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


Sounds like you are pretty well prepared.  One of the things I remember most
vividly about being "on my own" at home on the pump in my teens was that
everyone expected it to work perfectly -- all that time, all that money, how
lucky I was -- so I never ever ever dared to admit if I blew it, it would
have been proof I was irresponsible, ungrateful or incompetent.  As I got
closer to college age, I thought it would have been read as evidence I
shouldn't be allowed to go (I was fighting about that anyway).   The other
thing I remember is that while I knew I should test (urine in those days) on
MDI, I could simply repeat my day plan without thinking about it and
probably not be in very good control but be relatively safe.

Again, that was not meant to be a negative post.  I often work with kids
with family problems and so many families do have problems.  That's fine
except I don't think we encourage families to imagine those problems and
possible solutions for them or to make realistic choices about whether they
can sustain the investments they are making.

Best of luck,

Kim Huffman wrote:

> Ruth wrote: (clipped)
> >  Pumps require continuous thoughtful and well thought out calculation.
> They also require very sensitive support from family or significant
> others
> or whomever it is close to you.  That means that as a parent you have to
> walk an additional balance beam -- not only the diabetes one.  That is,
> you
> must be able to implement careful and always changing calculations while
> handing them over slowly (as she gets older) to your child without ever
> dropping out while always being unobtrusive -- tough act!  Many families
> do
> this brilliantly -- Renee and Michael seem to have amazing senses of
> proportion (a fantastically difficult thing!) and great technical
> ability
> and lots of financial and emotional resources.  Lily and Melissa seem to
> be
> handling this all very well.  If for one moment though, you imagine that
> the
> pump can be used to make things easier, it doesn't -- just better
> control.
> >>>
> Ruth, thank you for your input, it was very thought provoking! Thanks to
> all the others who responded as well!  I have to say though, that the
> regimen we are on with MDI, certainly requires much in the way of
> careful calculations, as well as one eye on the clock at all times!
> 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).  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. 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).  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.
> 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%.
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