Hello! I have some new questions that have come up since starting OP and I was wondering how you all handle these issues.
1) I worry that Mason's Pod could alarm in the middle of the night and it would not wake him. We are on the first floor of our house and Mason is at the opposite end on the second floor. I purchased a baby monitor and the range is too far. I check him between 2-3 evey night and sometimes between 11-12 if he goes to sleep with IOB. Do you guys hear Pod alarms in the night? Do you use a baby monitor?
2) Mason has breakfast at 7am. Snack at school is at 9:30am. Lunch is at 11:30am.
I am beginning to see that the IOB feature on other brands of pumps is far more important than I had originally thought. Our current plan is:
-the principal and secretary are bolusing for carbs at snack time. No BG check as there is still IOB from breakfast and I want to keep the process simple since there is no nurse at school at that hour.
-then at lunch we have IOB from snack so the Endo does not want us to correct at lunch.
Obviously we are stacking (I think this is the appropriate term) insulin all morning and I see why but I hate that we are not correcting him all day long at school. My nurse will ONLY do what is on the 504 and signed by an ENDO. If I make any changes, they must be signed by the Endo. She is great but a little difficult in that I, as a parent, have to make adjustments, as needed. So, if he is high at lunch it could be due to snack IOB, so no correction. If he is LOW, then I need her to correct with OP as OP recommends so the low is corrected. Is there a better way? Should I go to zero carb snacks? Any ideas/suggestions? Am I over thinking this? Is this as good as it can be? I want to have a good plan in place before I redo my 504 because tweaking it means endo signature.
Pod Alarm - since we’ve been using it (more than 3 years), it’s happened twice in the middle of the night. The first time I went in to check and it had been alarming for at least an hour - no bg issues resulted, another time Caleb woke up but I think that was a fluke. I have a baby monitor that I use sometimes for DexCom alarms, but I’ve never used it for OmniPod alarms as it’s never been a prevailing concern for me.
IOB - What’s Mason’s duration set at? Interestingly, as I was reading I was thinking, “Those times are just awesome!”, but then realized you didn’t think so! lol Caleb’s is set at 2 hrs. We bolus about 7:15, bg check at school bt 9:30 and 9:45, snack at 10am and bg check, bolus and lunch at 12:15. Caleb will correct if high at any of those times.
You may have noticed that I didn’t mention a bolus for snack. I have Caleb’s basal rate such that it covers a 20 to 24 carb snack. This allows him to get his bg checked before he eats and a correction working if needed, and eliminates another touch point with the nurse. This works well because snack is the same exact time every day.
There are a lot of elements to Mason’s situation. What is in the 504 that restricts the nurse? Caleb’s is vague enough to allow for my discretion. His doctor’s orders say something like “dose according to parent chart” which I create and provide to the school.
There’s more than one way to skin a cat. We’ll figure this out.
PS - And I caveat this with “everyone is different” - having the benefit of DexCom for more than a year, I have seen that Caleb’s blood sugar does not peak nearly as much as I had expected. He will typically not rise more than 40-50 points after a meal, and often times less than that. So in Caleb’s case, I know that if he is much above that, he needs a correction or his blood sugar will not come back into range. So not correcting if he’s high at lunch time seems like too blanket a statement to me. There has to be some kind of compromise, no?
Ah, the dreaded 9:30 snack!!! Have been battling this since Ty was diagnosed (at 20 months). I have found that I cannot correct a high in the morning until 3 hours post breakfast (same for myself and my son). But, after that initial 3 hour window, I will correct both of us 2 hours post bolus for any other snack/meal. I still have our IOB set for 3 hours, however, just in case! Until you figure out when Mason is “done” with his breakfast bolus, I would send him with a no carb (or very low) snack for the morning. (cheese stick, sunflower seeds, peanuts, hard boiled egg). I have even done sugar free jello (I know, so nasty, but it’s nice to get a special "treat"every so often when you can’t have what the other kids are having). In time, you should be able to figure out when you CAN correct from a morning high. Unfortunately, this does take some “figuring out”, and it’s a bummer you need to get ENDO signature with each change! Right now, Tyler is allowed a morning snack if he wants it (sometimes he will still pick a non-carb), with no correction. But then he is corrected at lunch. One other option - is it possible to have breakfast earlier, so you can be comfortable with a correction being given at snack time?
