Just getting used to the CGM...Is it Pump time (for a 2 year old!)

IMO, the long and short of it RE your son’s spikes boils down to the fact that he needs more insulin. After my daughter was first diagnosed, her endo (not unlike many others I’ve heard about) was overly cautious about lows. Unfortunately what goes hand in hand with few to no lows is a lot of highs. Now I’m not recommending you do the same as I did, but after about 10 days, I simply could not tolerate the high BGs her team felt it was okay for her to have, so I took matters into my own hands and ever so slowly increased her doses until she was pretty much always under 180, then I went from there. Before puberty reared its ugly head, my daughter rarely saw numbers over 130. There’s no way I would have ever been able to sit on a BG over 250. Then again, my daughter was 11.5 years old when she was diagnosed, and I’ve never had to treat a toddler.

I just feel badly for you all that you son’s endo isn’t more concerned about BGs up in the 300s and 400s! Heck, my daughter’s BG was barely over 300 at diagnosis…

Not so important to me because, as it currently stands, new-and-improved versions of the Dexcom crop up a heck of a lot faster than pumps advance. So at the exact instant that I’m typing these words (because I know Tandem is coming out with an integrated pump/CGM that will allow you to upgrade the CGM component) having an integrated system means that you will, in relatively short order, be tied to an older version of Dexcom. No thank you!

My son was over 500 at diagnosis…and he was in the hospital for almost 2 weeks because they couldn’t get his sugars to do what they were supposed to do. It took them nearly 2 weeks just to work out the right dosages for us to be able to take him home. They have given us the following range:

Night time needs to be over 100. If he goes under 80, we have to give juice.
During the day they want his bg’s between 100 - 200 BEFORE MEALS. If it’s over 200, we have to give 1/2 bolus unit between 200 - 300, and another 1/2 bolus unit for between 300 - 400.

We’re told to check ketones if above 350.

If he is higher than between 100 - 200 before meals, that’s what they’re still doing with us…still figuring out what’s the right dosage for him, and increasing, or decreasing bolus shots as necessary. The basal (Lantis) has always stayed 1 unit, 1 time a day…we’re now doing 2 basal shots per day (1 when he wakes up, and one in the evening, before dinner.) It just feels like it’s taken a long time for them to figure this out. He was diagnosed in March…I could probably do exactly what you did and figure it out myself through small dose trial and errors, but I don’t want to screw up and kill my son so that’s why we’re just hoping we get the right dosaging figured out soon.

We’ve been told toddlers run, and ride, much higher bg’s and that we don’t have to worry about ketones until the 350 mark and to just give corrections for anything over > 200.

That’s where we are now.

Unfortunately, what they don’t tell you is that you don’t have to have ketone in order to be laying down minute amounts of vascular damage that can, over time, accumulate and cause complications. Not everyone necessarily agrees with this theory, but I’m a big believer…

Yeah, we were given the “treat anything under 80” song and dance, too. “Normals” routinely run BGs under 80. Again, not meaning for you to follow our lead, but after my daughter became Dexcomified, we’ve learned to be pretty comfortable watching and waiting until my daughter’s BG is under about 62 (unless, of course, the dreaded double-down arrows rear their ugly heads) before treating (with a few carbs at a time, not 15!) I hear your frustration; reading about your son’s 300s and 400s makes me gnash my teeth for him.

It is quite remarkable how your experience so closely resembles my own. I have gone through almost the exact same issues you have. My doctor also had reservations about the 0.05 minimum bolus–but we figured we would just try it out, and it has worked well for us. I do have a few questions.

  1. What is the correction factor and carb ratio?
  2. Why are you not allowed to give corrections?

did you see this?

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1a) Correction factor: The correction factor is 1/2 unit for each 100, over 200. So 200 - 300 = 1/2 unit correction, 300 - 400 = 1/2 unit and 400 - 500 (heaven forbid) is another 1/2 unit.

1b) Carb ratio is 1 unit for 22.5 carbs

  1. We can give corrections with meals only - right now.

Also, my wife had to correct me about a few things (my memory sucks.) 1…he was diagnosed on February 29th of this year…she said I should remember it because the 29th doesn’t happen every year…leap year and all that. March 27th was when my youngest son was born. :: blushes :: (Did I mention I have 6 children so my mind is pretty much shot?) Also she said we weren’t in the hospital for 2 weeks like I had remembered…only 5 days. There, I feel better now. :stuck_out_tongue:

I did! Here’s hoping! We’ve both been very encouraged by the news of new potential long-term cures in the works, including the artificial pancreas and we’re hoping he sees something in his lifetime.

