dependent. My nephew was dxd very young and was dosed after meals at first. Eventually they were able to change that. His bgs are MUCH better because of it.

Mostly you are doing really well. Don't be too hard on yourself.

 

As for the carb ratio what do I do when there's a remainder of 5? I can try to draw up 1/4 units, but I remember that was such a nightmare. I didn't really intend to use a 1:25 ratio, I was just rounding so I wouldn't have to try to draw up 1.25 units.

Aha, so this is why you're all pumping!

 

May I suggest that you consider the serving sizes of carbs you are giving her? My 10 year old granddaughter has never had a meal that has 130 carbs in it. I know there are children that eat a lot, but I think it would be very unusual for most 4year olds to eat this many carbs at once. My thinking is this, you are giving her three meals and two snacks a day. If you reduce the serving sizes of the carbs/food she eats, you won't have so many carbs left over on her plate that you have to try to figure out how to subtract, and since you are waiting until after she eats to give her her insulin, she will finish her meal quicker, thus getting her insulin sooner. If you can give her her insulin sooner than 30 minutes after she is done eating, that would be a good thing. You can still give her whatever food she wants, just reduce the quantity. Then, at snack tme, you can give her a larger snack than previously, to make up for smaller serving sizes at mealtimes.

An example of how this works in our life, is that my granddaughter takes a lunch that is on the small size to school. She is a slow eater in the first place, and she has to spend some time in the nurse's office and still wants to have some play time at lunch. By giving her a smaller lunch, she can do all she needs to do in the small amount of time she has for lunch. When she gets home, she makes up for the smaller size lunch by having a larger after school snack. Just some thoughts I hope might help.

 

If the 291 at 7 AM had been corrected when the bg was taken, not hours later, it probably would have gotten the whole day off to a better start.

 

I realized it was because of not being able to draw that much insulin. But it worked pretty well.

Some people will draw up 1.5 units and make up the extra carbs with grapes (1 carb each), or a little bit of milk. Or really any little thing they're sure to eat.

 

After DD was dx'd, I remember feeling paralyzed by the math on some days -- I'd come up with a number to one or two decimal places, but was only able to give insulin in .5 units. We eventually wound up, generally, rounding up if she was high and rounding down if she was low.

I also found that numbers were much better if I was able to give a .25 unit dose, so I bought a little magnifier that attaches to the syringes and used that as best I could.

Yes! It is so much easier to do an immediate correction when DD is high. We have also found that, even though our DD was not the most predictable eater, being able to consistently pre-bolus a set number of grams of carb (with us 30 g, at school 20 g), has really helped. Not to mention the benefits of being able to "fine-tune" the basal rate.

 

This is true. And it certainly would be best to only be doing corrections at meal-times for the time being.

 

I understand your fears about pumping; I really do. I was NOT enthused about the move to the pump, and even now, I wouldn't like it as much without the CGM also monitoring.

But...with some of the issues you're having, I think you would really like the pump if you were to try it. Not saline start or trial when you have to also give insulin by shot; that's a doubling or more of the work and much more stress, but actual use of the pump alone.

You still need to know all the information you've been gulping down so fast this week, as the pump does none of that for us. What is does give us is freedom in dosing without additional pokes.

I have an older child than yours. It's different in that she can pretty much accurately tell me how much she wants for a meal after a year on MDI. We use the pump for seconds far less than I expected. But....we never pre-bolussed until we pumped. Now we do almost all the time. Spikes are hard on the body. They're hard on how she feels. They're something to minimize. We've gotten enough practice in guessing meal carb requirements that we will type in a given amount for pre-bolussing. We then weigh her food as we're putting things on the table. If she wants a bit more later, it's not a big deal. We don't pre-bolus for that typically.

Most parents with young children here will type in an amount of carbs 15-20 minutes before a meal and then adjust that as the child eats. You don't have to know exactly what they're going to eat in advance. You need to know how many carbs you've dosed for and when they exceed that, type in more.

Other benefits of the pumps are that they keep track of Insulin On Board (IOB) to prevent stacking as much. They're not fail-safe in this regard; it's still best to keep insulin far enough apart to see whether they've come back to target, but that isn't always reality. Growth spurts happen.

The pumps can also give very, very tiny doses. .025 unit doses. That means you can tweak your child's BG down, even when you don't want to give an entire unit or half unit.

