I agree, and in the moment, I am terrified to death! So I tend to overreact fast, hopefully it will get better the more we learn about him and his diabetes! It will be a learning experience that’s for sure!
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Quick question that someone may be able to help me with! Ok, so since my sons diagnosis his sleeping and eating schedule is so so MESSED up! With that being said, he usually gets so so hungry right bf he goes to bed which by then it’s already late like midnight or so. Well, I am so scared to give his Humalog and Basaglar close together so I make him eat a low carb snack instead of taking a bolus that close to bed time and that close to his long acting injection. I have voiced my concerns to his doc and nurses but they say I have absolutely nothing to worry about and it’s ok for him to eat whenever he wants despite when he takes the other injection and bedtime. Am I just being irrational here? He has gotten so tired of low carb snacks already !
I used to mix a NPH and Regular using syringe, back in 1980s, before switching to pump.
I think its fine for you to do, I assume as separate pen injections ?
I’m a late night snacker and take bolus at night frequently.
Once you are using omnipod, it won’t matter, you will use just one insulin in pod.
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Thanks for the insight, yes they are separate injection pens and the doc said I could even give them at the same time but just use different sites, it just worries me being so new to all this! Tomorrow is pump/Dex day!
I always gave my fast acting and then my slow acting at the same time, just aimed at a different spot. I think most diabetics usually do it all the time. Who wants to remember a shot again later?? The pump gets rid of that problem anyway.
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What happens tomorrow is going to change your families life for the better. Get some rest for your big day.
I have a family member diagnosed around that age and is a little older now. I have T1D too and these are the things we’ve noticed.
For lows and the 15/15 rule:
-That’s been the standard for a really long time, but I don’t think it’s the best rule to follow, better than nothing but… I was dx in the 90s and that was the recommendation.
Recommend considering the amount of active insulin (if he gets a pump that would be displayed), and the rate at which BG is falling. Sounds like you’re going to be getting a Dexcom, which will be extremely helpful with making that decision.
-if it’s falling fast (ie 75 and double arrow down on Dexcom) and there’s a significant amount of insulin on board (IOB), may need more than the 15g
-If it’s gradually falling and no IOB, may need less.
-Like most things with T1D it’s trial and error.
-Depending on basal pump settings maybe more sensitive to over correction of carbs (ie if basal is 30-40% versus if it’s 50% of TDD).
- If meal high in fat, takes longer for carbs to digest and may go low and then high, so may want to be more cautious in treating, but considering rate at which falling. For example, pizza.
We’ve found the best treatments for lows are:
-15g carb juice boxes (Juicy Juice or Apple & Eve)
-Glucose tabs. These generally absorb faster than sweet tarts. They make some sweet tart like flavors too!
- 15g Glucose drinks - but these are expensive
- Glucose gummies - better for daytime lows versus nighttime
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For the supplies to keep from MDI:
-I always have syringes as a back up for pump failure or extremely high BG (ie pump failure with high ketones)
-Long acting insulin - I get once per year or so as a back up. Learned the hard way a few years ago with a pump failure, and even with injections every couple hours of Humalog, ended up with high ketones.
- Extra pump supplies and old pump in case of pump failure. I know it will be a few years before you have an old pump on hand, but it’s worthwhile to keep it and a month or so of supplies just in case. I’ve used expired supplies before that were still sealed and no issues. Never used expired insulin though.
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For school:
He brings back up of everything but in his elementary school they wouldn’t change the OmniPod if it failed. Parent would need to come to change it. They also made him keep low supplies in the nurses office, which didn’t work well if he was low and had to walk down there.
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If getting OmniPod dash, it is a bit more user friendly, and will have better capabilities in terms of CGM / Horizon in future, than the older one, but a lot more expensive. There seems to be quite a few tech issues they’re still working out, below is an example of one, but will replace a pod once 3 failed days have accumulated.
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First, thank you so much for the wealth of information and perspective you have offered me. You have given me so much information thank you! I really like the advice you have given about when treating lows and what to think about. I know I have been told lows can happen at any time, but is it more of a situation that involves having more insulin given than actually needed, or is it just a phenomenon that we can’t even explain away and try to prevent?
They scare me badly, especially bc he can not tell me what one feels like yet! This is where the Dex is going to come in and help me immensely, I feel. Next, wow, I do not feel comfortable if his school is only gonna allow his low treatments be kept all the way downstairs in the nurses office. This can be life threatening, so that is not going to work in my opinion. I feel he should have a supple with him at all times ready to go if need be. Especially, bc he changes classes about 3 times a day. I will address this when I go to his before school meeting on the 12th and have it taken care of beforehand.
I may get him a little emergency kit that he carries with him every place he goes even outside at recess. What do you think? Wow, this is such a scary thing! Since his diagnosis, we have been in a whirlwind of emotions, one day he was a regular 9 year old and the next we are being admitted into the hospital with DKA bf I even had a real clue what that meant, and all within 24 hrs released back home with bare minimum knowledge of how to treat his diabetes, I have of course been given multiple classes in education now, but the first few weeks was such unfamiliar territory I thought for sure the hospital/docs was gonna sit by and watch me possibly hurt my child unknowingly by giving him something wrong, or doing unknowingly something wrong.
