There are multiple types of Diabetes:
Type 1 diabetes means that your pancreas does not produce insulin. You must get insulin from another source in order to live. It will be through injections or an insulin pump.
Type 2 diabetes means that your pancrease produces insulin. Either it doesn't produce enough or your body cannot absorb it well. You "may" have to get insulin from another source. You "may" be able to control it through diet and exercise. It "may" be a result of being overweight. You "may" be able to get your insulin through a pill or an inhaled version.
There are some that are identifying a new form of diabetes - slow onset. They are calling it type 1.5. A Type 1.5 will eventually need to manage their diabetes like a Type 1.
You cannot "get over" Type 1 diabetes and become Type 2. Could you have been misdiagnosed? Perhaps, but I doubt it. Once your pancreas stops working (definition of Type 1) it doesn't miraculously start again. Because, trust me, if there was a way for that to happen, every single one of us who suffers through or with someone with diabetes would be lined up to get that treatment.
Now back to your regularly scheduled programming.
Wednesday, October 31, 2007
Tuesday, October 30, 2007
I guess I'll take the good with the bad
subtitle: There is just something so wrong with this entire situation!
I had to do a site change this afternoon - it was approaching 3 days and we were running out of insulin. Believe it or not, I've been getting a little extra time out of our sites that past few times, even WITH her illness. That would be nice, because every 2 days was getting real old.
So, I got everything ready and I warned Emma that I was getting ready to poke her behind. She was laying on the couch watch her shows. I asked her if she wanted to hold my hand. She said no. So I went ahead and put in the site, counted to five and removed the inserter - and not a peep out of her! That was the first time! And we don't use any numbing creme. We just deal with the pinch for a second and its over.
But then, I'm trying to get everything "put back together", her pump back in her pouch, etc, and I was finding myself trying to get her diaper taped back up and not get her tubing all twisted up in the diaper tape. There is just something SO wrong with having to worry about pump tubing with a diaper. Something really wrong!!
I had to do a site change this afternoon - it was approaching 3 days and we were running out of insulin. Believe it or not, I've been getting a little extra time out of our sites that past few times, even WITH her illness. That would be nice, because every 2 days was getting real old.
So, I got everything ready and I warned Emma that I was getting ready to poke her behind. She was laying on the couch watch her shows. I asked her if she wanted to hold my hand. She said no. So I went ahead and put in the site, counted to five and removed the inserter - and not a peep out of her! That was the first time! And we don't use any numbing creme. We just deal with the pinch for a second and its over.
But then, I'm trying to get everything "put back together", her pump back in her pouch, etc, and I was finding myself trying to get her diaper taped back up and not get her tubing all twisted up in the diaper tape. There is just something SO wrong with having to worry about pump tubing with a diaper. Something really wrong!!
Saturday, October 27, 2007
Lack of sleep will make you lose your mind!!
We haven't had much sleep since Wednesday morning when Emma first got sick. Our experiment last night in giving carbs overnight (with insulin) didn't help the ketones - she still woke up with them. And she had them during the day today too.
I did Emma's 2-hour and then her 3-hour after dinner check this evening - she went up between the two. That didn't surprise me, frankly, since her numbers have been wacky since she got sick
I gave her juice (I know, why give her juice when she's going up - but we need to for the ketones) and a big old correction. I went to update my spreadsheet and mentioned to Mike that if she still goes up, I'll go ahead and change her site, thinking we were coming up on 2 days for the site.
Turns out we are coming up on 3 days for the site! She has never had a site last 3 days and she is already about 5 hours past the longest site she's had.
So, I did a site change. But, this was AFTER the big old correction that I gave her. So, who knows how effective that dose will be and we'll have another night of ups and downs.
We're running a 20% increased basal overnight right now trying to keep the numbers down.
I just hope she kicks this bug soon!!
I did Emma's 2-hour and then her 3-hour after dinner check this evening - she went up between the two. That didn't surprise me, frankly, since her numbers have been wacky since she got sick
I gave her juice (I know, why give her juice when she's going up - but we need to for the ketones) and a big old correction. I went to update my spreadsheet and mentioned to Mike that if she still goes up, I'll go ahead and change her site, thinking we were coming up on 2 days for the site.
Turns out we are coming up on 3 days for the site! She has never had a site last 3 days and she is already about 5 hours past the longest site she's had.
So, I did a site change. But, this was AFTER the big old correction that I gave her. So, who knows how effective that dose will be and we'll have another night of ups and downs.
We're running a 20% increased basal overnight right now trying to keep the numbers down.
I just hope she kicks this bug soon!!
Thursday, October 25, 2007
Another rough night
So, after getting Emma's BG down yesterday morning and her ketones back to trace, we had a relatively normal afternoon. She ran a bit high but I just corrected and she was fine through dinner.