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Thanks, jim335! I just ordered it from Amazon yesterday and the liquid is what I was more interested in because I feel like I’d use it more as a “save” for when the edges of my other stuff begin to come loose. I’m on Day 18 with this sensor and my poor Grifs is looking pretty sad and now has a bandaid helper-friend. LOL! Here’s to being able to order more sensors soon as my hubby’s big OT check comes in. rolling my eyes I’m having one of those “I’m grumpy about how expensive it is to have diabetes.” weeks. (months?) :wink: Bah. Anyhow, thanks!! I am looking forward to using the SkinTac asap!

Update:

So last night we gave our son the additional basil unit before bedtime and the numbers looked a LOT better. The whole night it rode between 100 - 250 for most of the night. There was a very short period where it went to 330, but it was literally under 30 minutes, then it got back under 300 again. Most of the night (3/4th’s of it) it was between 100 - 200…so we are VERY happy (for now) with the latest medicine change for our 2 year old son.

Ok. When my son came from the hospital he had a carb ratio of 1:40 with a correction factor of 120.
It sounds like your correction factor is around 200(ish)—meaning 1 unit will bring him down 200 pts, or 1/2 unit 100 pts.

This is all to say that a .05 bolus (the smallest available for Omnipod) would bring him down 10 pts at a time. This may be reasonable for a meal bolus, but may or may not be too much for his basal rate.

So, let me see if I understand this equation correctly…If my son’s BG is 460, let’s say…it’s very high for whatever reason.
I take that and subtract the target (let’s say 150 which is right in the middle of his good range.) That means, the “amount to correct” is 310. Then dividing the amount to correct by the correction factor (for us, it’s 200), that gives me 1.55. So the “correction bolus” we would give would be 1.5 units?

This formula comes out to the same correction we would give our son using the simple formula our Dr. gave us for pre-meal corrections. If BG is over 200 - give .05 for 200 - 300, another for between 300 - 400, and another for > 400. So using our formula, we’d come out to to 1.5 units also.

Is this formula for times OUTSIDE of meal times? Or is the formula you listed a meal time correction factor formula?

Just FYI, my dad is a smoker and I wanted to get him a nice shirt for Father’s Day. I went to kohls and found a huge selection of pocketed polos, t shirts, and casual button ups. Perhaps they are coming back in style.

Yes, that is correct. There are a few caveats however. The biggest being that you don’t want to do a correction bolus while there is still active insulin working (also known as “Insulin on Board” IOB). The formula given my your endo is purposely simplistic for new parents. You will see in time that you can use that formula to get more precise boluses. The Omnipod pump takes IOB in consideration so all you do in input carbs to eat and/or current BG–then it does all the calculations within.

I would say follow your endo’s instructions for now–but you will see that you will soon be more educated on your child’s needs than anyone at a Dr’s office. It’s more of a starting point than anything.

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It’s beyond me why anyone would recommend correcting to 150, unless they are overly cautious about lows. 150 is not a “good” BG level. If correcting to 150 results in frequent or severe lows, then something is seriously wrong with the basal rate(s)!

Additionally, IMO, it sounds like the correction factor you were given is not accurate, based on your report of how much of the time you son spends high (over 100).

ETA: Many people with T1D consider a BG range of 65 to 140 a “reasonable” one. Again, much easier said than done with a toddler. But I truly believe your son’s endo has done you a disservice in not adjusting your son’s doses to achieve much better control by 5+ months after diagnosis.

For us, right now…we are told 100 - 200 is our “perfect” range. So as long as we’re in that range (150 is good), then we’re good…according to our Endo. If we can get to even a 150 baseline…we’ll be happy. It’s better than what it is right now…

I will say that it is MUCH harder to get a “good” number for a 2 year old. Their tiny bodies react unpredictably to insulin–and is harder to fine tune since it takes so little to have an effect (remember that if you are on MDI’s, 0.5 units is the LOWEST bolus you can give). Throw a honeymoon in there and you are really unpredictable. I have noticed that Hypos are the greatest concern in Dr’s office. I agree that your correction factor is not exactly perfect and probably just serves as a starting point until you become more adept. I was told 180 as my target level (still to this day), but we have taken upon myself to lower that to 120 (even though our Endo disapproves). My son was diagnosed at 2 (he is 4 now) and we are continuously tweaking his corrections/basal rates. It is ever-changing and what seemed to work perfectly yesterday, doesn’t work at all now.