I have been discussing with him in the last few days about how when he is at school he has to be his OWN ADVOCATE for his diabetic needs, he has to speak up if he doesn’t feel something is right and if they won’t listen he is to call me immediately! Sending him off to school this year is going to be the most frightening experience yet! But hopefully, he will take well to the the new tech of the Omnipod and Dex and that will help us! Thank you again for your thoughtful reply!
@T1DMom
Have you had in-person meeting with the school nurse and principle to gauge how they will be working with you?
We had a really good experience with both such that we never bothered to do a 504 with the school. This seems to the exception and many people do find the 504 process to be what is required.
A number of good threads on this site regarding 504 plans and approach to such.
In terms of what the student can or can not do during the school day, this is very much different state by state. it is well worth it (IMHO) to find out what state laws you have which cover this.
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When I do that, I bolus for half of the excess carbs so that I don’t go crazy high later on. ie, if I ate 50 carbs but should have only had 20, the extra 30 I halve in my head and bolus for that. When my head clears in a few minutes, it’s not that difficult for me to figure out how much I SHOULD have eaten, and how much I DID eat.
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Sounds like you’re on a great path for learning all you can! Hope your Dexcom/ OmniPod appt went well!
For school and in general, if you haven’t already, I’d recommend contacting your local JDRF. They can probably put you in contact with another parent that goes to the same school, or at least another parent. They have a mentor program and generally other events for the whole family and it’s nice to meet other families with children with T1D and adults. They also have a school packet you can download.
You’re right though, him being an advocate for himself is important, but that’s hard to do if you’re low and not thinking normal. Hopefully your school will be accommodating, and he has a good friend that is aware of his diabetes that knows him well enough to know he’s acting different (and might be low).
It’s pretty easy to get a bunch of small tubes of glucose tabs and stash in a bunch of places, backpack, desk, OmniPod case, etc. I still do that (car, desk, work bag, other bags, bed, etc) and they don’t expire.
I’m sure you will learn as time goes on how to adjust rates and impact of food. But there’s other factors that impact BG too that aren’t as clear:
- Irregularities with Honeymoon period and later beta cell regeneration
- Hormones with growth spurt (generally need more insulin) as well as other hormone impacts
- Sugar alcohol (like sugar free popsicles) - generally raises BG slightly if no insulin, can also cause digestion issues.
- Alcohol lowers BG for hours after consumption (I know not an issue now
) due to impact on hormone release from liver - Prolonged exercise - can impact (lower) BG for a day or more
- Weight lifting (generally raises BG right away because of glucose release from muscles, then lowers later in the day)
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Well technically it is always a matter of more insulin on board than needed but there are multiple things that affect how much insulin you need at any given time which is where most of the unpredictability comes in. Exercise is probably the biggest monkey wrench in the equation and you will have to learn how much exercise affects his BG and take appropriate action.
With a pump you or he can give a temporary basal decrease and even a snack before he goes out to play or for organized sports, recess, P.E., etc. With MDI though you will just have to give him a snack and watch his BG like a hawk for sudden drops.
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We have his meeting to discuss his diabetes management at the school a few days bf it starts back, our apt is Aug 12th, school starts the 15 I think! He is already on an IEP at this school for his ADHD and Sensory Processing Disorder, and last year was his first year at this school, we had a couple of issues at the beginning but it all went well the rest of the year after I voiced each concern to the appropriate channels. We are new to the state, we moved here last summer for my husband’s job So he has only been one school year at his current school. I had another mom who is from my hometown, she has a daughter with T1D who is 11 and she said to get the 504 started before school starts so that it is in place and no questions can be left unattended to especially since he is so new in his diagnosis and can not relate how he feels and he still needs lots of help with his diabetes!
That’s a good idea!
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Thank you for the explanation of things that can affect lows, he is coming up fast on the age of pre teen hormones and the doc said we will have a hard time once he hits that stage! His appointment is at 330 today central time! I am so nervous but excited too!
Thank you for the advice I will address PE and recess at the meeting with the school too. I do know that when he does his karate class he drops FAST! Most of the time he is high so he doesn’t go too low but it does drop him a good bit and quick!
I used syringes for 25 years before I switched to the pump, so it doesn’t bother me at all to give myself a shot “the old fashioned way.” I don’t have any pens. The same insulin vial is used both for the pump and by syringe. So, I keep my open bottle of insulin and some syringes in a small cosmetic bag. If I go away for the day or longer, I always take it with me. (It also includes alcohol wipes). I really should take it all the time, since a natural disaster like an earthquake could keep me from getting home. The problem I have with keeping pens around is the waste of insulin; I’d probably be throwing away at least 90% of the insulin. You could ask your doctor for a prescription for some syringes; they last forever.
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Ok he is officially on the Pod! He did awesome, said he didn’t even feel it! Wow I had no idea how much the pump actually can do like the auto correction and so on! Wow! So, she lady who done the training for us was with Omipod only but she used to work at the Children’s Hospital here, she could not officially put his Dexcom on but she schooled me on everything I was worried about and we will be doing that here after dinner! Thanks for all the help everyone!
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Awesome. Congratulations! I’m going to suggest that you set your Dexcom alert thresholds conservatively at first.
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What do you mean exactly? Like set his targets a bit higher than normal? Like for his target and correction on his pump we went higher to be safe for now, we got his target set for 110-150 and it will not auto correct until he is over 150
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