Hello All,
Hope everyone is doing well. I don’t post often, but read every O-Pod post and do chime in when I have advice or input. Now I have a question of my own.
My son has been using the O-Pod since January. We love it and would not change to another pump for any reason (that I can forsee). He is 3 1/2 and very active, and eats all the time. He typically eats Breakfast, Snack, Lunch, Snack, DInner and Bedtime snack. Many of his snacks are carb based (fruit, chips, etc.) The frequency of the carb intake is such, that it is at times difficult to see normal BG readings during the day. He had a good A1C at his last check-up (which was the first since starting the O-Pod), but is often over 300 2 to 3 to 4 hours after eating. I am wondering if I need to increase I/C ratio, basal, etc. (Don’t wory, I am not going to rush and make changes based on responses here. We would, of course, involve our CDE and Endo first.)
Thanks for your time, input and support.
Joe Boyd
dad to Austin (3 1/2) dx T1D 9/08 and Jackson (20 mos) dx Neuroblastoma 2b 7/08 now NED!
www.caringbridge.org/visit/jacksonboyd
How long does it take you (or your loved one) to come back down to normal BG readings after a meal or snack?
I would say that those highs are unusual and probably need to be addressed by a change in insulin. It’s hard to tell from the information if it’s just a change in insulin/carb ratio that’s needed or if there’s a basal change too. Two hours after I eat I’m usually about 40 - 70 points above where I was when I started eating and by 4 hours I’m always back down to a similar reading as long as I’ve bolused correctly. I’d love to hear from more parents with young kids with diabetes though as it may be very different for me as a young adult. I believe everyone will be concerned with the 300’s though and recommend that you work with your Endo to bring them down.
OK…first make sure that you are accurately counting carbs…if you are and your I/C ratios are correcct you shouldn’t be constantly having those after meal/snack highs to knock down. Your basals might also need to be tweeked. Of course, everyone is different in reaction time…sometimes depending upon what you’re eating…for example, carbs associated with pastas…you could use an extended bolus. For me, I can expect to see a fall to normal well within an hour…usually by 40 minutes.
When Caleb started pumping, it took a little while to figure out his IC ratios, but once we did that, they have not change the more than 2 years he has been pumping. Any changes since I became confident with his ICs are to basals. However, I agree that you should ensure carb counts are accurate - I found that to be critical on the pump, whereas on injections, estimates were more tolerable. And then he sure you are comfortable with IC ratios. It’s hard to know which is causing the problem when they are both unknown - it just takes trial and error.
Caleb it typically in range by an hour and a half after his bolus. I know that he will still come down a little from then to the two hour mark, but typically not by more than about 30 points. This is something I’ve come to learn over time and it took time and of course everyone is different.
Lo
We are meticulous with our carb counting. We measure it down to half-carbs. We get it from Nutritional Labels and even weigh other foods that do not have this (fruit, etc.) with a Salter scale purchased from Amazon. Is it possible it just takes Novolog longer to work for him?
Great - well that’s one variable out of the way.
Even if it takes longer - lots of people use a longer insulin duration than two hours - I don’t think his BG should ever be getting to the 200s just to come down again by the end of the insulin duration. Caleb of course sees a 200 or even 300 every now and then, but it is something to be corrected, it’s not a normal course of business. Even for his breakfast bolus which takes much more insulin and thus has a longer tail of duration, his BG doesn’t seem to get above 170 (based upon periodic finger sticks). Lo
His BG does go down back to normal after 3 - 4 hours, which suggests to me that the dosing is correct. If it was not, it would just continue to stay high (the basal couldn’t bring it down).
I am afraid that a higher I/C ratio would cause it to stay lower, but then after full duration he would go low…
I have a 3.5 hour insulin duration, and my BG is back to target within 2 hours, sometimes 3 hours, after eating. I take my bolus 10-20 minutes pre-meal to avoid the post-meal spike, which puts me about 40-65 mg/dL higher at one hour after.
Your son is so young that I don’t think bolusing too early before a meal is wise, but if you’re bolusing after, that could be a contributing factor, too, actually. The food could be converting quickly before the insulin peaks in his system.
If he’s that high that long after a meal, I think it could be that his basals are off. Or his IC ratio in combination with his basals. I don’t think I’d blame the IC ratio alone. I agree with everyone that 300s are bad news. Hope you come up with a solution!
I dose my bolus usually after I’m finished eating b/c I have digestioon problems and if I do it b/f I eat then I get low and I then get high a few hrs after that, that said I usually have a normal “target” bs two hrs no more than three hrs after the bolus. I would definitely talk to your cde or endo just to see what they think. I think A1c’s are great but I think day to day readings can tell you alot more. You could be (just for an ex.) high for a month and the next month you could be low all month and it’d still make you have a decent A1C because they would even each other out, kind of cancel each other out if you know what I mean.
Alesha is right. If you’re using CoPilot to download results from the PDM, check out the statistics screen and look for something called “Standard Deviation.” This will tell you how tight his control is and it’s a better indicator of good diabetes control than the A1c alone. A standard deviation below 50 is optimal for good control. (Mine sits around 37 lately, down from the 70s!)
For instance, a person with blood sugars of 200, 54, 64, 190, 117 will still end up with a 125 average, but a person with blood sugars of 125, 130, 146, 102, 122 would have the same average but tighter control because the range deviates less from the average.
Great News All! I adjusted the I/C ratio from 1u : 24g to 1u : 20 grams and it made all the difference in the world! No lows all day (which I was a little afraid of). Was back down to target range within 1 to 2 hrs… NICE !@#$ Thanks for your input and messages!
