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.
Tuesday, January 29, 2008
Thursday, January 24, 2008
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!
Tuesday, January 22, 2008
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.
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.
Sunday, January 20, 2008
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.
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.
Saturday, January 19, 2008
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!
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!
Friday, January 18, 2008
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.
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.
Saturday, November 24, 2007
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.
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.
Monday, November 12, 2007
LO!
As much as the parent of a diabetic doesn't like the blood glucose meter to greet you with a HI (meaning blood sugar ABOVE 600), you REALLY don't want to see LO.
LO means less than 20. Many diabetics have had seizures with blood sugar levels higher than that.
We got a LO on the meter yesterday. It was during a time that Emma typically goes a little low, so we were checking her. We got a LO on the meter! So, while I was checking it again, Mike got Emma some juice. My 2nd reading was 24 - so that LO was pretty accurate.
Emma's only symptom of a problem with a bit of stumbling disoirentation. She doesn't know when she's low - or if she does, she doesn't know how to explain how she is feeling.
So, after quite a few days of degrees of lows around dinner, I lowered Emma's basal rate during that time. Not that I can check it today, as she has been running high all day so its tough to tell how effective a change in treatment is.
LO means less than 20. Many diabetics have had seizures with blood sugar levels higher than that.
We got a LO on the meter yesterday. It was during a time that Emma typically goes a little low, so we were checking her. We got a LO on the meter! So, while I was checking it again, Mike got Emma some juice. My 2nd reading was 24 - so that LO was pretty accurate.
Emma's only symptom of a problem with a bit of stumbling disoirentation. She doesn't know when she's low - or if she does, she doesn't know how to explain how she is feeling.
So, after quite a few days of degrees of lows around dinner, I lowered Emma's basal rate during that time. Not that I can check it today, as she has been running high all day so its tough to tell how effective a change in treatment is.
Tuesday, November 6, 2007
Finally, someone in respected media agrees with us
Reputed doctors are finally saying that Halle Berry's "miracle cure" of Type 1 diabetes was probably an initial misdiagnosis of Type 1 instead of Type 2.
ABC News Report
Well, Duh
ABC News Report
Well, Duh
Monday, November 5, 2007
PSA: Yes, my child can eat sugar
I'm a pretty trusting person. I also give most people the benefit of the doubt. So, I don't get as spun up as others do when "well meaning" people make assumptions about their children because they have Type 1 Diabetes.
A common one is this: Your child has diabetes; they can't have sugar.
Well, that USED to be true. Kinda. The older regimens of diabetic care (NPH and NNR) had insulins that "peaked" at certain times. So, you had to eat at certain times to avoid a low. And you had to eat just a certain amount to avoid a high. And you avoided sugary things because, well, they just weren't well managed with the older regimens.
Take the old regimens, old ways of thinking, and combine it with a media blitz talking about childhood obesity and diabetes (that would be Type TWO), and many "well meaning" people will assume your child should not or cannot have sugar
Not true.
Now, I don't stuff Emma full of sugar. But, then again, I don't stuff my other two children full of sugar either. Emma probably gets the same amount of "Refined sugar treats" as my other two children did at this age - not much. This was our first Halloween since diagnosis and its been the same for her as the other two - a couple of pieces after trick-or-treating and then one piece a day as dessert with a meal since then. It hasn't been every day that she's had a piece of candy after lunch or dinner, but we've had it when she asked (and when she ate the rest of her regular food, which is always a requirement).
I have stayed away from the "pure sugar" candy, such as sweet tarts. They will do nothing but spike her and then drop her. We'll save those to treat lows! But, she's had chocolate and has quite enjoyed it. We just add the carbs from the candy into her meal and give her a dose of insulin to cover it all. It works best that way, as the candy has a high glycemic index and putting it with some protein and lower glycemic index foods helps to slow the absorption and avoid the peak.
So, thanks for caring - but she can have sugar. We just regulate it just like we do with our other kids, because we don't want THREE of them bouncing off the walls!
