This shows how important your work on the artificial pancreas is. There is not only the long term goal of a closed loop system. There are many small steps of evolution before that to make the pump algorithms better. Take the pump to the next level so that even convinced MDI users like me will switch without hesitation. I know that the FDA is the biggest road block here but I think in Europe it would not be easier.
Out of curiosity Holger, and totally off topic, but what would be the “next level” that gets you to make the switch? You seem pretty deeply entrenched in MDI and it can’t be just the level of control possible on MDI versus the pump.
I feel for your son and I’m glad you are willing to switch doctors, if necessary. You are a great advocate. When my sugars go wonky, I start ruling out possible causes and it is logical for the docs to want to remove pods as a possible factor but they need to account for how your son feels. If docs disapprove, that is their problem and they are not the ones living with it! My 2 cents is I’d make a deal with your son to stay on pod so long as he tests extra often until you can see what the patterns are and adjust accordingly. I like Holger’s suggestion to run a little high for now at 140-150. (And I would not make changes to your regimen based on any data you get in the first few hours after pod changes because infusion sets have a known tendency to not deliver optimally right after being inserted–if you don’t know about this, search TuD.)
Stay calm and don’t give up!
Gil, having been on MDI for 2+ years, them Omnipod for 1/2 year, I can give my input. As is said in many threads, YMMV. I found that latus did last the whole 24 hours, and that my body “somehow” could modulate its release to accomidate slow carbs, fats, and proteins, and still offer a degree of stability in my post 2 hour meals and nighttime. The pump needs more precise carb counting, and even the TAG method to give as reliable results. However, the Bolus dosing is much more precise on the carbs, and allows me to lower the basal to account for exercise and hormonal changes, as well as dose when eating and deciding to eat as I go, and a real person does, instead of a meal plane, and then I’m not as hunger as injected, and need to eat up to it, or can’t decide on 2nds unless I want to take another shot. Or when exercise, I would need to eat up to the basal, rather than just turning it down at at an appropriate moment. It also allows for dawn phenom, and slower carb, TAG without more injections. I have a 1:45 and 1:90 unit correction factor, so I can dose in less than 1/2 units, and less than 1 unit.
Our CDE uses a similar fasting protocol to set basal rates. The fasting is hard for active teenagers but my sons basal stayed a perfect 100 without fast food. The only problem is that we did the testing this summer and they think his basal is too high during the day because he is more active during school. So he is manually adjusting his lunch bolus so he won’t be low in the afternoon. Even after adjusting his basal down in the afternoon and eating pizza , he is low.
So, now we are back to basal testing as soon as we can find a day in the life of a teenager when we don’t have hockey, tests or other BG distractions. We will try to do the fasting during school hours this time breaking the test into several parts. Our endo does not allow us to change basal settings either although they have trained my son and suggested temp basal settings during hockey games, practices and overnight after hockey.
Thank you for the very nice explanation and comparison.
OK… now he is home sick w/ a stomach virus. and I can’t reduce his basal w/a PDM cuz he is on Lantus…grrrrrr
On the Pump he was running more like in the 200’s then crashing too… It was very hard to find the right mix. According to the OMNIPOD instructor he was on too low a basal rate and trying to “fix” things w/corrections and boluses and that is what was causing the rollercoaster…I can’t wait to get back on the pump and have her help him w/it… HE is home sick now and I can’t adjust basal rates for low…grrrrrrrr want the pump back!
Does he have a CGM ?
We have been waiting for the POD/CGM integration to get further along. Our Endo said not to hold our breath - they are having such a hard time getting anything new approved including the new, smaller Pods.
I just thought that it might give more insight into what his BG is really doing. I had heard that some doctors have actually “checked out” demo CGMs to patients to try and use them to diagnose BG problems. And, some on this site have said that it really helped them to get their BG under control because they could see trending although many do not wear it constantly because of the cost or additional work to calibrate it, etc.
Sorry that he is sick. Mine was sick during finals last week also - between the cough, fever and stress, I thought we did OK. I’m sure a doctor would be up in arms over his numbers, but you do what you can do. We get in trouble every time with severe lows when we over-correct those stress or exercise highs. Such a hard age.
No he doesn’t have a CGM but they did mention putting a loaner on him for a few days… it doesn’t beep or alarm it just gives them the data so they can see what is happening.
He is doing a bit better now. Yes… this is a hard age…but he is handling better than I would have at his age and I am proud of him.
He has been back on the Omnipod since Valentines day…so far so good…
Good news! Fingers crossed that it stays that way…
Nice to hear that pump vacation is over!
Katsz,
They are giving my 17 year old son a loaner CGM for a week on March 7th. His numbers were really bad this time (8.2)although lower than his first Omnipod testing when we seemed to have a lot of pod malfunction highs on his arms. He was slightly over 7.0 on MDI. He too runs a lot of lows and highs which she is trying to smooth out. Wew may also be headed for a “vacation”.
This new CDE reset his basals slightly lower since he was having lows in the sfternoon and increased and adjusted his ratios for each meal during the day. He was doing only a little insulin at lunch because he was afraid that he would be low in his afternoon classes. He was having spikes after meals that we could see on 90 minute after meal testing for the clinical trial because he had stopped pre-bolusing and was bolusing the carbs he actually ate after the meal (sometimes a long time after the meal if with new friends and wanted to wait until he was alone).
He also was eating a lot of snacks and correcting which sent him into lows. She is having him not correct when having snacks if he has had a meal within 4 hours (which is always with a teenager!) because the IOB on the Omnipod does not calculate as you would think. (Clinical Trial coming soon on that change.) She is having him to input only the carb amount and bolus for that. She will continue to monitor those ratios and if he is consistently high at the next meal, she will need to adjust the ratios for the prior meal. The correcting with insulin on board for the snacks was only adding to the confusion.
And, then all of the adreneline hockey highs and highs after the afternoon lows where he ate everything in the house without insulin. But, he does say food tastes great! when you are so low.