ISF and I:C for a 10 year old?

I have a lil 10 year old friend who is also a type 1. He's on an insulin pump and bouncing BGs all over the place. She is getting little results from the so called specialist. Looking at his numbers it's like his I:C and ISF are way more than he needs. His mom is only giving him 1/2 the bolus suggested due to him bottoming out after every correction. Right now his ISF is 80 and I:C is 16. Giving 1/2 the suggested coverage for the I:C has been working great. But the doctor isn't listening to her. Is it common for a kids to have such a high I:C as 1:30? And should mom go ahead and take charge by changing that on his pump to make bolusing easier for him when school starts. I know I had to research and take charge of my pump settings. But I am scared to encourage her, for fear the Dr. would stop taking care of him since he's the only specialist in this area. But on the other hand this kid could really use better control. He really feels like crud bouncing up and down all day. I'm conflicted. I want to pass on a Pumping Insulin book to help.

Any suggestions?

Also his ISF is 1:80 but he was 322 at 11:30 am. His pump suggested 2.75Units. Mom had him take only 1.5U. At 1:25 pm he was 111. that would make is sensitivity like 150. But now it's 1:54 pm and he's at 75 and feels like he's bottoming out.

Well its individual for each person. I highly recommend that if the doc isnt listening, to play with the numbers. If children are very active (like they tend to be in the summer) then I would recommend basal testing as described in the book Think Like A Pancreas by Gary Schneider. Its a GREAT book with a ton of info pertaining to this subject. It can be tricky to nail down the basal patterns, but once its done, it should be smooth sailing! Try that (the book is like $10-$12 online) and if not it never hurts to play with the numbers yourself. Thats what i do and Ive had some great success doing that as of late. I hope this helps some.

Great idea to loan her your Pumping Insulin. His mom is already changing his settings so better that she have more info to do it. We all have to make constant adjustments on our own & it’s even harder for active kids with growth spurts. Would be good if her doc could refer to a CDE. They usually know a lot more about pumping than doctors & have more time to spend with patients.

Horrible to be bouncing high & low all day. He may need more insulin when he goes back to school & isn’t as active.

I agree.

I agree Gerri. And he will most likely need more when he hits puberty too. But his Dr. which specializes in pediatric diabetes and his CDE have been told by mom that she’s only giving him half the suggested amount but they just aren’t making adjustments or teaching them how to make temp adjustments on their own. They only adjust his basal. Which isn’t much of a problem. I haven’t read “Think Like a Pancreas”, is it better than the “Pumping Insulin” by John Walsh?

I don’t have a pump, so can’t say which is better other than it’s the bible of pumping. Think Like a Pancreas is good & as is using Using Insulin by John Walsh,

Think like a pancreas is a great book for the fact that it breaks all the medical mumbo jumbo down into plain english. It has a lot of the theories of why we give insulin, and how the doctors arrive at the numbers they recommend. Its very detailed, but more important its very easy reading. Its definately worth looking into. Having had D for 28 years there is stuff in there that I had forgotten. I hope this helps some.

Great advice so far, but I’m just curious. How long ago was he diagnosed? Is it possible that he is still in his honeymoon?

FHS I thought about that but he was diagnosed Feb of 2009. So, his Dr. says he’s already over it. That’s why he started him on a pump in Jan of this year.

Hmm, short story.

My first internist put me on pills because I was diagnosed at the age of 20.

They did absolutely nothing for me. A few months later, I switched to an endocrinologist when I enrolled in a study on newly diagnosed diabetics in their honeymoon period. He immediately put me on insulin. IIRC the period of time was between 4 and 6 months after DXed to insulin. A year later, my activity level was so high (ran track in college) and my insulin dosage was so low (something like 5 units of NPH and 3 units of R before each meal) that my endo actually toyed with the idea of taking me off insulin. He suspected that I was still producing some insulin, even at that point, and that combined with my activity level was creating my dosing situation.

This probably doesn’t help your friend with the situation she is having with her doctor, but it still might help explain the high IC and dosing issues. Not sure how it could help you practically though. =(

Mom and son might be able to get some one-on-one assistance from trained personnel that work for the pump manufacturer. It would certainly be worth making the inquiry. If the manufacturer does not have skilled personnel available for one-on-one training, they might be able to refer Mom and son to a few pump education sessions to get them on the right track. Sites like medtronic have on-line pump tutorials, but I believe these just cover the basics of pumping.

Cheryl

It could also be that the basal rates aren’t right. Pumping insulin would be a great guide to getting the settings right – step by step.

We all have different insulin needs. For example, my I:C ratio is 1:13, but my ISF is 70-80. It seems that my ISF should be lower based on my I:C ratio, but I checked them and for whatever reason, it seems right.

I feel for your friend, as incorrect pump settings are so difficult to live with and hard to correct.

You could also suggest that she meet with a CDE (if there is one available) or the pump representative for the region to see if either could make suggestions.

By stark contrast my I:C is 1:5 and my ISF is 1:12…Insulin is like air to me.

Honey moon phase in some could be longer and can at times easily last for years. Some many not even have a honey moon phase. Its better to put him on CGM for 2-3 days and see how his sugars are changing on a minute by minuet basis.

There could also be a problem with his basal rate setting. Could try with different basal profiles.

332 is too high while on pump and makes me suspect something happened in the morning!!! probably there was a low that made the glucagon in his body kick in.

I assume that he had a meal at 12:30?? probably can move the I:C to 1:18. But then it depends on his body weight. looking at his sensitivity my guess is he below avg weight??

The MANTRA is Don’t worry about Highs, correct the lows and the highs will automatically be taken care of.

These are my questions??

  1. what happened in the morning? between 4:00AM and 11:00AM?
  2. what did he have for break fast and what were his sugars like in this period if any?

WOW…That’s some insulin resistance. Do you take any oral meds to increase your sensitivity? I have seen high insulin resistance like that in the ER. It’s hard to believe though.

My I:C is 1:9 during the day but 1:8 after 7pm. My ISF is 1:40.

Just have to add my thumbs up for “Think Like a Pancreas.” It’s true that it cuts through the mumbo jumbo, is easy to read, fun to read, and yet presents extremely important information. I have it within arms reach in my bookshelf right now. Great book. And I agree that also great are John Walsh’s and Howard Wolpert’s books on pumping - even if you don’t pump. They have a lot of information that applies to injection users.

Mine lasted several years, that’s why they had a hard time figuring out which type I was. Finally got the right tests for the right diagnoses.

He had not eaten since 8AM and he had 48 carbs of cereal (not sure what kind) and about a cup of milk. He was 117 when he ate. And he wouldn’t eat lunch till he got down to 75 at 1:54pm because his head hurt. Yes he is skinny but the Dr. says he’s not under weight just on the border. He’s about 62 lbs.

I’m going to try to help mom find a good I:C and ISF so that they can fine tune his basal.

I guess I know which book i’ll purchase next…lol.

I didn’t mean for that to sound like I didn’t believe you. By hard to believe I meant scarey to me. We had a man just last week whose sliding scale called for 76 units of Novolog for a 348 BG. That’s more than my daily dose on a high carb day.

I used to be with a doctor that didnt really listen to my mom either. Im 16 now, but at the time I was around 10 or 11. Mom ignored the doctor and changed my pump settings herself. Turned out that the doctor was not listening to the point of not really caring that she changed it. We’ve switched doctors since then. Either way we have to drive 2 hours for a specialist. I say let the mom do whats safe for her kid. I mean, this is a kids life we’re talking about here. The kid staying healthy is way more important than them getting into some trouble with the doctor.