A common one is this: Your child has diabetes; they can't have sugar.
Well, that USED to be true. Kinda. The older regimens of diabetic care (NPH and NNR) had insulins that "peaked" at certain times. So, you had to eat at certain times to avoid a low. And you had to eat just a certain amount to avoid a high. And you avoided sugary things because, well, they just weren't well managed with the older regimens.
Take the old regimens, old ways of thinking, and combine it with a media blitz talking about childhood obesity and diabetes (that would be Type TWO), and many "well meaning" people will assume your child should not or cannot have sugar
Not true.
Now, I don't stuff Emma full of sugar. But, then again, I don't stuff my other two children full of sugar either. Emma probably gets the same amount of "Refined sugar treats" as my other two children did at this age - not much. This was our first Halloween since diagnosis and its been the same for her as the other two - a couple of pieces after trick-or-treating and then one piece a day as dessert with a meal since then. It hasn't been every day that she's had a piece of candy after lunch or dinner, but we've had it when she asked (and when she ate the rest of her regular food, which is always a requirement).
I have stayed away from the "pure sugar" candy, such as sweet tarts. They will do nothing but spike her and then drop her. We'll save those to treat lows! But, she's had chocolate and has quite enjoyed it. We just add the carbs from the candy into her meal and give her a dose of insulin to cover it all. It works best that way, as the candy has a high glycemic index and putting it with some protein and lower glycemic index foods helps to slow the absorption and avoid the peak.
So, thanks for caring - but she can have sugar. We just regulate it just like we do with our other kids, because we don't want THREE of them bouncing off the walls!
Friday, November 2, 2007
67 and 545!
I saw both of those numbers today - yes, I did.
We have many days where we rarely see over 200 - except at breakfast(which I'll discuss in a minute), so to see 67 and 545 in the same day was quite a feat.
Now that Emma has finally kicked her bug, she has a couple of trends that I want to address. The first was the SPIKE that she has after breakfast - she can easily hit 350 to 400 at the 2-hour or even the 3-hour mark after breakfast (she has a 5 hour IOB). So, I wanted to try what so many on the Children With Diabetes board suggest - pre-bolusing. I had discussed it with the CDE and a couple of different approaches. Today, I wanted to just be simple. Estimate her carbs and then dose her when she sits down to eat (instead of after). That will give the insulin a 20 minute head start.
So, we do that and her 2-hour reading was 250 - not bad. But, then I realized that might not be good at all. A quick IM to Mike confirmed that she had NO protein at breakfast. Without protein, she SPIKES really high and then PLUMMETS to a low because the insulin can't catch the food. I don't know WHY Mike thought we could leave out the protein, but oh well. So, today wasn't a good test of the pre-bolus. That's where the 67 came from - at lunch.
So, I gave her some juice and then her lunch, did a slight negative correction and she went down for her nap. I set her a temporary basal rate of +20% when she goes down for a nap because she always goes HIGH. Well, definitely she did that today. She woke up at 545! Turns out we were at the full 3-day mark for her site - and her sites don't last 3 days. So, I did a quick site change (if I don't have to reload the cartridge or prime new tubing, I can do it very quickly) and gave her a correction to handle the 545.
But, the 2nd trend I wanted to treat today was perpetual lows right before dinner. Its usually between 4:30pm and 6pm that she drops - just about every day - whether she has a nap or not. Mainly because that is our running around time and she is often running down the sidewalk at Tae Kwon Do, or on the soccer field. So, I decreased her basal rate at 4pm (my first change in basal on my own without asking the CDE). But, I couldn't test it because of the 545 at 4pm that had to be treated.
So, two changes tried and none able to test the result. We'll try again tomorrow.
We have many days where we rarely see over 200 - except at breakfast(which I'll discuss in a minute), so to see 67 and 545 in the same day was quite a feat.