Here's an example from our life of how pumping is benefiting my daughter: I check my daughter when I wake up and tweak her down to her daytime target at that point. When she gets up, she takes her thyroid medication. We've learned she needs .4 unit for it, but her thyroid is supposed to be given 30-60 minutes before she eats. Then, we prebolus her for breakfast and she eats 15 minutes after that. The difference these three boluses have made on her spike according to her CGM graph is big. And she feels better, which is what makes it the biggest winner of all. On MDI, this would be 3 shots instead of one, or 4, if she were still hungry after eating her amount of carbs at breakfast. We were already doing 8 shots some days with the demands of puberty, and I wouldn't have even considered trying it. Now I see the difference even little tweaks can make.

 

Agreed.

At least you can "see" that even a small correction along with the meal bolus will keep her lower.

With MDI, I know extra shots are no fun. With the pump, we correct an hour before breakfast so the spike is less.

Do you have syringes with .50 markings? If so, you can generally "eyeball" it.

Example: 25carbs / 20 = 1.25 rounds down to 1 if BG low or up to 1.5 if BG high

96carbs / 20 =4.8 - I would probably round to 5

Pre-bolusing for an average amount of meal carbs and then post-bolusing for the remainder would be great ------but it means an extra shot. Try to post-bolus as close to food intake as humanly possible.

Overall. I would say that yesterday was a success compared to previous days. Give it a few days without changes to fully evaluate. As always, TEST, TEST, TEST the BG.

 

[

See above notations in pink

 

Just a reminder that the OP's child is 4 years old and pre-bolusing may not work the same as with an older child.

For me, the latest numbers confirm what I was concerned about. That giving less bolus insulin would result in higher post meal numbers.

 

Thanks guys. Yeah grandma took her to Red Robin. I hate restaurants for that very reason. It's rare though.

Today is frustrating. Seems she just always wants to be high between breakfast and lunch.

7:36am..........261..........25 carbs, 4.5 Lantus, 2 Novolog
10:06am........320..........9 carbs

I'm wondering what lunch will be like if I don't cover the snack right now?

 

the 427 was because they did not correct the 291 at all until later and the 324 was only 1hr post bolus after 96 carbs and 40 minutes of time between testing and shot. Then within 3hrs she was below 100 and treated.

I think that they are doing wonderfully in such a short period of time. I agree that for breakfast they MIGHT need to lower the ratio if they are unable to prebolus. But at this point they need to get good starting breakfast numbers to hammer that out.

In regards to the pump, it can make it so easy to prebolus and or bolus while they are eating, and even if you prebolus for more than they eat you can cut back on basal for a little while to get the the overall right amount of insulin. Also have you spoken to the scholl that she will attend? What are the accustomed to doing in regards to insulin?

 

Yeah, I'm thinking we do need to be pumping. I am halfway through the hoops they make you jump through, so maybe another month or two? I guess I will just take the Animas and pray that the next ins. covers Dexcom.

I will be meeting with her teacher before school and going over everything. I will type up something she can refer to and keep a box of supplies in the classroom. It's a small private school so they'll do whatever I tell them to. They had a first grader dx'd last year and put on the pump and the teacher did great. The third grade teacher was a nurse so she should be able to help with shots. Of course DH is available by phone all day, and I'll talk to my extern site and find out what arrangements I can make to be available by phone as well, since I'm really close to the school.

 

She went into breakfast high, and the second check was only 2.5 hours later, so there is still quite a bit of insulin working. I think you'd be amiss not to cover her snack, at least just the carbs.

Something you might want to consider is setting an alarm to test between 5-6AM and correct then, before she wakes up. That's what we had to do on MDI because more Levemir sent our dd low overnight, but she has a strong morning rise.

 

I guess we can agree to disagree. I think until the OP starts giving more bolus insulin instead of less, she will continue to see high post meal numbers. But I could be wrong, wouldn't be the first time. :cwds:

 

I would have dealt with breakfast as OP did:
- 25 carbs get 1.25 Novolog
- 261 gets 0.75 unit correction, which should bring her down by 135 if the Correction Factor is appropriate

Total bolus for breakfast plus correction = 2 units

She would have been below the starting 261 by lunch if not for the snack..

To the OP, what range are you aiming for?

 

Covering the snack and modestly correcting with 0.5 units would be appropriate.

 

Wilf is there a chart for IOB for MDI that you know of? to me it looks like her kiddos DIA is at least 3hrs, it would be helpful for her to give partial corrections in instances like this when it has pnly been 2.5hours as long as she can get a good grasp of the concept. I think there is an APP out their for ipods and the like.