Right now I have been giving my daughter(3 yr old) a no carb snack in the morning for that very reason - the first day on the new schedule they accidentally tested and corrected and she went to 45 by lunch but now it is under control - I wish Omnipod would figure out IOB with meals - I think it affects us with little children more than the rest of the population because our kids have other people controlling their pumps(and not everyone in charge of our children have taken a pump class).
My diabetes educator said that with other kids she has done what Lorraine has done - so if the no carb snack wasn’t working we could change.
I am with you, Jen. I have always hated the 9:30 snack especially when most kids have junk. We are new to pumping so I have never “corrected” until the next meal with MDIs. (The 2 times in 18 months we got a needle out to correct a high at night were awful…fighting a low in the middle of the night both times.) The gap between breakfast and lunch is so short I have still not corrected a high in between BFand LN on the pump. You guys have me wondering about the duration…for example…when we first started on OP the Endo had us testing every 3 hours and do zero carb snacks so we were bolusing at 6:30-7am and then testing at 9:30 at school…so looking back he was always VERY high…cereal spike (that is another post all together) 377, 313,346, 412. Since then we have adjusted BF ratio but I think this leads me to believe his duration is longer because by lunch he was 240, 131, 259, 328 respectively…ugly numbers I know but he did still come down with no additional insulin at snack. I am starting to think his duration is indeed 4 hours;) Wow.
Yes, breakfast earlier would help also bolusing 15-20 min before breakfast would help the cereal spike but that is easier said than done:) He is a slow starter like his Momma!
Lo, glad to hear the Pod alarms are few and far between! Sometimes I feel like I am “What IF”-ing myself to the brink of craziness but “What if…” We do check him in the night now at least once if not twice so we would catch it eventually. Going to look into the baby monitor for the long haul.
As for my school nurse, a good example would be the week before we started Podding, our endo suggested changing Mason’s sensitivity number. She would not do it unless I had the endos orders rewritten. But when he was in cross country I would write on the lunch list, all the carb counts and ask that she would reduce the insulin by 0.5 units because he had practice after school and SHE WOULD DO THAT? It is the same thing…She is very cautious and that is the most important thing but she needs to understand that diabetes requires constant tweaking. (She also calls him “brittle” I cringe every. SINGLE. TIME.)
Celeste, I too, hope that OP is working on this because it is a bigger deal than I thought. Talking to friends on other pumps and the IOB calculations are one of their favorite things! Thank you so much for your input! I still dont know what I am going to do but you guys really have me thinking:) XOXO
Before going on the pod, Ty and I would both be in the high 200’s (sometimes low 300’s) as late as 3 hours post breakfast and then we would drop 100 points. It is better on the pod, though. I also worked on getting him to eat a less carb-y breakfast, for this exact reason. Right now I am doing the Whole Wheat Eggo waffles, with just butter and some bacon. A half cup of millk, if he asks. The waffles are only 13g carb, and I believe there is 2g of fiber in there. (maybe more?) If Mason is craving something more sweet, you could always add a few drops of sugar free syrup. Most diabetics have a harder time in the morning with insulin resistance. As I said in my original post, this is just a breakfast thing - after that I am comfortable with correcting 2 hours post bolus.
Caleb’s timing would be almost perfect for my son. After 2 hours, his bolus is doing practically nothing more for him.
What I would suggest if you are worried about stacking is to make his correction threshold on his PDM higher. That way, when you hit the 9:30 snack, you can bolus for the food, even if his BG is still a bit high from his breakfast bolus not quite being done. For instance if he was still 200 at 9:30 and you set his correction threshold very high (for argument sake, let’s say 225) then it would recommend a bolus amount that had not correction factor in it. This would have the same effect for lunch as well. This would allow you to bolus for the food without overdoing it.
Also, I would make your 504 refer to your testing and dosage schedule as opposed to having exacts in it. Things change frequently and you need to have the flexibility to change Caleb’s details with it without running to the Endo each time.
My son is 16… is empty reservoir alarm went off…he got up… turned it off and went back to sleep! Good thing I was testing him that night for basal testing and I got there 2 hrs after he turned it off… and I had corrected him 1 hr before he shut it off… he was high…but not crazy high. Yes… this is a big fear for me. wish that his PDM could read his pod anywhere in the house and I could keep the PDM by me so I’d hear the alarm… Another time… it went off and it was on his stomach and he didn’t even hear it… it had been going off for 1 hr! Not sure a baby monitor would even pick that one up.
