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Question about prevalence of pattern management

Discussion in 'Parents of Children with Type 1' started by kevin@diabetech.net, Feb 28, 2008.

  1. kevin@diabetech.net

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  2. momtojess

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    Thats intersting.. after reading that, apparently I dont do pattern tracking too often. We treat her immediately, but then if we notice we keep doing the some corrections etc at the same times, then we usually do some pattern tracking without the correction to get to the bottom of the problem.
     
  3. Mom2Deacon

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    Thanks to Co-Pilot I see patterns so I am up on the patterns. They have a nice graph for 3 days, 7 days, 2 weeks, month and up to a year. This is how I knew that Deacon was spiking before dinner and needed an adjustment for his ratio. I saw the spikes on the graph. If today he doesn't spike, then I know we got it right. He hasn't spiked for the past two days. But you also need to be really good about recording the data.

    --Sara
     
  4. valerie k

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    If something is wrong, we look back a few days, and watch the next few days. Like morning highs, we then, go back, and then, we either bump up lantus or we pay attention for the next three days and do some night checks.
     
  5. EmmasMom

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    I upload graphs at least once per week and look for patterns/trends. With all the data from the pump and cgm combined it's really easy to spot problem areas.

    I can't imagine trying to keep track of patterns and adjust insulin doses w/o technology! What a nightmare!
     
  6. Nancy in VA

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    I think we pretty much do what they are calling pattern management. I'm trying to figure it out right now as we have started a string of highs - but I think she's sick.

    The Animas software has some decent graphs and charts that make it easier to do that.
     
  7. Gwyn

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    Thanks so much for this post! We do pattern management, but it is not taught at our dr's office. In fact, they often comment that I do all the tweaking of numbers so there is nothing left for them to help me with when I get to the appointment.

    I told them maybe they could use the "extra" time to entertain Devin while I took a nap.........
     
  8. twodoor2

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    Thank you so much for this post as well!!!:D

    I was never officially taught pattern management, except through reading "Using Insulin" by John Walsh. However, I do analyze patterns very closely, and have a spreadsheet that keeps track of all her blood sugars and several other variables.

    It also produces stats at the end of each day that allows me to associate them with specific patterns. If I didn't watch patterns, I might as well be doing diabetes management with a blindfold on. I think it's extremely important.

    Endocrinologists can only analyze patterns at a high level since they have so many patients and very little time, and they cannot take into account all variables. I feel it is my responsibility to do detailed pattern analysis to make sure that when there is a dosage change, there must be a very good reason for it. That being said, someone I know is going to an endocrinologist that really does analyze the numbers with other associated variables, in detail. Unfortunately, that is usually not the norm.
     
  9. Heather(CA)

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    I was taught this by our Endo. We started with a sliding scale, then went to carb counting. I still rarely give Seth corrections other than at meal times. YDMV/IMO all the corrections would make him hate D even more while also clouding my view of whats going on. At this point, I see the pattern sooner, make changes in ratios sooner, and I'm able to take exercise in account when dosing. At the last visit I explained this to the Endo, she agreed with my efforts.:D
     
    Last edited: Feb 28, 2008
  10. wilf

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    A classic example of how YDMV..
    We graph every day's BG by hand, in the handy log books we have. It is not a nightmare - takes a combined total of about 2 minutes per day. I on the other hand can't imagine trying to deal with all that technology! What a nightmare! :)

    *******

    Unless you are a computer brain, patterns are hard to discern out of a jumble of BG numbers. But graph those numbers so that the daily rises and falls in BG can be seen visually, and patterns start to jump out at you.

    We do a lot of pattern analysis, though we do it as much by intuition as by any rigorous method such as is described in the paper that this thread links to.

    The paper is interesting, but rooted more in the clinic than the real world. I don't know about your families, but "consistency of schedule, carbohydrate intake, insulin doses, and activity level" is just not part of our lives. And DD would never put up with us trying to impose such consistency for the purpose of fine-tuning her insulin regimen.

    The challenge as i see it is to work with the inconsistencies in the data and nonetheless identify the patterns that are there waiting to be recognized..
     
  11. Mama2H

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    We do use the cgms graphs on a VERY regular basis to look for patterns but other than that I agree with Wilf about the schedules intakes and doses :)
     
  12. Heather(CA)

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    So true Wilf..I don't use the numbers form Seth's dad's house. Not because I think he's "doing it wrong" But because I'm just not SURE it's right. I wsn't there...He could have a high from a misjudgement of carb, unauthorized snack etc...It makes it hard
     
  13. wilf

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    It would make it SO hard. Amazing that you do as well as you do in the face of that challenge..
     
