New pump user with questions...please help!

I have a question. We have only been using the pump for a few weeks with our son.
He was getting insulin through his arm by syringe. He is extremely skinny ( 3% for his age). They said the only place he can put the insets is his buttocks ( top part). Well, the problem is… we had great control on the syringes. He was always within target. He could eat 15 minutes after the shot in the arm. Now, his BG are fine if he doesn’t eat ( so background insulin level is fine), but every time he eats…he spikes. I know it’s not a ratio issue because he does come down to where he should be after 4 hours. I think it’s a timing issue. I have had him wait 30 minutes and it still spikes. Anyone else have a skinny frame and needs to put it in this site? Any idea how long we need to wait to eat? The convenience of the pump is being lost by how long we have to wait. He is using the angled inset as well…which is supposed to be better for skinny people. Thanks in advance for any tips/ help you can give. I’m getting frustrated and want to bail and go back to needles! Help!

At nearly 64, I’m considerably older than your son (grin)…but when I was VERY skinny after coming out of the hospital a couple of years ago, I also had to use the same upper buttocks locations you do. I found that I also suffered more spikes after meals.

I’ve never seen this mentioned in any of the books I’ve read, but my personal experience showed me that sites far away from my stomach usually meant more spikes after meals. Kind of makes sense, I guess, since it would take the insulin longer to get into your system.

Wish I could be more help…

This is interesting because I feeel my buttocks makes the insulin work faster. I theorized it was because when I move I use those muscles far more than my stomach which makes absorption and take up also faster.

Crusso you say you HAVE to use the buttocks for the pump but were using his arm for shots. Why can’t you use the arms for his pump sites?

At least I know I’m not the only one… Thanks

They say he is too skinny to use it on the arm. They said he has only the top buttocks and that’s it. It’s a bummer.

If it was my child and I was having the problems you are I would be inclined to at least try and monitor closely for any problems.

you believe insulin to carb is OK because of the end result. Sounds good to me. Some points to ponder: 1) look at fat content. If high fat, spread the insulin out with a combo bolus. If carb is high and fat low, use a quicker bolus. If carb is high with fat use some now and spread rest. Percentages and times are a scientific guess for you and your son. 2) if you are using a CGM, try the same meal several days in a row, locking down as many variables as possible to test keeping the CGM values between the lines. One TD member calls it “helicopter” to go up and down but staying between the lines without crashing.
BTW, I give 90% of my insulin (I am almost 60) over one hour and my CGM stays between 60-160 80% of the time and 60-200 95% of the time.

Hope this helps

Thanks. All good ideas. I will try them. We don’t have a CGM, but I can have him check his BG every hour after eating up to 4 hours and see the results. What’s weird is that he can eat the exact breakfast and one time he stays in the target and the next time he goes way up to 280!! It’s a bizarre thing.

The eating the exact same thing, same time of day and all things being as equal as possible, yet getting different results is what frustrates me the most about this disease.

There are some other variables - for example:

  1. happy vs sad
  2. activity level
  3. health vs illness - watch the bugs
  4. mom’s variables of all of the above can steer the lad’s BG into bedlam.
  5. when mom’s frustration level goes up, the lad may look cool and calm but be stressed to the max.

    These are just a few of the additional variables that will help you pull your hair GRIN>>>> and make management difficult.

    DO NOT LET THIS GET EITHER OF YOU DOWN! I can share this crazy happening. I ate the same pasta dish three nights in a row while at a confence. I used the restaurant’s nutrition guide for insulin dose calculations. First night was fine, second way HIGH and third bottomed out. Go figure. I shared with my CDE and she said “welcome to the world of diabetes frustration”.

    Keep up the good work. At this point, there are formulas and intuition. Your job is to balance the formulas and intuition. I have heard a mother’s intuition is always on target. Relax and stay on target.

Great list to keep in mind. Thanks

Agree with all the above. It’s frustrating when you think you think you’ve got it nailed and it changes on you.

I also like Jay’s list too. But I think I’d add one more and that’d be blame it on the gremlins…In that case I just shrug it off treat and move on. Not much else you can do.

Thanks. It’s been so frustrating. I thought the pump would be better, but his numbers are higher! And more lows. All because of eating and timing and the site,etc… I know it’s bad to have him go up and then come down. I think this is worse than staying higher, isn’t it?
I don’t know how anyone with diabetes or a parent of a diabetic child could not believe in intelligent design…the pancreas is an amazing system that is so difficult to mimic… Frustrating but amazing at the same time…

It has taken almost 3 years for me (pumper since 28 Sep 09) to have it run on auto-pilot with minor corrections along the way before the helicopter crashes or goes to high. I am beginning to grasp the points of fine tuning a pump to my list of variables in my earlier message. Mastery of sweetness (BG levels) does not occur over night.

If I were to take a board with 25 nails started in it and an expert carpenter could drive all of the nails in with 50 hits, how long would it take you to be able to do the same? An insulin pump is a TOOL. It takes time to learn how to use a tool - not only the tool but how your body (your son in this case) reacts to the tool.

Ask the endo if there is a different insulin. I did not see which insulin you are using. I had to change my half life of Novolog from 2 to 3 hours in order to get things right.

Use your intuition.