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Are you numbing the area of sensor application with EMLA and then wrapping with Saran wrap for 20-30 minutes prior to insertion? We found that our son does not feel any pain that way. We bribe him with a video during the time we are inserting the sensor but he doesn’t even flinch.
What he hates is removing the “sticker” when it’s used. We apply baby oil and that makes it less adhesive, but he still hates it.
I would say the main benefit of the pump for a 2-year-old (which we also have) is that it allows them to eat more flexibly. So if they want more food, you don’t grit your teeth and think “oh God I have to give him another shot.” – you just bolus him.
The downside is that site issues are real…some sites work better than others, sites get old, and some simply don’t work for mysterious reasons. That is YET another variable to work with, and my kid hates it when we fiddle with his pump, he often dislodges his sites. So I would say don’t expect better BG control by just switching to the pump.
Your child is also at greater risk of DKA on the pump. Because it only delivers short-acting, if something goes wrong with the pump site, they can be in DKA within several hours, versus several days when they have long-acting insulin like Lantus or Levemir in their system.

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An option to consider if you are concerned about DKA while pumping is utilizing the “untethered” approach in which you inject (“old school”) a long-acting insulin to cover part of your basal needs along with pumping. I’ve never done this, but know of a few folks who swear by this strategy.

The primary reason we had for switching my daughter to a pump was also the flexibility with mealtimes. My daughter has always been a “grazer”. After her diagnosis, concerns about “stacking” insulin doses resulted in me having to say “no” to many requests for food :pensive: because her D-team did a poor (read nonexistent) job of explaining the differences between stacking corrections versus stacking carb boluses. Soon after beginning to pump, we began to more fully appreciate the many other benefits of pumping: a bolus wizard that (for the most part) accounts for IOB, the ability to set variable basal rates, the temporary basal rate feature (which has always been much appreciated after swimming), the ease of dosing as often as needed without the hassle of an additional injection, etc.

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@Tia, We just got a prescription for Lidacaine cream, purchased it and used it for our most recent change out…he still didn’t like it much. We also tried the arm this time and he doesn’t seem to like it any “less” than his belly…we’ll give it more time. I put the Lidocaine on a band-aid and put that on his spot for 10 minutes or so (the box says 10 minutes). Should I be keeping it on there longer? How does aluminum foil help? Also, I’m assuming since you use pump that you have the CGM on one of the arms, and the pump either on your childs belly or back end?

I’m confused about the pump basil -vs- bolus injections…I don’t know why I thought pumps were used to inject both kinds, but if they’re NOT used for Basil…there isn’t any other alternative, right? If your child is supposed to be taking bolus and basil don’t you just have to do the basil via daily injection? Or is what you ladies saying that the pump does away with the basil requirement?

DKA used to not scare me until we started riding high most of the time…We haven’t had a low in weeks now, but nearly every day he’s between 200 - 300 and frequently even above 300 nearing 400.

This morning our son was still sleeping and his sugars were 398…I gave him his daily Lantis shot and he didn’t wake up, so I asked my wife…what are we going to do? If it’s not “meal time” (not snack time…the meal times, breakfast, lunch, dinner), we aren’t supposed to give Humalog shots…but if he’s not waking up yet why do we have to just sit and watch his numbers hover over 200 or 300? So, this morning, I was closer to ever to giving him 1/2 unit of Humolog…but he ended up waking up anyway before I had to do an “out of cycle” Humolog shot…

So I’m now wondering…is what I was going to do this morning OK? The typical scenario we run into is him being OVER 300 during the night…and we “can’t do anything” because it’s not being done “before a meal”…do you all just administer Humolog whenever you think it should be administered? I don’t know where we go from here as far as what our future directions will be from the Doctor, but I have to assume…EVENTUALLY…we’ll be let go and be able to administer shots in whatever fashion we think is required?

There are so many times I want to give 1/2 unit but I don’t because it’s not been “approved” by the doctor (who’s child isn’t in threat of DKA…)

Would love your thoughts on this.

Thanks.