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Re: [IP] zero to DKA in nothin' flat?

With a pump, here is what will change.

> Every morning after Stephs bg test, I "calculate" how much insulin to
> give based on what she is having for breakfast, also making any
> adjustments for a high reading. 
> I pack her lunch with a 15 gram carb.
> snack for 10:00 am, and 60 grams for her 12:00 lunch (she knows she must
> eat every bite of food because the NPH "says so").  When she gets home,
> she immediately has her 30 gram limit of snack (she wishes it were much
> more, but not enough to take another shot).  On days she has piano
> pratice, she has 10 minutes to woof down her snack before she must be at
> her lesson (on days her carpool runs late, she eats in the car on the
> way to the instructors house).  

No snacks, eat when you want, what you want (pretty much)

> At dinner, it's the same routine all
> over again.  Test,  calculate dose based on what she will be eating,
> adjust for any highs, etc..  Most nights she eats alone as my husband
> can't predict what time he will get home (we have a family lumber mill
> business), and her brother may have sports practice, etc. 

She can eat with the family. Caveat: it is much better if you have 
your last insulin 4 - 5 hours prior to going to bed -- then you know 
you are stable for the night. This is not so for vanilla snacks like 
toast and milk, etc...

>At 8:30, she
> tests, has snack based on the bg, if high, she gets nothing (even though
> she might "want" something).  Again, she could take some humalog, but
> doesn't want another shot.  She goes to bed at 9:00, and I go in at 10
> or 10:30 to give the NPH (she has a strong dawn phenomenon, so they
> don't want her to get the NPH until later).  
The pump will take care of dawn phenomenon, you will just need to do 
a middle of the night check occasionaly (or a lot if you're paranoid 
like me). As she reaches adolescense and basal requirements change a 
lot - rapidly, you will have to do this on a more routine basis. But, 
this is true whether or not you pump.

> I guess I could give her
> any extra humalog at that time so she could have the option of a bigger
> snack on some nights, but then I am chasing after the carbs 1 1/2 hrs.
> later.... So, I DO think that the pump would make life "easier", at
> least as far as our schedule goes.
> I also think that the "balance beam" of gradually handing over control
> is much the same with MDI.  As she has gotten older, she has taken over
> her care a little at a time as she feels comfortable.   We also have had
> the same "always changing calculations" with MDI.  Her doses are
> changing constantly!!  I always feel we are one step behind.  Just when
> we get the dose fine tuned (as much as is possible), it changes again.
I really believe this is easier with a pump. The basal rate 
adjustments can be separated from the meal insulin and the overall 
set of calculations become much easier. This is easier for the child 
as well. She will not worry about basal adjustments (that's your 
problem) and is left only with the relatively straightforward task of 
matching carbs to insulin - and  later, figuring the unused insulin 
rule (aka unused carb rule).

> The most important thing to us is what Stephanie wants.  She knows that
> there is no pressure to make a decision right now and that we will be
> behind her 100%.
Think HOT FUDGE SUNDAE! Lily  eats quite a few of these during the 
summer. Her first request on the way home from the doc's after 
getting insulin in her pump (I will never forget, it made me cry) was 
to stop at Mc Donalds for an apple pie.

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