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?) 
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 
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.
Goodness! It seems like you are not getting the best care from your ENDO. First off, during the initial diagnosis period we were to check in with our endo every day, then every week, and then every month. If we ever had questions about dosing we were to check in with her via email and she would give her suggestions, but she ALWAYS offered us the option of figuring things out ourselves.
Second of all, you should be correcting his highs! Even when we were just two days out of the hospital, we were told that if it’s been 3 hours post meal and he’s high, you correct. We were given an insulin sensitivity factor (ISF) to figure out how much to give between meals. Then, on a night when he was running high and we gave corrections, the endo looked at the data and realized the ISF was not strong enough, so she made it a stronger ratio. This is what your endo should be doing!!!
If your kid is running in the 200s 300s and 400s consistently then he is NOT GETTING ENOUGH INSULIN. You need to call your doctor and insist that s/he change the dosing, most likely on both the long acting Lantus and the short-acting Humalog, and likely both for meals and for corrections of highs (carbF and ISF). In the meantime if I were you I’d give the half unit of Humalog when he does run high and not worry about “stacking” insulin doses. Have confidence in the hypogylycemia protocols! If your son does go low, a fast-acting carb snack like a glucose tab will most likely bring him up quickly with no lasting harm, but running in the 200s+ for days and weeks is really not good.
However, you can’t just administer Humalog whenever with no regard to how much you gave the last time. You need to calculate how much is still left acting in his body from the last dose you gave. A rough rule of thumb is that about 20 percent is used up every hour. If you gave half a unit two hours ago, then 60 percent is possibly still left from the last dose, or about 0.3 units. So figure out how much you’d like to correct him, use your insulin sensitivity factor to calculate how much he needs to get to that dose, then subtract the insulin still left in his system (insulin on board, or IOB). It may be that because you’re using such small doses, you can’t always give a correction sooner than about 2 hours from the last dose, but certainly you should be able to do by 3 hours after the last meal. Let’s say he needs 1 unit for correction of the high, but 0.3 units of insulin are still on board. You’d give a correction of half a unit.
The other thing is that you can actually do all the troubleshooting to figure out if his basal rates, insulin senstivity factor and carbF are right…but first you need his basal set at least close to correctly. I’d talk to the doctor about increasing his dose of Lantus. Then let him have a light, early dinner and after five or six hours, watch his BGs all night. You want him to be at a fairly steady blood sugar all night long. You can also check the daytime basal rate by having him fast for a few hours, but that’s tough in a toddler.
As for your question on basal/bolus – the way it works on a pump is that instead of giving a long-acting insulin such as Lantus, you give tiny, microdoses of short-acting insulin such as Humalog. It serves the same purpose – keeping blood sugar steady between meals – but it doesn’t last as long so you need to give tiny doses continuously. Instead of using two medicines, you would just use one.
Good luck! It’s hard in the beginning but the more you can feel comfortable troubleshooting your son’s care on your own without the doctor’s orders, the better his numbers will be.I’d also pick up a book like Think Like a Pancreas, Pumping Insulin, or the like so you understand how your doctor is doing all the calculations. They really are intended to just get you started on your diabetes journey; you’re going to be the ones making all the little tweaks and changes to his care from now on!
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Saran wrap is like a cellophane clear plastic wrap, not aluminum foil. I doubt a bandaid size will be big enough. The cellophane wrap just keeps the Lidocaine cream on and makes sure it works to numb the area.
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Yes, we had to do the same @Tia_G. Our son was diagnosed in February and we had the “daily” phone calls to review his sugars, adjust doses, etc., then it went to weekly, then monthly, now they say we don’t need to contact them unless we have concerns, and now he is scheduled for checkups every “3 months” where they review A1C’s, etc., I feel like we’re pretty much on our own right now except that we still have “marching orders” that we follow pertaining to doses of Lantis and Humolog, but I feel like they’re not enough. We’ve talked to the Doctor and they HAVE made tweeks (even as recently as earlier this week adding another Lantis shot in the evenings to compensate for his nighttime highs), and his numbers were in the low to mid 200’s the first night…but the past couple nights, they’ve been high 200’s and into the 300’s again. He IS sick right now…so we’re thinking the hormones are just making his body do crazy things right now…we don’t want to rush anything while he’s sick and it not be the right thing to do for his body post-sickness.
This disease is just so…discouraging, at times. You think you have something figured out then BAM…a curve ball is thrown and numbers are shot.
Regarding the IOB, yes, we know to watch out for that and to be sure not to give TOO MUCH insulin in cases like I was mentioning above and we’ve been advised that “most” of the fast acting humolog is “out of his system” within 3 hours. So IF I were going to give him an out-of-cycle “correction” unit it would definitely be at least 3 hours after one of main meals. If the 20% per hour is a better gauge, then we will start using that because this community knows best imho.
Thanks!
Harold
you need to have a good blob of it on there for almost an hour. it’s going to seep out from under a band aid too, I use some old IV3000 occlusive bandages
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I congratulate you and your wife in staying with this struggle with your son’s diabetes. This is a complicated dance to to get better at. None of us ever really get it perfect because it changes and if you don’t move with it, you’re left with doing what worked last week but is not appropriate this week.
The above suggestion for framing how an insulin dose works over time is a good enough guesstimate of insulin action. This is a linear approximation is adequate but it actually works in a curvilinear fashion. Insulin pumps use an integration calculus function to more closely guess how much insulin is left on board to still exert its effect. The 20% per hour idealization of insulin action assumes that the duration of insulin action in your child plays out over five hours (20% x 5 hours = 100%). I just want you to be aware that using this method is less than ideal but good enough for your situation.
You and your wife are asking all the right questions but more importantly, you are following up your observations and question with real world action. Try to aim for making more and more insulin dosing decisions yourselves. No doctor has enough time or resources to follow your child’s every metabolic move. Eventually, by making more decisions yourselves and observing their consequences you will receive the most valuable education you can. That is how your son’s metabolism actually works, not some textbook generalization.
You are doing your son’s health a huge favor. Don’t let the effort wear you out. You will get better and better at this!
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I was able to do most Dexcom/Omnipod/Calibrations timed while he slept. The amount of time insulin is active varies from person to person (3 hrs for my son). When I was doing MDI’s, I would give a correction bolus when I saw that IOB was out, nearly out, or still rising after “prime time” (what I call the mid-point where the insulin bolus is most effective).
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yes, you’re right about it being an approximation! It just seems like in their case (tiny doses, using a syringe that limits them to half-unit increments), the error involved in rounding up and down and having to eyeball with the syringe probably drowns out the error associated with not estimating the curvilinear decay (and also with everyone’s DIA being different).
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