Thank you for the advice! Well we are shooting for a target of 150 until we get better with controlling this stuff. The doc didn’t want him to go to low, bf the pump I would see him at or right at 150 pre meal. Now, however since they changed up his Basal he is trending higher like 190-210 range pre meal. His spike from there get up to 340 after eating maybe a little higher. Then I can see the insulin fighting against his BG and he will go down to about 250 but then when his insulin runs it’s course he will have a smaller spike there at the end and kind of linger there for a good while. Sorry I hope I explained this in a way that is easier for you to understand!
@T1DMom
I would argue the case that is too high.
I get the Doc said that and this is not medical advice and just a forum and you don’t know me and all that happy horse ****.
But …
Higher BG takes more insulin. It is not liner.
We might use 1 unit of insulin to drop 35 points from BG of 115 to 80.
But trying to get a 35 point drop from 285 to 250 will take more insulin. Maybe 1.5 units? I am not sure except I know it takes more.
IMHO using a 150 pre-meal BG will make things significantly more difficult.
On the other hand that is what your Doc said to do and I am not a Doc.
But I am a parent.
I sympathize. Your situation sounds very tough.
BTW - I never see a downside to getting advice from a different Doc. In this case, I would highly encourage a second opinion from a different Pediatric Endocrinologist.
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I totally get it, I was confused too, bc all the training I received from the diabetes team said his target was to be 70-130. Then a couple weeks later, the endo’s nurse practitioner told me to shoot for 150 to avoid him having lows while he is Honeymooning. He was having quite a bit of lows at that time. I confirmed this his is PEDS Endo our last appointment and he said it was ok but we would want to reel it in tighter as time goes on. He said when first diagnosed they don’t like to bring them down to fast and he likes to give them time to adjust and find the right med dosage and so on! I have gotten very upset and frustrated with them throughout all of this, especially right after them giving his diagnosis and just sending us home not knowing anything it seemed! His Endo is with the Children’s Mercy Hospital here in Kansas City so they have tons of patients and I think they are understaffed. When I call with an urgent question it I would take several hours to get a call back and that is scary when he just left the dang hospital and got this new diagnosis ya know. We have taken many classes since then to learn the ins and out but I found even that is not enough!
BTW - Doing the roller coaster up to 340 and back down to anything in range and then repeating for the next meal would make my child feel like complete crap. Way worse then riding along at 55 or 355.
Roller coasters are the worst.
In terms of lows, we don’t usually bother treating unless under 65.
How low does your child get where it was/is an issue? When he gets low and you treat:
What do you treat with and how much
How long does it take to recover
What do you consider “recovered”
Everybody had their own definition of “low”, “high”, “spike”, etc…
I am only wondering what that consists of in your case.
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Yes, I talked to the doc about him doing these rollercoasters and how he doesn’t seem to act like he feels bad when he is running high, and he said it’s likely bc his body has become adapted to running higher. On the flip side, when he gets around 120 and lower he starts feeling bad and shakes a bit and a little dizziness. So, I treat with fast acting carbs if he is under 110. The protocol states under 70 fast acting carbs such as 15 carbs of juice or reg soda and so on, and if at 110 before bed a 15 g carb snack. I am so confused with his reactions of things bc 120 is a normal number but yet he feels weird at that range and below.
If you don’t mind me asking, how old is your child now and when were they diagnosed?
Sorry I failed to answer all your questions. He usually will begin to go up within 10 mins of treating and a 15g fast acting can send him up about 50 pts or so, now this is very minimal data that I have so far but that is the best information I have at the time. As far as recovered, I thought the idea was to be back at the target of 150, I really want to get this figured out and get him at a good range esp before school starts so avoid a bunch of issue during school.
My child would feel the same at 120 IF AND ONLY IF doing a rapid fall from a very high (300+) number. For my child, it is the rapid descent not the absolute BG that causes feeling very bad.
BTW - I would agree with a daytime target and a nighttime target.
Before we were running the Basal-IQ algorithm (Tandem t:slim X2 with Dexcom G6) we would use BG of 100 for a daytime target and 140 for a nightime target with my definition of target meaning what we would correct to.
If your protocol says not to treat with fast acting carbs unless under 70, that would make sense to me (assuming daytime). Nighttime should have its own BG number to treat at.
15g sending him up 50 pts seems reasonable.
I would suggest stop treating 120 (daytime) as a low with fast carbs and go with your Doc provided protocol which is treat at 70 (or lower) with the fast carbs. That makes sense. (daytime).
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Yes that makes perfect sense thank you for all the help! It is so confusing and exhausting sometimes!
Yes it is.
You will get better at it.
The learning curve is steep.
Did you already get a list of some recommended books? There are a few really good ones.
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That sounds pretty much like what I experience when I have something with a high fat content. When I see the second spike start to ramp up I may bolus a bit more to try to stay ahead of it, or at least get it to come back down again sooner than it would otherwise.
So this is the thing. Now you have this picture from the CGM, it’s hard not to feel like its telling you “My little kid’s body is going completely haywire, I gotta fix this now!” All your protective instincts kick in. But it’s doing what a T1’s body will do. A spike, as such, isn’t anything to panic about as long as it doesn’t go so high or last so long it’s putting your kid in DKA territory. Over time you get better at this stuff, but it’s important to have some perspective on it now so you don’t burn out. For me personally I hate it when my BG gets over 200, but it happens, and I’ve been at it a long time.
We call this “pre-bolusing.” I’ll do the bolus about half an hour before I eat (that timing is very individual). Then I watch my CGM and it’s usually pretty obvious when the insulin starts to kick in: you want to see your numbers starting to tick downwards over enough readings that you can see it’s a trend and not just the normal fluctuation.
Yup, I’ll still see that. Typical would be a not-too-high-carb lunch, maybe 40-50 grams. I usually want to see my BG trending down under 100 before I eat, like 80-90, and when the carbs kick in it and it comes back up again I want to see it starting to level off by 140, peaking at 160 or so. If I’ve eaten something unexpected and the CGM gives me a sharp up-arrow when it starts, I may add some insulin. And understand that this is what I’m aiming for, not what I always achieve.
I do see 200+ spikes every so often and I get annoyed at myself, but it’s like this: you’re a tight-rope walker, and you have one of those balance bars to keep you from teetering too far one way or another. Only a real tight rope walker only does this for a matter of minutes before the routine is over. We have to do it constantly, every minute of our lives, 24/7/365. NO ONE can do that perfectly. NO one. So you try to set goals you can reach most of the time, and you don’t beat yourself up when you fall off every once in a while.
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Sorry, I have a quick question, we are changing his pod now, man that adhesive is super strong, he is all red and has welts. Is the site supposed to have some redness and he did have a tiny bit of blood come out open taking the cannula out. I got the user manual in front of me and it says check for signs of infection, some signs being redness, swelling and so on. So, is this a normal thing ? Or not? Also is there anything I can put on him to avoid so much irritation to his skin? I have unisolve coming in the mail today or tomorrow, but I hear of skin barrier being mentioned here, what is that about?
Sounds like he’s allergic to the tape/adhesive on the pod. You just can’t catch a break🤪
If you are comfortable doing so, you can upload a closeup picture of the site where the omnipod was.
A picture is worth …
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A picture is worth …
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Say it… Say it…Say it…Say it!!!
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…22
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A bit of a long post here but VERY comprehensive. Perhaps worth reading through and see if there are relevant things in here that would be helpful?
Listen to this man. Not only is he a doctor, he plays one on the internet.
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