But, then she didn't come down much after her dinner dose and hit 400 again and stayed there. So we gave her a correction and waited a couple of hours. After she didn't budge, we ended up doing a site change and another correction in the new site. Her ketones were up to 2.4 already. She stayed awake for a little while that time (after not going to sleep until after 10pm).
She woke up in range this morning - but barely - she was 84. But, she still had ketones in the high moderate range. Treating ketones with low blood sugar is tough - because the way you treat ketones is with insulin. And the way you treat a low is sugar WITHOUT insulin. So, I had to get a lot of carbs in her, to get her up above her target range, so I could then correct her and give her enough insulin to clear the ketones.
I got her back down in range for lunch with no ketones thankfully. She's upstairs now taking a nap with an increased basal of 20% (which is typical - I just hope its enough).
And all of this because she has a low-grade fever - and no other symptoms.
But, then she didn't come down much after her dinner dose and hit 400 again and stayed there. So we gave her a correction and waited a couple of hours. After she didn't budge, we ended up doing a site change and another correction in the new site. Her ketones were up to 2.4 already. She stayed awake for a little while that time (after not going to sleep until after 10pm).
She woke up in range this morning - but barely - she was 84. But, she still had ketones in the high moderate range. Treating ketones with low blood sugar is tough - because the way you treat ketones is with insulin. And the way you treat a low is sugar WITHOUT insulin. So, I had to get a lot of carbs in her, to get her up above her target range, so I could then correct her and give her enough insulin to clear the ketones.
I got her back down in range for lunch with no ketones thankfully. She's upstairs now taking a nap with an increased basal of 20% (which is typical - I just hope its enough).
And all of this because she has a low-grade fever - and no other symptoms.
Wednesday, October 24, 2007
Rough morning
So we were a little surprised when Emma woke up today in the high 300s. Especially since she was 50 at 2:30am and we have gotten her juice at night DOWN so that she ends up in the 100s - sometimes the high 100s but the 100s no less.
So, when I saw the 397 on the meter, I took it again to make sure. The second reading was 409. Within the margin of error.
When you have a pumper with an unexplained high, you check for ketones (which is usually a good sign of whether your pump site is actually working or not). A trace amount of ketones is a measurement of 0.2. The last time she had a bad site, she had ketones of 1.6. I kinda expected some ketones in that range and I was fully prepared to treat those.
I was not prepared to treat ketones of 4.4!! I can't find a smilie that demonstrates the shock at that number. I took it again in the event it was just off - it wasn't. So, we quickly gave Emma a correction dose of insulin at 150% of the calculated correction dose - because the only way to reduce ketones is with insulin. I then paged the nurse to see what else I should be doing. Emma felt hot so we took her temperature and it registered just over 100. So, a low grade fever which COULD have triggered that enormous spike in her ketones.
Celia's response was just to keep testing and slowly correcting, feeding the extra insulin that we needed for the ketones to prevent a low.
Within 1 hour, her ketones were down to 2.2 - a shocking figure if I didn't know they were going DOWN. Within 2 hours, her ketones were down to .3.
Within 3 hours and 15 minutes of her first dose, she was back in range for her blood glucose.
That was a pretty uncomfortable 3 hours - I was actually WILLING time to move faster so that I could see that she was adjusting. And I think I tested ketones about 3 more times throughout the day because she has continued to complain about her stomach hurting despite the fact she is in range and has no ketones.
She still has the low grade fever, so she is probably fighting something. That means another night of extra checking so we can stop this from happening again tonight.
Boy, its situations like this that I wish we had a Continuous Glucose Monitor. For all the challenges and struggles you hear about these new machines, there are definite benefits - such as getting an alarm when that type of high reading comes out of nowhere.
So, when I saw the 397 on the meter, I took it again to make sure. The second reading was 409. Within the margin of error.
When you have a pumper with an unexplained high, you check for ketones (which is usually a good sign of whether your pump site is actually working or not). A trace amount of ketones is a measurement of 0.2. The last time she had a bad site, she had ketones of 1.6. I kinda expected some ketones in that range and I was fully prepared to treat those.
I was not prepared to treat ketones of 4.4!! I can't find a smilie that demonstrates the shock at that number. I took it again in the event it was just off - it wasn't. So, we quickly gave Emma a correction dose of insulin at 150% of the calculated correction dose - because the only way to reduce ketones is with insulin. I then paged the nurse to see what else I should be doing. Emma felt hot so we took her temperature and it registered just over 100. So, a low grade fever which COULD have triggered that enormous spike in her ketones.
Celia's response was just to keep testing and slowly correcting, feeding the extra insulin that we needed for the ketones to prevent a low.
Within 1 hour, her ketones were down to 2.2 - a shocking figure if I didn't know they were going DOWN. Within 2 hours, her ketones were down to .3.
