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question about basal rates and pump sites with varying absorption rates

Discussion in 'Parents of Children with Type 1' started by Annapolis Mom, Feb 19, 2016.

  1. Annapolis Mom

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    I've been off this board for a long time but I'm having a lot of difficulty with basal rates and I know this crowd has great expertise so here goes:

    My daughter is 11, has had type 1 for 7.5 years, and has been pumping for four years (I think). Over the past 2 years we have had a lot of site problems. Some sites have great absorption and some sites have terrible absorption. I have tried to solve the problem by creating three different basal programs: 1 for great absorption, 1 for terrible absorption, and one for something in-between. The problem is that it takes about a day to figure out which one it is. Often more if her activity level changes from the first day to the second (she is very sensitive to activity). As a result, her basals are all messed up because I don't know if her bad blood sugars are due to a mismatch between the site and the basal program or some other factor (usually activity level). Even when I do make changes, I don't know if they work because a day later we have a new site. It is very frustrating and her numbers are everywhere.

    Six months ago her A1C was 6.9--amazing for us (we give her a lot of freedom which means we have to accept a higher A1C, so we were not expecting to see her below 7.0 until she was much older). Last month it was 7.7. Not awful, but not where we want to stay. But my problem is not really about lowering her A1C. It's more about how to methodically work through these three basal programs to get each one of them in better shape for her. For example, should I make it a rule to always fine-tune after day one, at least a little? Should I get rid of these programs and try to keep just one basal program but really work with temp basals? Should I insist that we try new sites which will almost certainly be good sites so that we don't have this variability (new sites flip her out)?

    I'm looking forward to your insights. Thanks in advance.
     
  2. Sarah Maddie's Mom

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    Ugh. Three basal programs would make me nuts! If you are really sure that it's an absorption thing then I would encourage you to get her to try some different infusion sets. What are you using now and where is she wearing them? Oh, and is she CGM'ing?
     
  3. Annapolis Mom

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    I am sure that it's an absorption thing, but just because I'm sure doesn't mean that I'm right.

    She's using the omnipod so no different infusion sets. She wears them on her stomach (lots of real estate, better absorption), the front of her thighs and the sides of her thighs. She's afraid to use her arms (even though she had shots on her arms for years) and her butt.

    She does have a CGM.
     
  4. Sarah Maddie's Mom

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    Ok, that gives me a clearer picture.

    Well, I'd probably take a month or so and just use her best spot, assume that's her belly, rotate, but see if I couldn't get a handle on basal needs without the interference of absorption issues. I'd use that time to lay the foundation for getting her to try her arms after the month was over (or whatever part of her body that she isn't using that you think might have a bit more padding than her thighs) I'd offer numbing cream and even a cash reward or some other incentive. You know, they get stuck in their routine, in their comfort zone, in the rituals that give them some sense of control, we found we just had to push our kid to try anything new. i.e., new site, new location... but lots of warning and a reward for doing something scary really did seem to make it easier.

    Good luck.
     
  5. Annapolis Mom

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    Thanks Sarah. That's an approach I wouldn't have thought of on my own. I'll give it a try.
     
  6. Sarah Maddie's Mom

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    Well, you had me with three basal rates :) NIGHT-mare, to me at least. Change is hard for them, it was hard for me but maybe if you can get a handle on the basal rates you both will get a little break from the uncertainly and a little clearer perspective. FWIW my kid favors her rear for sites and has been pumping for almost 12 years. "Rotation" can take place in a pretty small space and still be effective. Best of luck!
     
  7. Sarah Maddie's Mom

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    Oh, and just reading back it occurs to me that at 11 you could easily be seeing hormonal issues, not absorption issues. Even long before getting her actual period. It's fun, isn't it ;-)
     
  8. forHisglory

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    We have a favorite spot too on the thighs. We move the sites a few cm each time but have you ever noticed the area getting slightly puffy after a few times in the same area? Even though we move a few cm over, I wonder if the tissue in general gets a little irritated?? My son likes to switch legs each time, but I try to stick to the same leg so we don't keep picking the same spots. He even says his leg feels "tired" where we put the sites. Maybe it's sore? I don't know the sensation he's trying to describe to me.
     

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