Fasting basal testing

When you are a diabetic, you are constantly trying to manage your insulin needs through the balance of basal insulin (background insulin whose sole purpose is to keep you at a steady rate when there are no carbs ingested) and boluses for food.

When you have unexplained lows or highs, the only way to really tell what is going on is to take as much out of the equation as possible. On the pump, we have so many different time periods of different basal rates that we have to have a fasting basal test at a bunch of different times of day.

Last week, I did a fasting basal test skipping lunch. I bribed Emma with promises of great snacks after her nap if she would skip her lunch for then. I did get her to skip and saw some areas that we need to keep watching.

But right now, we are dealing with a very difficult time period - after breakfast. We have adjusted our carb ratios several times, taken difficult foods out of the equation, and even stretched out her breakfast insulin and she was still spiking. So, we figured that we needed to confirm that her basal rate during that time was accurate, because if it wasn't, it could be contributing to the spike.

So, this morning, instead of her regular breakfast, Emma had cheese, pepperoni, and Crystal Light "Breakfast in Bed" in my room (we didn't want her to see what her siblings were eating).

So far so good - we've had one increase of about 70 points in an hour that is probably a basal rate problem. I'm hoping to get her all the way to lunch to really see what's going on in the AM.

One tushy, two sites

While we did a site change after Emma's bath the other night, I took the opportunity to take a photo of both sites on Emma's bum! Pump site on the left cheek, CGMS sensor on the right cheek.

Enjoy - and yes it IS as squishy as it looks!

CGMS trial - Day 4

Well, today's challenge was getting the sensor restarted. It was the end of 3 days, so time to restart the sensor. When the time came, Emma was so high that we couldn't dial in a #. It took a while before I could get one in, and I put it in knowing that she wasn't stable, just to get it moving. We had lots of highs and TOO HIGHS to be read.

We finally got her back into range and despite some spikes, made it to bedtime ok. We dialed up her basal rate by 30% to address the perpetual highs, figuring we'd turn it off when she got back into the low-end of range.

So, I dozed off around 10:30 and must have turned off the baby monitor. Mike fell asleep on the couch and neither of us heard the alarms going off for a lost sensor. Finally, we heard them but I had to do a complete restart. But, we got a decent starting reading and a 2 hour reading and we were able to finish the night with some decent readings.

CGMS trial - Day 3

Well, today's trial is screwed up by Emma being sick. She had a cough and a cold. So, her blood sugars are all over the place. She was ok in the AM but kept going steadily up in the afternoon.

Mike misunderstood the calibration requirements, so he didn't calibrate before lunch. We couldn't calibrate before dinner because 1)she had insulin on board from a correction 90 minutes earlier; and 2) she was over 400. We still couldn't calibrate at the 12 hour calibration mark because she was still over 400. It took until 9:30pm when I could calibrate again. That of course meant that the readings were off during all that time.

Once it finally got calibrated, we dealt with quite a few high alarms overnight due to the cold. We had to give a couple of overnight corrections and she had small ketones - a true sign she is sick. We got one "low" alarm overnight but she tested in range and then actually woke up in range.

CGMS trial - Day 2

So, we're in a decent groove with the CGMS now. We went to Michael's basketball game and could watch it spike up from breakfast and then come back down. Lunch and dinner both had only little spikes and we got a couple of "potential high" alarms, but that's it.

So, we put her to bed last night and did our typically 2 hour and 3 hour testing. She was in range for both the 2 hour and 3 hour readings.

But, here's the problem. When Emma's in range overnight, she's in a good range - 85-120 usually. And she stays there all night (except for an early morning spike that we are now observing on the CGMS). And the threshold level for the CGMS is 90. So, it didn't like the range that it was detecting for her levels. From 2am - 4:15am, it went off every 15 minutes to tell me she's low. And we HAD to go in and clear the alarms or they just get REALLY LOUD!! So, I was up every 15 minutes for those 2+ hours. I even gave her juice at one point to try and get her up above the threshold to stop the alarms. That didn't work. I finally turned off the baby monitor at about 4:30 and ignored the alarms the rest of the night so that I could get a little sleep.

Ugh!

CGMS trial - Day 1

We are doing a one-week trial of a CGMS for Emma. With a few episodes of undetected lows (and I mean LOW), we wanted to see how this works. The practice we are with is pretty anti-CGMS but they do the trials. I'm hoping after the trial that we can talk to them about maybe a periodic use of it.

So, we went into Children's Hospital this morning to start the trial. Didn't start off well, with Emma spiking over 500 at 3 hours after breakfast, I assume from a bad site, so I went ahead and changed it.

Insertion went well. Not even a little peep out of Emma when the nurse put it in. We got her all hooked up and ready to go.

Calibrating it was a bit "off" at the beginning because we didn't wait until 2 hours to eat lunch, so I tried to enter the first BG before lunch and it didn't want it because it hadn't been 2 hours. It then asked for it at 2 hours, and I know it wasn't stable because she had finished eating about 45 minutes early. But I put it in.

I got 2-3 high alarms over the next couple of hours. The meter readings were actually pretty close to the CGMS and I finally corrected after she appeared to not be coming down. So, we finally got a little into the groove.

When Emma was ready to go to bed, we rigged the receiver for the signal to the railing of her crib, lashed to the baby monitor so that I could hear the alarms. Here's what it looks like:



So, the first night was a little screwy. We got a "low" alarm and the CGMS said 116 going down. We tested her and she was 41!! So, it didn't quite catch that low!! We then proceeded to get a few "low" alarms throughout the night that were pretty off from the meter. One time the CGMS said she was 80 going down and she was actually 120. I actually recalibrated at that point to see if it would catch on and be a little more accurate.

Highs ... and Highs

I have posted a few times about Emma's sling-shotting Highs and Lows. Well, for the past few days, its been basically Highs. And not small highs, big highs. I corrected a 476 at 3 hours after dinner last night. She didn't even eat enough food to spike her that high. That has been the case for the past few days.

I have checked her ketones over and over and she had none, so I'm confident she was getting insulin. And with corrections, she eventually comes down. So, I think we need to change some meal ratios. But gosh, I hate to do that right as we are going on vacation - talk about screwed up. We're probably gonna be so out of whack by the time we return.

Now I'm just waiting to hear back from the nurse about my proposed changes and then I'll be making some. This is just so frustrating.