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Sliding Scale Only?

Discussion in 'Parents of Children with Type 1' started by Blue, Sep 24, 2010.

  1. Blue

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    The "sliding scale" we have to use now has no way to correct at any time other than Breakfast, Lunch or Dinner.

    I think it's crazy - especially when I see high numbers at bedtime or snack.
     
  2. wilf

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    If this is what they have you on, then it's time to get off the regimen.. :eek:

    A true sliding scale (that works) is based on preset amounts of carbs for meals, and predetermined insulin dosages for different ranges of blood sugar levels. The insulin dosages for each range of blood sugar levels have a component which covers the meal-time carbs, and a component to correct the blood sugars up our down.

    I would ask your team to confirm that you have the correct understanding of the sliding scale. If you do, then I'd get off it as soon as you can.
     
  3. Blue

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    We do understand the sliding scale. His being a toddler with no set schedule or reliable eating habits didn't work out well with that treatment plan. So we were taken off of it and put on a carb based calculation/correction factor. His mother requested that we be put back on the sliding scale for many of the same reasons his father wanted off of it - namely the complicated corrections based on glucose readings, carb factors, insulin sensitivity, time since last dose, etc. made the "simple" sliding scale more appealing for her.
     
  4. denise3099

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    This sounds like just correcting highs and treating lows rather than actually preventing them from happening. Eat what you want and correct at the next meal. Not a proactive approach.

    I would make it easier for everyone and get a pump. It does all the math for you, keeps track of what everyone's doing, so communication is much easeir and everyone is using the same formula's. And the doc can make changes and everyone can stick to the same programing. just my 2 cents.
     
  5. wilf

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    This can't work.

    Diabetes management is "complicated", but taking a "simple" approach at the expense of the long-term health of this child is utterly unreasonable.

    His mother needs proper adequate training, so that the D can be managed properly.
     
  6. deafmack

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    People with type 2 who are on insulin do not use a sliding scale unless their doctor is way behind the times and not up to date on current medical treatment for diabetes.
     
  7. Blue

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    I agree that the easier approach for the caregivers now at the expense of the child later is very, very wrong.

    The pump has already been discussed at diagnosis and rejected because his mother and her family didn't want him to "look different" than his friends and "it will get pulled out when he's playing". My response to these fears was to keep the real pump under his clothing and inaccessible when he was playing, and if something was said about it to educate his buddies and then make pretend pumps with aquarium tubing, cardboard boxes and stickers. It didn't go over well, which doesn't surprise me since most of my suggestions as a step mom aren't taken well.
     
  8. wilf

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    The debate about whether or not to get a pump is a distraction. Besides, if doing MDI properly is deemed to be "too complicated" then a pump and all the training it requires would be even more so..

    The issue is the little guy needs a sensible insulin regimen.
     
  9. Blue

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    I agree. We're working on it.
     
  10. chbarnes

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    Well, yes. But you still see it quite a bit. Heck, I met a T1 adult last week who is on Humulin 70/30!

    Chuck
     
  11. Lee

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    My stepdad is - he just refuses to change. and a sliding scale.
     
  12. Lee

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    Each house can have and probably needs different ratios - and that is ok.

    Each house should try and use a scale to measure carbs - that takes some of the variability out.

    Learn to work together...and always remember what happens at your house is your house and what happens at the other parents house is their house.

    This is probably the single hardest thing to do. But if they are keeping the child safe, then that is what you have to do. Don't compare #'s, don't compare carbs, and don't get into a pissing match about always being high at one place or low at the other. My ex used to say she was always high at my house - so I started keeping a spreadsheet that tracked every blood sugar. I then marked it high or low, and mom or dads. Come to find out - we were only different by less then 2% almost every month. I did this for 3 1/2 years and took it with me to every appointment. We have finally moved on from that stage - but it was the WORST feeling in the world.
     
  13. mandy092570

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    Jacob sliding scale

    My 5 year old son in on a sliding scale

    he gets his shots on the amount of carbs he eats

    his sliding scale
    is
    7 am Breakfast he get 1 unit of Novolog for 12 grams of carbs
    9:30 am snack 10-15 grams
    12:00lunch he get 1 unit of Novolog for 15 grams of carbs
    3.00 snack 10-15 grams
    6:00 supper he gets 1 unit of Novolog for 15grams of carbs
    9:00 he gets 3 1/2 units of Lantus and a 10-15 grams snack before bedtime to make sure his sugar is above 100 before he goes to bed .

    And his sliding chart
    Blood sugar below 80 subtract 1/2 unit
    Blood sugar 161-240 add 1/2 unit
    Blood sugar 241-300 add 1 unit
    Blood sugar 300 or higher add 1 1/2 units
     
  14. Lee

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    This traditional MDI becuase he can eat 30 or 45 or 60 carbs at lunch - you would just increase the # of units. So - to translate - your son has a few Insulin to Carb Ratios (I/C Ratios ot ICR). So for lunch, his ICR is 1/15 - so for every 1 unit of insulin, he can have 15 carbs.

    A traditional, or old fashioned sliding scale means that he would only receive 15 grams of carbs at lunch and take 1 unit of insulin. That is it - no ifs ands or buts about it. He's not hungry, to bad...he is starving - go eat a pickle then, there is just no room for negotiation.
     
  15. Blue

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    Yes, exactly to the poster above.

    Telling a toddler that is laying on the floor crying for "mulk in ca-cra" (milk and crackers) that he needs to eat/drink this no-carb alternative because his levels are too high and you can't correct for another hour is not fun for anyone involved.

    On a positive note - We are back on a carb based calculation as of today!

    His diabetes team tried their best to figure out an "easy" sliding scale that would give the control that we saw with the formula and couldn't.

    So now we can feed the kid when he's hungry and dose accordingly! Yay! :D
     
  16. Lee

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    That is awesome news!
     
  17. deafmack

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    Yes, I agree. I see it as well.
     
  18. Blue

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    I just re-read the responses and saw the post about Type 2 treatment using a sliding scale. His great-grandmother is a Type 2 - I wonder if she uses a sliding scale so that is what they are used to. That could be why his mother and grandmother insist on using a sliding scale . . .

    Something to consider, anyway.
     
  19. Alex's Dad

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    We have something similar to this.

    8am depending on her bg 4units NPH and 1 1/2 Humalog and 20g carbs
    10am 10 to 15g
    12pm 25 to 30g (if more than 200 1u Humalog)
    3pm 10 to 15g
    6pm 25 to 30g (1u Humalog)
    9pm 10 to 15g (1u NPH) (if more than 350 1/2u humalog)
     
  20. deafmack

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    Yes, I think though that most people never question their doctor about the insulin regime they are given or the types of insulin they are prescribed. I know that most people just accept whatever their doctor tells them. They never ask for their numbers from the test results or anything. And then there are those who have been on sliding scale for so long they just can't imagine doing things differently.
     

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