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[IP] re: about to give up...

Hi, "wornout mom"

I'm curious as to the pre-pump training your daughter had.  Was she
taught to count carbohydrates, and write everything she ate (plus carb.
values) plus insulin and exercise info on a sheet of paper each day?
That was done with me for a month before I went on the pump.  I hated
it, and as a diabetic for 34 years without the pump, thought I knew by
"estimating" more than I ctually did.

The key is to write even snack items, junk food, etc. down, and make
sure she knows how many carbs it is and then bolus for it (I assume she
knows what her insulin to carb ratio is??  That's another key element in
pre-pump training).

To simplify matters, she may want to do what I have done for the first
month I've been on the pump:  I have had the identical breakfast and
lunch  (and bedtime snack!) for the whole time!  Boring, yes--but it
reduces the variables so that you can get the right basal rates set (has
she done the fasts to establish the proper basal rates?).  As a young
woman going through all sorts of hormonal changes, she doesn't need the
extra variables of different foods, etc., while starting the pump.

When her HbA1C's were better, was she eating "practically whatever she
wanted"?  I doubt it...  My guess is that you may have sold her on the
freedom of the pump (more flexibility in eating, etc.) without also
mentioning the initial demands and responsibilities of the pump.

So here are the key things as I see it (recognizing I am not a doctor,
etc., etc.--but I think these are common-sense things not requiring a
medical degree...):

1) she must stop eating whatever she wants whenever she wants until she
has more pump experience with a regular, fixed amount of carbohydrates.
The increased flexibility should come later, after proper basal rates
are set, and proper boluses for the # of carbohydrates she is eating.

2) she must write down everything she's eating (and when!), every amount
of bolusing (and when), and every amount of abnormal exercise (or
sickness, etc.).  That's the only way you'll be able to analyze
patterns.  Even if she doesn't do #1, impress upon her the importance of
#2 (and not "hiding" what she is eating--write it all down!).  I thought
this wouldn't be necessary, but it is--and you get used to it after a

3) she needs to redo her fasts to set the basal rates.

4) she needs to makes sure not to "overtreat" lows, so that she bounces
back high...a horrible cycle we've all been through.  For me, it means
using 3-4 of the horribly-tasting glucose tablets (sorry list--I think
they taste awful!) or (much more preferable!) a small pack of Necco
wafers (13 grams of sugar), and no more until she tests 15-20 minutes
later.  Like most diabetics, I tended to overtreat lows.

Hormonal changes, etc., will still make this hard (this is the toughest
age!), but the pump will give her far greater flexibility, once she
exercises  a bit more discipline (and knows what foods affect her blood
sugar in what way).

Hope this helps!  Don't give up on the pump yet!!

Todd (parent of two teens...and diagnosed at age 13 myself...)
<original message>
Subject: Re: [IP] ready to quit the pump-help

My husband, 13 year old daughter and I are all really smart, educated
and motivated people.  She went on the pump in December and our bg
numbers have generally been worse, the stress on all of us is
unbelievable, and her A1C went from 6.9 to 7.4.  I expect it will be at
least this number at the next appointment.  There has been one problem
after another, all resulting in high bgs.  She only uses the Siloette,
has 3 basel rates during the 24 hour period, and checks 4-10 times a
day.  She tends to nibble a lot, and eats practically whatever she
wants.  In the past week, over half of her bgs have been over 200;  in
spite of close checks of tubing and pump.  She boluses the right amounts
and it takes forever for the insulin to bring down her bgs.
Often, we have to re-bolus to bring bgs down, so we are forever "chasing
numbers" - up until bedtime.  Then we have to stay up to stabilize her
bgs, finally go to bed, and often end up with a low in the middle of the

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