Yes, my response exactly!!! Then she told me that she’d been a pharmacist for 20 some odd years… and she knew what she was doing. I decided to call back the next day at which time I spoke with an incredibly helpful pharmacist. I suppose it’s just the luck of the draw!
Someone posted on FUD a while ago on how to split cartridges. Have you seen that or tried it? Split some 8’s into 4’s maybe?
Otherwise, maybe some creative endo script writing.
Just fill in the V, W, X, Y, & Z numbers for what you need:
Administer V 4 unit doses daily for breakfast;
W 4 unit doses daily for lunch;
and X 4 unit doses combined with Y 8 unit doses daily for dinner.
Use Z 4 unit doses as needed for post-prandial hyperglycemic excursions.
Doesn’t matter if you use certain amounts for breakfast, lunch, or dinner. Or even if you never eat breakfast. Or if you need much less for any particular meal.
All that matters is you get the script that gives you the numbers you need.
So either work with your endo to get a script like that (if you have a sharp, helpful, and competent endo).
Or just tell your endo that is what you need.
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I made this effort. Still not sure what weill actually be delivered in the mail. We’ll see sometime over the next few days.
I’ll keep this little template handy for next time. I suspect he didn’t end up ordering any 8 unit cartridges. The nurse was the go-between for the doctor and me, so I think some things were lost in translation. Using the template would likely result in less information being lost.
Thanks!
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We started with a carb counting or estimation, but based on the results we tweak it until we find the dose or doses that would work. For example my kids love Chipotle and for the dishes Jaime eats our doses range between 6-8 units.
The best way I have to explain it is that we rely in experiences. If it is a new food we would look up the carb count, but based in ingredients, fat, etc.
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I understand - you’re dosing based upon foods, but not getting to the nitty gritty of carb counting. I find that easier to do as Caleb is older. He was much more sensitive when he was wee and it seems like just a carb or two off would make a difference. I remember when he would treat a low with a single sugar tab!
Exactly! By now we can say we know how his bg’s typically react to certain foods or times. For example if he eats oatmeal during the morning the amount of insulin he needs is way higher that if he eats it at night. Also, remember we have a pretty controlled environment, and his routine is pretty active, that I believe helps a lot.
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I eat pretty much the same too but I still do the carbs because my pump adjusts everything for me, I dont always use those features but it is nice to have it there if I want it to reduce my bolus or whatever. I usually eat 5 g more than I bolus for to stop lows so I have my, own weird way of calculating everything. It almost never woeks thoigh and I usually drop or spike or crash in varying degrees, and then correct things with the pump and or food before it gets bad.
Yes, this is what I do - I start with the carb count, but because I am low carb other factors influence my insulin requirements: I also have the added stress of pancreatic insufficiency so have to supplement digestive enzymes as well, and those also impact how well a meal is metabolized and whether I increase or decrease the amount of insulin for each meal. I also have complete support of my endo who often tells me he wishes more of his patients would take such an active role in managing their diabetes.
What does SWAG mean?
Told my CDE that I look at the pump calculation but then do what I think. She said that I was defeating the purpose of the pump’s calculations. I didn’t tell her that I often just input how much insulin I want.
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Scientific Wild-A** Guess
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Same here, mostly. I go ahead and enter everything into the bolus wizard but when it comes to the actual dose I often tweak it according to whatever previous experience or intuition suggests. Keeping a record of what you’ve done is one of the advantages of having a pump, even if you aren’t always taking its advice about what to do.
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Thanks, sounds like what I often do!
What you are doing enhances the pump’s calculation with your 8,760 hours/year skin-in-the-game hard-won wisdom! Maybe she needs to be reminded that doctors often assert that what they do is “practice” medicine. This is a not so subtle nod to the fact that while medicine is based on science the best clinicians will listen to the clinical knowledge they’ve gained that is not in the books, formulas, or science. Their art does not ignore their science knowledge, it enhances it.
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I do both?
I will guess carbs while eating out. I don’t eat out that often, so I am not going to overly worry about it.
But, until they have a REAL bolus adviser where you can enter in protein and fat, and ratios for those as well, plus maybe a glycemic modifier, I will have to make do on my own.
Now, what I do when I eat something fairly often (breakfast burrito for example.) I can count the carbs in the tortilla, but have to guess at the protein and fat.
I basically enter in my own ‘carb count’ for this based on experience (55 carbs is what I enter.)
Basically, I am lazy and figure out a generic carb number to enter for foods I already know. I do this most of the time.
The other times, I will count carbs, put it in the pump to see what it recommends, then add what I want for protein/fat then split the bolus.
I also really wish you could program the split bolus separately, but what I do usually works good enough. I do this for pizza and have had some really good results. And some not good results while learning… oh well.
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I carb count and log everything. One carb or .1 insulin really can make a difference. I must say that the recent acquisition of the Dexcom has made a huge difference for me. I always do an extended bolus for protein and fat and to see when it actually hits helps in the adjustment.
I use carb counting, experiential bolusing, and some guessing.
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I WAG most of the time.
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It’s not an exact science, even with scales, carb. apps, and good labeling. Even when I eat the same things, my metabolism is not always the same and the absorption and potency of insulin is not the same from day to day when using a pump. Whether counting or guesstimating, there are corrections to be made here and there. Eating lower carb helps for sure and lower calorie as a lifestyle is helpful for me.
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I definitely need a higher carb ratio and basal rate in the morning and so much less in the evening.