  14. Lee

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    Hey Heather,


    I just want to add for all of us split household out there, that it may not be right for your house, but it is for his...we always have a tough time with this issue, and it just boils down to my house is mine and his house is his...

    It makes identifying patterns incredibly difficult since they are two days dads, two days mine, then 3 days (Fri, Sat, Sun) rotation. Our endo keeps saying, wait 3 days for a pattern, but then they are off to Dad's and she comes back and it is all different anyways.

    Each house has their own Basal routine, with the days matching for school. It just comes to the fact the she needs about 3/4 more a unit of insulin at my house to keep her steady. I chalk it up to how we measure - I use a scale and they eyeball...

    When we were on shots, I had different carb ratios than Dad to cover this. It wasn't the unauthorized snacks, or being wrong, or being lazy (I wish she was lazy!), it was just being different...no to people manage d the same way...hope you don't mind me chiming in, but I just think that htose of us who split households deserve an award! Or maybe just a drink...
     
  15. wilf

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    I will be submitting your names for both an award and a drink.. way to go gals! :)
     
  16. Lee

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    Make it a big one - and I prefer a Mojoito!
     
  17. Heather(CA)

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    I don't mind at all...But, he doesn't have different ratios for his house. I do ALL the adjustments. Then, I write them down on a card and he does the best he can to follow it. That's why I was upset about Seth going to camp I wrote down my best guess but I had no idea if it would be right, and I was afraid he wouldn't call if he had a problem...Last summer he took the boys to Lake Havasu, Seth spent 3 days in the 300's because of the extreem heat and exercise, then he called the Endo and was waiting for the call back. His wife called me so I could "fix" it. Totally differant from your situation:cwds: Our schedules are close though..Ex has the boys 1 1/2 days, then I have them 1 1/2 days, he has them 1 1/2 days, then I have them for 4 1/2 days. Then the same sch. repeats...I make most corrections during the 4 1/2 days I have them, with some exceptions.

    BTW, thanks Wilf...Mojoito's work for me too LOL
     
  18. EmmasMom

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    Yep! It's about as big a nightmare as cell phone and Ipod... ;)

    Maybe "nightmare" was too strong a word for paper logging, but after having tried all kinds of management and logging styles at our house in the past 7 years... what we are doing now is far simpler and more effective than anything else we've ever done.
    It literally takes 5 minutes per week to have access to numerous detailed reports that include graphs of 288 readings per day, every finger stick, every carb entered, every bolus, every drop of basal, every adjustment made during the day, etc. It really is pretty phenomenal and easy to use, even if your not tech savvy.
     
    Last edited: Feb 28, 2008
  19. twodoor2

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    The time consuming part for me is not logging the data, but determining what to change once you see the patterns. I don't think any software (correct me if I'm wrong) tells you exactly what to change, if it did, we'd all go out and buy it immediately. The difficult part is figuring out what to change. Is it ISF? carb ratio(s), DIA, basal rate(s)???

    I have a homemade Excel spreadsheet taylored to Elizabeth's needs and I have to say it works out for me incredibly well (others may not care for it). Not only do I have immediate access to all the statistics provided once I log the days numbers, I can also make adjustments to various variables on past days, or that day to see how an adjustment will increase/decrease the dosage.

    Sometimes, even with all the fancy shmancy software, and charts, etc. . . it can still be a challenge to figure out what to change. Something that may look obvious might have been from stacking, a bad breakfast ratio, too high basal, etc. . . You might think you need to change a ratio here and there, but the real culprit is sometimes not very obvious. Example, our endo downloaded all our information from the pump, and not only did she make incorrect decisions on how to dose Elizabeth, but the fancy shmancy charts really didn't give her the entire picture.

    From what I read on the borads, I think even with CGMS, it is still a challenge to make changes that are safe and effective sometimes. There is absolutely no software out there that is better than the human mind in figuring out exactly what to change. I think that is the "holy grail" of diabetes management and will lead to the artificial pancreas, but in the meantime, patterns are useless unless you know how to interpret them.
     
  20. Nancy in VA

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    I was using a spreadsheet on MDI and it worked great. I kept using it after we got on the pump for a long time. Then, I started downloading the pump to the pump software and realized the graphs and charts in there are amazing. I found a process to get all of my readings into that software, whether or not they resulted in a bolus, and the abilty to analyze is great.

    I can see a trend chart for a single day or the average over multiple days, I can see distribution charts that tell me what % of the readings are in certain ranges at certain times of day, so I can see that she is in range at breakfast 85% of the time, but only 30% of the time at 3 hours after dinner.

    The charts are really giving me an idea of what's going on and what to change. I didn't use them nearly enough in the last quarter, so I'm hoping that my use of them over this quarter will result in an even lower A1C
     

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