I have seen people that have a poor appetite that are told to bolus after they eat. They regularly have post meal spikes into the 300’s that come back down to normal at the tail of the insulin response. I try to get them to bolus even a little bit up front to blunt that but they are so scared of lows they won’t.
Jake/Gil - everything is different when you are dealing with a small child. It is not at all the same as with an adult. I am a diabetic and so is my five year old son (diagnosed at one). Our care is totally different! I would always correct a 300 for myself. Not always for my son. 
I do not see any reason why it should be limited. But if it should - I can imagine 24 would be enough. For a toddler, even 250 is sometimes not correctable. I would imagine - no limit.
Well, imagine the situation that we deal with every morning. He eats at 8:30 or so, we enter all of it as a correction and not as compensation. Now, at 10am, his BG is normal, so we would want to bolus for carbs only, but if we say “Yes” to include BGs into calculation, the IOB will be deducted from his insulin for carbs, and he will get free carbs, which we do not want.
I am not sure how to find the correct solution for that.
Here is something off the top of my head. When figuring out the dose the first time choose NOT to include the BG’s into the calculation, put in the carbs, and get the dose needed. Exit out and this time choose Yes to include BG’s into the calculation and no to “are you going to eat”. Override the pump and put in the dose that was previously suggested. With that you would be covering the carbs and getting them into the IOB. I guess the other way would be to just do the math for the carbs and use that given as a correction through the Pod.
This is absolutely ridiculous that people have to go through this when you are suppose to be using advanced technology. It is not just OmniPod that has these weird issues either.
True, but this insulin will be on board and deducted from carbs even if his BG is normal. This way he always will get free carbs for snack…
We are down to calculating targets/correction factors based on how much IOB we might have, but then run into limitations of upper trash-hold only being 200.
We have to start patenting those formulas soon
And yeah, it is soo ridiculous, we spend hours every evening trying to figure out how to send him to a day-care the next day.
The problem is getting stuff like that past the FDA…
I know ideally youd have no restrictions… but if you have some soft restrictions vs hard restrictions… (Soft restrictions throw up an idiot box, with an are you sure you want to do this, actually my pumps pda (yes i said PDA not PDM,), if you bolus more than your average number of units, or some such (tends to seem to go off if it calculates a high insulin bolus, kind of saying this is higher than your normal boluses… are you sure you did the math right kinda thing)the FDA may let it through… thats what im seeing… having soft limits with a warning dialog may actually let the lack of limits or the higher limits needed for a child or someone with different than usual needs but by helping to protect users such as you and I from ourselves… Ideally did you know the FDA would like a one button bolus… they dont trust us to do our own math! ;)… Thats whats gils getting at… the idea is to put in a high enough limit to satisfy the FDA… but be usable for your situation… FDA doesnt like approving things without some failsafes/limits…
I know its not ideal but completely ignoring the PDM and using a sliding scale for meals and have that entered as a manual bolus? Youd solve the math problem for the caretakers and you could always do carb counting and IOB at home…
Just trying to think around this problem for yah.
Thank you all !! Yes, the FDA is typically OK with allowing high boluses or skipping one, as long as it’s a multiple step procedure, to avoid an accidental key press and getting the user in trouble. Having a “safe” maximum/minimum default value for things and forcing the user to enter “Settings” and change that default to whatever he/she wants, then having a pop-up “Confirm” screen when actually, for example, delivering the bolus is perfectly acceptable.
Seems hard to find the ideal solution. Other than teaching them how to go back and see what insulin he already has from his breakfast carbs, and subtracting that the way you do. I know it is hard to get kids up and eating early, but if his snack is at 10, what about eating breakfast at 7 so his insulin is reaching peak or post peak when they check for snack, or going with small carb/no carb breakfasts so the IOB isn’t a problem?
Yes, maybe, as suggested by you and others, the best solution for this is to have MANY I:C ratio and correction factor time slots AND a higher/no limit for skipping a correction. This would avoid last-minute calculations and deductions and possibly making a mistake. Thank you !!
They told me at the ADA in San Diego they were back on the drawing boards for two reasons: 1. Their “pod” is not waterproof. 2. Their “PDM” looks like a 1980’s garage door opener.
So it could be longer, but a release towards the end of 2012 sounds likely, for the tasks at hand.
This is what we are probably going to end up doing. Except … then he has a lunch at noon :)))) But his snack is small and we can play around with correction factors at lunch, not too much IOB from snack.
Thank you all…
Our daughter has just come out of daycare and we used to give her a no carb snack in the morning (they had snack then 1.5 hours later lunch) and they would just check her glucose at lunch. My daughters lows tended to happen after lunch so it wasn’t much of a problem for the no carbs in the morning. Her afternoon snack was timed much better - so they could correct in the afternoon.
No-carbs snack is a solution, thanks. They provide their own food there, so all kids eat together. I would not want him to have a separate snack, but if this is the only option - I will have to do it. Thanks again for your suggestion.
My son follows this formula: If it’s been less than 2 hours since he bolused, he “uses his number” if he’s in range or below. If he’s above range we don’t use the number. I want the bolus for the food, but not the correction since he’s probably still going to come down. It’s not perfect, but it’s simple and he can do it at school himself (he’s 10) It’s also simple to write down for someone else who has to take care of him. Yes, sometimes that means he’s higher than I’d like for longer than I’d like, but it rarely means he’ll go low.
Yeah - my daughter was the only one eating a different snack - but I was providing her lunch too (they also provided lunch) because the large catering packages they received were not labelled with carb info. THough on Wed they had local pizza delivered - so that one I could handle. My daughter is somewhat of a picky eater -so it was easier for me to provide snacks - though any of the parties I would try to have her eat what the parents were bringing in.