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.
Showing posts with label Pumping. Show all posts
Showing posts with label Pumping. Show all posts
Tuesday, October 23, 2007
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)
Friday, August 24, 2007
Another step towards the pump
We had our meeting with the child psychologist on Wednesday. For most families they schedule a separate meeting with the patient. I am told that many teens come in and say that they are only there because their PARENTS want the pump and they don't - that's a sure-fire way to get your pump process put on hold.
The meeting was fine. They asked some questions about how treatment was done. I think they were impressed with how much we've learned and how far we've come in 5 months - yes its only been 5 months but the longest 5 months of my life. The only recommendations they had were:
- Get her a medical ID bracelet - the shoe tags just on the sneakers were enough; and
- At some point in the future, Emma may not WANT to wear a pump. Now is a good time while she is more resiliant to change.
So, they forwarded out to the CDE that the appointment was completed so we could move to the next step. The next step is getting the pump ordered, which means going head-to-head with the insurance company. We want that started as soon as possible because I know there will be rejections and fights and lots of phone calls. Unfortunately, the CDE is out until Tuesday. So, it will be almost a week from our psych appointment until the process can start. I know that doesn't sound like a lot, but when you get up every night at midnight and 3am, and often have to have juice and peanuts in the middle of the night, every day that takes longer is painful. The psychologists feels that we SHOULD be able to get rid of the 3am checks once we get all the settings tested and tweaked (about a month after we get the pump). I will always make sure I change her infusion site in the AM so that we have to day to make sure we have a good site and once we see that she's not typically messing with it in the bed, we might actually be able to sleep. What a novel idea.
Other than that, her days have been relatively normal. Today she got up from her nap and while I wasn't looking (I've been suffering from a pinched nerve in my shoulder for days, so sitting on the couch in pain) she got the Goldfish crackers out of the closet and took them on the porch and served herself a snack. It hadn't even been 3 hours since lunch, I hadn't tested her or counted out her food. A test for me. I tested her right away, guessed at how many she might have eaten and tried to dose based on how much insulin was still in her system from lunch, what her reading was, and how much she ate. WAY too many variables and she went low a bit later - but Mike was checking because of this and caught it with juice. Little rascal!
The meeting was fine. They asked some questions about how treatment was done. I think they were impressed with how much we've learned and how far we've come in 5 months - yes its only been 5 months but the longest 5 months of my life. The only recommendations they had were:
- Get her a medical ID bracelet - the shoe tags just on the sneakers were enough; and
- At some point in the future, Emma may not WANT to wear a pump. Now is a good time while she is more resiliant to change.
So, they forwarded out to the CDE that the appointment was completed so we could move to the next step. The next step is getting the pump ordered, which means going head-to-head with the insurance company. We want that started as soon as possible because I know there will be rejections and fights and lots of phone calls. Unfortunately, the CDE is out until Tuesday. So, it will be almost a week from our psych appointment until the process can start. I know that doesn't sound like a lot, but when you get up every night at midnight and 3am, and often have to have juice and peanuts in the middle of the night, every day that takes longer is painful. The psychologists feels that we SHOULD be able to get rid of the 3am checks once we get all the settings tested and tweaked (about a month after we get the pump). I will always make sure I change her infusion site in the AM so that we have to day to make sure we have a good site and once we see that she's not typically messing with it in the bed, we might actually be able to sleep. What a novel idea.
Other than that, her days have been relatively normal. Today she got up from her nap and while I wasn't looking (I've been suffering from a pinched nerve in my shoulder for days, so sitting on the couch in pain) she got the Goldfish crackers out of the closet and took them on the porch and served herself a snack. It hadn't even been 3 hours since lunch, I hadn't tested her or counted out her food. A test for me. I tested her right away, guessed at how many she might have eaten and tried to dose based on how much insulin was still in her system from lunch, what her reading was, and how much she ate. WAY too many variables and she went low a bit later - but Mike was checking because of this and caught it with juice. Little rascal!
Friday, August 10, 2007
Three Steps Forward
Well, we have completed 3 steps on our checklist to putting Emma on a pump.
1) We attended pump night and we chose our pump - the Animas 2020. We liked the color screen the best, we liked the feel of the buttons and I think it has the best management for our 2 year old with little teeny doses
2) I scheduled our appointment with the child psychologist. Everyone going on the pump has to go through this step, and they even have a point where they talk to the children and the parents separately. I'm sure this is much more valuable for an older child than Emma, but if they'd like to carry on a conversation with her - I guarantee you she will oblige. Our appointment is in two weeks.
3) I faxed the paperwork to the pump company for them to start the process with the insurance company to purchase the pump. From what I understand, working with the particular medical supply company that our insurance company requires is painful, so I hope that they can navigate this as quickly as possible.
I hope to have her starting on the pump by mid-Sept. After we go through the psych appt, then the pump will be ordered and shipped. A pump representative will come to our house to train us on the pump and then Mike and I each have to wear it for a time with a saline drip before Emma wears it.
