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[IP] Hi Karen--kids and pumping

Hi Karen,
     I bet you are excited, but also nervous about the pump start up.  I know 
that I was.  
     My Claire starting pumping 13 months ago, she was age 6 but about to 
turn 7.  She was average size (can't remember weight, but now is 59 pounds) 
and I think used about 24 units with needles.  She was very sensitive to 
Regular and Humalog, NPH didn't work on her at all.  Claire is a good eater 
and eats a lot, about 210 carbs a day, both pre-pump and post-pump.  
     Her basal rate was started at .3.  She was really somewhere between .3 
and .4 according to my calculations, but the nurse said, quite correctly, to 
start lower and then move it up if needed.  
     The carb ratio used to start her was 1:15.  I have NEVER heard of 1:10 
used in kids.  Claire now uses a 1:20 ratio if she is eating before exercise 
or lots of fun playing, eg at lunch at school when outdoor recess immediately 
follows.  I have noticed that in the mornings she needs more insulin, but we 
still use 1:15, running a higher basal rate in the morning hours. 
     I am in Canada, so the high bg correction factor sounds a lot nicer in 
our measuring system--.1 unit of insulin drops her 1 mmol.  Translated to the 
USA system, .1 unit drops her 18 points, and thus .5 unit drops her 90 
points.  This is what the nurse suggested to us at start-up, based on her 
experience with kids.  It works very well, except when bgs are very, very 
high, as you have probably heard about before.  I would advise you to be 
extremely careful in giving high bg boluses!!!  One half unit without food 
will likely drop your daughter a lot, unless she isn't sensitive, but with 
such a low daily dose it sounds like she must be quite insulin sensitive.  
     I'm not telling you to disagree with your doctor, but if it was me, I 
would just use the ratios and correction factors that I felt were the best 
for my child.  Does your team have experience with young kids?  Is this the 
starting rate they use with all kids?  Or is there something particular to 
your child?  
     Are you a member of the Parents of pumpers list?  If you post your 
question there, you will likely get lots of other responses.  Maybe you 
already have, I am on digest mode, so it takes me awhile to get the mail.  
     Good luck!  You can write me with any other questions if you want, but 
we are moving house next week so computer may be out of service for a bit.
Barbara, Mum of Claire 8--H-tron and Quick-sets

> Subject: [IP] starting insulin ratio and correction factors
> Lauren, age 6 and dx'd 11/00, is wearing her pump with saline now, and we
> will start with insulin on Tuesday.  Our new CDE and her endo are
> suggesting a correction factor of 1:60, and an insulin to CHO ratio of
> 1:10.  Her total daily dose is about 15-17 units now with injections.  I
> think 1:60 and 1:10 is way off.  By the rules of 1800 and 500, with 16
> units TDD she should be 1:113 correction and 1:31 insulin to CHO.
> Wouldn't 1:60 and 1:10 probably make her too low?  I'd like some opinions
> on this.  
> Either I need more lessons in algebra or the doctor and CDE do.
> Thanks in advance.
> Karen
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