Hello, I am new here. My daughter is 7 and was diagnosed Sept 13, 2010. She is doing fairly well however she is still on the old fashioned Humulin N and R. It isn’t working out well for her schedule and how she wants to be so active. The scheduled days are getting to her.
We are getting ready to switch her over the summer to the basal/bolus method. Her CDE calls it the “pen”. Anyway, I don’t want to go into the classes completely uneducated. Could someone give me a quick break down on what this all entails. Will her life be more flexible?
She’ll likely have to do more shots than she is doing now, but you will probably see fewer lows, and you won’t be as much of a slave to the insulin schedule. Your doctor will likely give your child one pen for basal and another for bolus. The basal will likely be lantus or levemir, and the bolus pen will probably be humalog or novolog. With lantus or levemir, most kids take one shot a day of this, and it does need to be the same time every day. But, you can choose what works best for you. My daughter was 13, and wanted to sleep late on the weekends, so we did the basal shot at 10 p.m. each night. The bolus doses will be given when your daughter eats. With the pen, this can be done easily, and discretely. You’ll find that you definitely have more freedom. As she gets older, you may want to think about a pump. They offer the most freedom of all, and one needle stick to change the site every two to three days, instead of 4-6 shots a day.
Also, I got a great book when my daughter was first diagnosed that answers SO many questions. It’s called Type 1 Diabetes and the author is Dr. Ragnar Hanas. It’s like a type 1 encyclopedia. Also good is Gary Scheiner’s Think Like A Pancreas.
Good luck, and don’t worry about being uneducated – we all were in the beginning! It’s a lot to learn, and you probably can’t come up with a question your CDE hasn’t already heard.
I am not very familiar with the Humilin N and R routine - but we did Lantus (basal) and Humalog (bolus) for about a year before my son switched to the pump. (which offers even more flexibility with scheduling and being active if you are still feeling restricted)
Basically, the body continually releases sugar into the blood stream in order to keep itself going, and basal insulin takes care of that - most people are on Lantus or Levemir, which are as close to 24 hour insulins as there are, without a peak. So in theory you could give yourself one basal shot every day around the same time and never eat, and keep your blood sugar relatively stable (you know, as long as you didn’t get sick, run around, start growing . . . etc)
The bolus insulin (usually Humalog, Novalog, or Apidra) is given before meals to handle the rapid increase of carbs/sugar in the blood. Different people react differently and need to take it 30 minutes before, 15 minutes before or sometimes right before eating (little kids often take it after eating if you are worried about them not eating all their food, but that doesn’t provide quite as good of control) You need that at almost every meal (again - it depends on a lot of other factors that your CDE will help you figure out) and you can correct a high with it if necessary.
With bolus insulin you will have a carb ratio, so that you get 1 unit for each # of carbs. My son gets a unit for every 15 grams of carbs. And then you can subtract or add insulin based on their blood sugar as well - again your CDE will have to help you figure out what amount you will subtract or add. At first it may seem overwhelming but once you’ve done it in practice it actually isn’t that complicated.
Good luck! I think you will find this much more accommodating to a kid’s schedule!!
Thanks! I was wondering how you calculate the amount of insulin for the amount of food you eat. That makes a lot of sense and seems MUCH easier than trying to force her to eat a certain amount of carbs (which is what we do now). My brother is type 1 and on the pump. Allie was excited about perhaps getting the pump one day, but right now we have no plans for it. She dances and does competitions and having the site visible isn’t an option. My brother likes the pump but he is considering going back to the pen. Not sure of his reasons but he just said he prefers the pen.
Her Endo and I had a talk about her pickiness at meal times, her active dance schedule, and her just plain tired of eating all the time, so she recommended this. I am excited and so is Allie.
One more question…right now if she is even 10 minutes late for a meal her BS begins to drop and she has to eat. How flexible is the pen with eating times. For instance if she normally eats at 5:30, but dance isn’t over until 5:45, would she be able to wait the 15 minutes til class is over? Does time even play a factor for this?
Whoops, sorry I forgot about how you have to force a kid to eat a certain number of carbs when they’re on those other insulins. That was horrible. You’ve already learned basic carb counting, and the way it works is that you give a certain number of units for the carbs. My daughter started out at a ratio of 1 to 15. That means for every 15 carbs she wanted to eat, she needed a unit of insulin. So, it WAY, WAY more freedom than she has now. Once you get the basal worked out, she will be able to eat at just about any time. Lantus and Levemir don’t have the same kind of huge peak that N insulin does. They give a small, steady dose throughout the day. When she’s dancing, you’ll probably still have to give her extra snacks because she’ll be using insulin more effectively (this is where a pump REALLY comes in handy. Maybe when they come out with the smaller OmniPods, she could use those?) But, this is something you can play with and adjust with your CDE and endo. You truly will be amazed at how much easier it is on these insulins. My daughter was on the other type for 3 months, and I really felt like we’d gotten our life back and didn’t have to schedule everything around insulin and eating. That was so difficult.
This is VERY good news! hahaha Oh my goodness, we are a slave to the eating/insulin schedule. It’s exhausting. It’s hard to make plans to go anywhere. She hates eating in public or when we are out anywhere and people look at me strange when I won’t let her do anything until she is finished. hahaha I am going to be very excited to throw the stupid schedule out the window.
Unless she changes her mind about competitive dancing, she probably won’t do the pump anytime soon. She watched my brother put in the site once and said, “No I am never doing that!” hahaha She is only 7 so we will see.
The OmniPod has autoinsertion, so it’s not as bad, and you never see the needle. BUT, you definitely see it under clothes.
And, you know, I had completely forgotten about how you have to literally STUFF your kid full of food to match the insulin. And the struggle of making her HAVE to eat the food when she was already beyond full. For the most part, those days will be gone for you. When my daughter played sports, we bought those small bottles of G2 (doesn’t have as much sugar as regular gatorade) and she’d drink one of those beforehand, which often was enough for her.
The pen is wonderful for going out. I know adults who give themselves shots right through their clothes. It’s just much easier to be discrete when you don’t have to flick air bubbles out of the syringe!! You’ll love the change. The only real downside is that it’s more shots. That’s actually what got my daughter on to a pump. She got tired of all the shots.