1) We attended pump night and we chose our pump - the Animas 2020. We liked the color screen the best, we liked the feel of the buttons and I think it has the best management for our 2 year old with little teeny doses
2) I scheduled our appointment with the child psychologist. Everyone going on the pump has to go through this step, and they even have a point where they talk to the children and the parents separately. I'm sure this is much more valuable for an older child than Emma, but if they'd like to carry on a conversation with her - I guarantee you she will oblige. Our appointment is in two weeks.
3) I faxed the paperwork to the pump company for them to start the process with the insurance company to purchase the pump. From what I understand, working with the particular medical supply company that our insurance company requires is painful, so I hope that they can navigate this as quickly as possible.
I hope to have her starting on the pump by mid-Sept. After we go through the psych appt, then the pump will be ordered and shipped. A pump representative will come to our house to train us on the pump and then Mike and I each have to wear it for a time with a saline drip before Emma wears it.
Saturday, August 4, 2007
Pumping
Next week we are starting the process to put Emma on a pump. Its not going to be easy but we hope that it will make things a little easier for us in the long run. For one thing, she has some strange "times of day" that we cannot adjust for well with the regimen we have (namely her body wants to go low between 10pm and 2am each night, leading to a juice and protein snack in the bed with us).
The process is supposed to take 2-3 months but we are trying to do it as quickly as possible to eliminate a couple of these lows that we are currently experiencing. This week is "Pump Night". We go have an introduction / initial training with the Nurse and then we meet with the pump vendors. I think I've narrowed it down to 2 pumps that I want to look at. The Nurse said that she normally doesn't recommend a pump but she is going to in our case because Emma is so little and her doses are so small. The pump she is recommending is one of the two - so we will spend a lot of time looking at that one on Wednesday.
After we decide on a pump, it has to be ordered and processed through Insurance. I have made, oh, 5 calls to the insurance company to confirm exactly how and where we can get a pump. The bad news is that I kept getting conflicting information - which is what I expected and the reason I called 5 times. The good news is that the one consistent piece of information I DID get is that it is covered 100% with no co-pay. That is good news since these cost about $7500 and even a 10% co-pay wouldn't be cheap.
After the pump arrives, Mike and I each have to wear it for a couple of days. We wear it with simply a saline drip. This is so that we understand what it takes to use a pump - since we will be managing the pump 100% until Emma is old enough. After we each wear it, then Emma will wear it for a few days to get used to it while we still do injections. There are lots and lots of cute little pouches that they sell to hold insulin pumps on a belt so I'm going to get her a couple so she'll enjoy it a little more.
Then we start the insulin drip through the pump. On all accounts, I understand that what you go through to get it calibrated is as bad as when you were first dealing with the diagnosis. The doses are little/teeny and they can be administered almost as frequently as every 15 minutes, so you are coming up with a scheme that gives the right dose in each time frame all day and all night long. Lote more finger sticks while you are figuring it out. AND then hoping that your infusion site is good (or the insulin won't get in) and the tubing doesn't get kinked OR your child doesn't disconnect it (I'm hearing funny yet not funny stories of 3 and 4 year olds disconnecting their own pump because they think its funny)
But in the end we should be able to manage her reading much better. No injections and insulin on a better schedule that SHOULD keep her from some of the shooting highs and dropping lows that we have been experiencing recently. I'll keep you updated.
The process is supposed to take 2-3 months but we are trying to do it as quickly as possible to eliminate a couple of these lows that we are currently experiencing. This week is "Pump Night". We go have an introduction / initial training with the Nurse and then we meet with the pump vendors. I think I've narrowed it down to 2 pumps that I want to look at. The Nurse said that she normally doesn't recommend a pump but she is going to in our case because Emma is so little and her doses are so small. The pump she is recommending is one of the two - so we will spend a lot of time looking at that one on Wednesday.
After we decide on a pump, it has to be ordered and processed through Insurance. I have made, oh, 5 calls to the insurance company to confirm exactly how and where we can get a pump. The bad news is that I kept getting conflicting information - which is what I expected and the reason I called 5 times. The good news is that the one consistent piece of information I DID get is that it is covered 100% with no co-pay. That is good news since these cost about $7500 and even a 10% co-pay wouldn't be cheap.
After the pump arrives, Mike and I each have to wear it for a couple of days. We wear it with simply a saline drip. This is so that we understand what it takes to use a pump - since we will be managing the pump 100% until Emma is old enough. After we each wear it, then Emma will wear it for a few days to get used to it while we still do injections. There are lots and lots of cute little pouches that they sell to hold insulin pumps on a belt so I'm going to get her a couple so she'll enjoy it a little more.
Then we start the insulin drip through the pump. On all accounts, I understand that what you go through to get it calibrated is as bad as when you were first dealing with the diagnosis. The doses are little/teeny and they can be administered almost as frequently as every 15 minutes, so you are coming up with a scheme that gives the right dose in each time frame all day and all night long. Lote more finger sticks while you are figuring it out. AND then hoping that your infusion site is good (or the insulin won't get in) and the tubing doesn't get kinked OR your child doesn't disconnect it (I'm hearing funny yet not funny stories of 3 and 4 year olds disconnecting their own pump because they think its funny)
But in the end we should be able to manage her reading much better. No injections and insulin on a better schedule that SHOULD keep her from some of the shooting highs and dropping lows that we have been experiencing recently. I'll keep you updated.
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