Within 3 hours and 15 minutes of her first dose, she was back in range for her blood glucose.
That was a pretty uncomfortable 3 hours - I was actually WILLING time to move faster so that I could see that she was adjusting. And I think I tested ketones about 3 more times throughout the day because she has continued to complain about her stomach hurting despite the fact she is in range and has no ketones.
She still has the low grade fever, so she is probably fighting something. That means another night of extra checking so we can stop this from happening again tonight.
Boy, its situations like this that I wish we had a Continuous Glucose Monitor. For all the challenges and struggles you hear about these new machines, there are definite benefits - such as getting an alarm when that type of high reading comes out of nowhere.
Tuesday, October 23, 2007
Pretty stable
Things are finally getting pretty stable with Emma on the pump - well, that is as stable as they can ever be with a 2 year old with diabetes.
A couple of really nice results of pumping:
- When she is only 125 after her dinner dose is done, we can have confidence that she "probably" won't go low. That isn't always the case but in the past with Lantus, a 125 after dinner was a sure sign of a 50 at 2am.
- Emma will more often get into range after a meal - and into range will usually mean the LOW 100s. In the past, we were happy with higher 100s after meals.
We still have a couple of time periods to tweak. When Emma naps, we increase her basal rate by 20%. That doesn't always keep her in range so we might need to increase it to 30% and give it a shot.
Nap or not, Emma tends to head low right before dinner. I think its because the late afternoon is when we are at Tae Kwon Do or soccer or at some other activity while she's running around. We have lowered that basal rate but I think its needs a bit more lowering.
We have switched her I:C ratio for dinner about 5 times - back and forth from 1:20 and 1:22. Believe it or not, that crazy 2 carbs makes a big difference. If we dose 1:20, she will often go low at 3 hours after dinner. If we dose 1:22, she'll go high - into the mid 200s. That's a big swing for 2 little carbs.
But, despite those areas that I'm still monitoring, we are VERY happy with the pump.
A couple of really nice results of pumping:
- When she is only 125 after her dinner dose is done, we can have confidence that she "probably" won't go low. That isn't always the case but in the past with Lantus, a 125 after dinner was a sure sign of a 50 at 2am.
- Emma will more often get into range after a meal - and into range will usually mean the LOW 100s. In the past, we were happy with higher 100s after meals.
We still have a couple of time periods to tweak. When Emma naps, we increase her basal rate by 20%. That doesn't always keep her in range so we might need to increase it to 30% and give it a shot.
Nap or not, Emma tends to head low right before dinner. I think its because the late afternoon is when we are at Tae Kwon Do or soccer or at some other activity while she's running around. We have lowered that basal rate but I think its needs a bit more lowering.
We have switched her I:C ratio for dinner about 5 times - back and forth from 1:20 and 1:22. Believe it or not, that crazy 2 carbs makes a big difference. If we dose 1:20, she will often go low at 3 hours after dinner. If we dose 1:22, she'll go high - into the mid 200s. That's a big swing for 2 little carbs.
But, despite those areas that I'm still monitoring, we are VERY happy with the pump.
Friday, October 12, 2007
Pump start has gone well!
I haven't updated in a while. Perhaps because we have been so busy with pump start. Pump start has gone pretty well. But just about every expectation we had about how her settings would be have been blown out of the water.
- We have adjusted basal rates almost every day. We have about 6 different rates going throughout the day and will probably add a couple more before we are done.
- My CDE has finally admitted that Emma actually goes high when she takes a nap. She says she's only encountered one other patient that did that - so we now set a 20% increase in basal when she takes a nap
- All of our meal I:C ratios that we thought would be stable are not.
We've had sites go out in 6 hours, none of our sites have lasted 3 days, we had a lot more cases of ketones with the pump.
But despite all of that, it is still SO MUCH BETTER than injections. Its so much easier to get out of the house than it used to be. Its so much easier to dose her for a meal. I'm starting to see trends with her pumping the same way I saw them on injections, so we can try and counteract them.
So, definitely, this was the right decision for us!!
- We have adjusted basal rates almost every day. We have about 6 different rates going throughout the day and will probably add a couple more before we are done.
- My CDE has finally admitted that Emma actually goes high when she takes a nap. She says she's only encountered one other patient that did that - so we now set a 20% increase in basal when she takes a nap
- All of our meal I:C ratios that we thought would be stable are not.
We've had sites go out in 6 hours, none of our sites have lasted 3 days, we had a lot more cases of ketones with the pump.
But despite all of that, it is still SO MUCH BETTER than injections. Its so much easier to get out of the house than it used to be. Its so much easier to dose her for a meal. I'm starting to see trends with her pumping the same way I saw them on injections, so we can try and counteract them.
So, definitely, this was the right decision for us!!
Subscribe to:
Posts (Atom)