Thank you for taking time to answer all my questions with your experience, and I realize everyone is different but I just wanted an idea. I think the docs and team have put this idea in my head about insulin and it has me so scared of it.
Itâs perfectly natural to feel the way you do. Insulin is not dangerous unless it is misused. Youâre not going to hurt your son with it.
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Thanks for the reassurance, I just want to get better with all this! I know it will take time, I swear something feels off since we have been on the pump he is much higher in the in between times of not eating, they have his Basal messed up I think and itâs throwing everything else off too. He just ate something that he normally eats and we have eaten and dosed with the pen needle and not had this happen bf, but now he is running so high the CGM has maxed out. Itâs an hour post meal right now and he still has IOB
I agree that the posts about Sensoenics were not relevant to this thread and have deleted them and the direct replies, which were getting a bit acerbic. Up to the poster if s/he wants to start a new thread on that topic.
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Thank you! I tried to ignore! But it was a bit irritating!
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The basal rates definitely need to be adjusted.
To be honest that looks pretty normal after removing an adhesive device. The adhesive can be a little harsh especially if you have sensitive skin, but if the site isnât itchy or inflamed or painful to touch I personally wouldnât worry. The unisolve or similar product will make removal easy-peasy. You can put skin barrier products on beforehand, there are several available and you would just have to try them to see which one works for your son.
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This is how it goes when youâre acclimating to a new regimen, so take a breath, itâs ok. Using a continuous basal delivery system is different, it takes a while to get it dialed in, and theyâre always going to be more concerned about lows than highs, for good reason, so they do it incrementally.
Thatâs not good, and you should consider a correction dose. SOP is to use a pen injector in case there is a delivery issue with the Omnipod.
IOB is also something that varies by the individual, the type of insulin etc., so like the other parameters it has to be tweaked in light of empirical data from the actual patient. More to the point is that maxing out the CGM is telling you that he just doesnât have enough insulin in his system for the carbs heâs had and a correction is needed. Standard advice as above: use an injector in case thereâs an issue with the pump.
A high isnât going to cause any immediate harm necessarily, but if youâre pegging the meter you want to be sure heâs not spilling ketones because thatâs a precursor to DKA. Do you have ketone test strips?
ETA: Iâm kind of assuming you know the signs of DKA but in case not: sweet/chemical smelling breath, gasping or difficulty breathing, and nausea or vomiting. Iâve been urging you not to hit the panic button, but those are the signs that mean, yup, ok to hit it, and head to the ER.
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Very well said
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Did you verify with a meter (fingerstick) ?
How much IOB and what is his correction factor? ie - how many BG points does 1 unit normally correct?
Also do you have a Glucagon emergency kit?
I would likely do a 5-unit syringe (we do not have any pens but same concept syringe or pen just not pump in case there is a pump issue) at/over 400. That would not be a complete correction but enough to get things moving in the right direction. As the BG came down, I would give more insulin in smaller doses.
Benefit of having Glucagon is you donât have to worry quite so much about a possible subsequent low as you can use the Glucagon if need be. We have not had to use it for emergencies but did use it once (on a different adult relative) as a test and to get comfortable with it. Really much easier to use than it looks.
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Yes, I did verify with finger stick, it was 392! He is drinking water and it is going down some! It takes me so much to get him to drink his water every day! He has sensory processing disorder so he hates it! But he HAS TO HAVE IT! His correction factor is 1 unit will drop 100 pts but that is on the very high side, in my book according to his age it should be 1 unit for 75 points.
Yes I have an emergency glucagon kit, but I am confused with what you are telling me to do! Now he is dropping more than 2 mg per min, itâs down to 332 now and got a straight arrow downward!
You want the arrow going down right now. What is his basal rate now?
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Downward movement is good.
It takes insulin to go down.
That is the nutshell.
Glucagon is great backup in case too much insulin and ultimately ends up too low. Emergency backup.
Gatorade has G zero. Less than 1 carb for 12 ounces.
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Oh ok I see. Yes, he drinks the Gatorade zero orange flavor pretty good! I was told to wait 4 hrs between corrections? Its still high and his IOB is 0 but that is set at 3 hours, so do u wait for 4 hours? This is the confusing part! And like say what if I would have given a correction when he was at 400 and his sugar began to drop naturally like it is now, would it have been a dangerous situation?
Yes arrow down is good right now! Sorry if that sounded different! His Basal is set for .45 units per hour, at total of 10.8 daily. He was on 14 units a day of long lasting by pen bf the switch!
I would definately not wait 4 hours at this high BG.
I would be dosing every two hours.
Did they give you a sick day protocol? If so, what does that say? This could be treat the same if they gave it to you and it was a good one. lol.
And no. At 400 it is almost impossible to get a dangerous situation/drop. That is so high and you will have so much time to catch it at the bottom and give carbs if necessary to smooth out a landing.
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@Tim35 is giving you fabulous advice here. I would just add that maybe you should set a temp basal at 1.00 units per hour for a couple hours. The correction bolus is going to need help. I would also advise, calling your Endo team tomorrow and tell them to look at the Dexcom clarity reports from the CGM data to adjust Aaronâs basal rates.
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Thanks you guys! As far as his âsick dayâ protocol goes, I have a binder full of instructions, for sick days with Ketones Mod-Large I am to give it based on ketone color- if moderate I give 2 % of his TDD, if Large I give 20% of the TDD. He has no ketones right now which is what I am confused on!
What is his BG right now? How much IOB and how much time is left?
No ketones is good.
You gave a bolus (I think but maybe you did not??) and he is dropping.
As Jason asked, what is his BG now and how much IOB (units and time). Was the last bolus from the pump or pen?
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