Now that Emma has finally kicked her bug, she has a couple of trends that I want to address. The first was the SPIKE that she has after breakfast - she can easily hit 350 to 400 at the 2-hour or even the 3-hour mark after breakfast (she has a 5 hour IOB). So, I wanted to try what so many on the Children With Diabetes board suggest - pre-bolusing. I had discussed it with the CDE and a couple of different approaches. Today, I wanted to just be simple. Estimate her carbs and then dose her when she sits down to eat (instead of after). That will give the insulin a 20 minute head start.
So, we do that and her 2-hour reading was 250 - not bad. But, then I realized that might not be good at all. A quick IM to Mike confirmed that she had NO protein at breakfast. Without protein, she SPIKES really high and then PLUMMETS to a low because the insulin can't catch the food. I don't know WHY Mike thought we could leave out the protein, but oh well. So, today wasn't a good test of the pre-bolus. That's where the 67 came from - at lunch.
So, I gave her some juice and then her lunch, did a slight negative correction and she went down for her nap. I set her a temporary basal rate of +20% when she goes down for a nap because she always goes HIGH. Well, definitely she did that today. She woke up at 545! Turns out we were at the full 3-day mark for her site - and her sites don't last 3 days. So, I did a quick site change (if I don't have to reload the cartridge or prime new tubing, I can do it very quickly) and gave her a correction to handle the 545.
But, the 2nd trend I wanted to treat today was perpetual lows right before dinner. Its usually between 4:30pm and 6pm that she drops - just about every day - whether she has a nap or not. Mainly because that is our running around time and she is often running down the sidewalk at Tae Kwon Do, or on the soccer field. So, I decreased her basal rate at 4pm (my first change in basal on my own without asking the CDE). But, I couldn't test it because of the 545 at 4pm that had to be treated.
So, two changes tried and none able to test the result. We'll try again tomorrow.
Wednesday, October 31, 2007
Quick Public Service Announcement
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.
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.
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!!
Wednesday, September 12, 2007
Pump Start in 6 days!!
We are excited. Emma will be going on her insulin pump in 6 days. We are looking forward to this as we really believe this will make our lives so much easier. It will also give us some greater control with Emma as the pump can be so much more precise in her dosing than we ever can.
We had our training yesterday on the pump. While it seems intimidating, its really not that difficult to use. I have been wearing it now 24 hours and I have been given a steady "basal" dose of saline (for the test) and given myself doses for meals and to correct readings out of range. I have overriden the suggestion of the machine, taken it as is, and even cancelled a dose mid-stream. I even slept in it last night - it wasn't too bad.
I will wear it for a couple more days and then Mike will wear it - and yes, he will be putting in Emma's meals and dosing himself for her food as well (all with saline). Then Emma will be put on it with saline and we will practice dosing her with saline at the same time we are still giving her insulin shots. And then we go in next Tuesday and we start her insulin doses on the pump. Yay!!
A recent email from a friend made me realize that there is so much that people don't know about diabetes or diabetics. My next post will be geared to educate folks about diabetics, diabetes, and what Emma's life will be like as a diabetic (and what it could be like if we didn't have the advances we have today)
We had our training yesterday on the pump. While it seems intimidating, its really not that difficult to use. I have been wearing it now 24 hours and I have been given a steady "basal" dose of saline (for the test) and given myself doses for meals and to correct readings out of range. I have overriden the suggestion of the machine, taken it as is, and even cancelled a dose mid-stream. I even slept in it last night - it wasn't too bad.
I will wear it for a couple more days and then Mike will wear it - and yes, he will be putting in Emma's meals and dosing himself for her food as well (all with saline). Then Emma will be put on it with saline and we will practice dosing her with saline at the same time we are still giving her insulin shots. And then we go in next Tuesday and we start her insulin doses on the pump. Yay!!
A recent email from a friend made me realize that there is so much that people don't know about diabetes or diabetics. My next post will be geared to educate folks about diabetics, diabetes, and what Emma's life will be like as a diabetic (and what it could be like if we didn't have the advances we have today)
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