Re: [IPp] fluctuation in daily insuline doses
The leg cramp issue has been brought up here before. I believe some
conclusions were that it was related to growth spurts.
On Wed, Jan 7, 2009 at 9:44 AM, <email @ redacted> wrote:
>
> Tracy,
>
> Thanks a lot for your reply (I've been away from the computer while
> traveling)
>
> Yes, we are giving him 7-8 shots/day after just about every time he eats!
> We
> use the 30ml syringe and try to go in between lines to get .25 when he eats
> only
> 15 grams.? Our carb to insulin is .5 units/30 grams. His fastings number
> vary a
> lot - today it was 87 but he's been over 120 which is what the endo says we
> need
> to go on the long-acting. We have not diluted because the endo didn't
> recommend
> it.? We have an appointment with her on Jan 14th so all of this discussion
> is
> very timely and I hope we can come up with something better to suggest to
> her.
>
> I don't know if I've asked this before, but does anyone have problems with
> leg
> cramps?? Miko oftern cries with pain in his thighs and ankles in the
> evening,
> waking in the night and in the morning.? He also has a stomach pains and
> gas
> frequently that come with and without loose stools.? the leg pains are not
> associated with high sugar at exact time but could have been high earlier
> in the
> day.? Delayed response?? I'm concerned about Celiac with the stomach
> symptoms
> and will do the blood test next week.? We also had he checked out by
> rheumatology and found nothing so far.
>
> Best,
> Susan (4 year old Miko's mom)
>
>
>
>
>
>
>
> -----Original Message-----
> From: Tracy Winsor <email @ redacted>
> To: email @ redacted
> Sent: Fri, 26 Dec 2008 4:10 pm
> Subject: Re: [IPp] fluctuation in daily insuline doses
> ?
>
> I am almost certain Ben started out with 5 or less units a day when put on
> the pump. We were initially told that he could not go on the pump until
> 6-12 months after diagnosis because of honeymooning. I switched practices
> when I was given him faced with the ridiculous dietary suggestions and
> giving him 7-8 shots per day. He req'd littke bits of insulin with each
> meal and with any snack and then we were told to administer long-acting by
> way of two shots a day. AND still he was bouncing all over the place
> BG-wise.?
> ?
>
> His initial basals were .05 per hour which allowed us to even out immensely
> the ups and downs we had previsouly seen with injections. He was also
> considered EXTREMELY insulin sensitive because of his correction factor
> (i.e.1 unit of insulin brought him down 500 points). Again, all of this
> was
> made more manageable by the pump.?
> ?
>
> You mentioned his fasting BG's, are you correcting alot with meals though?
> It seems to me that in the absence of Ben's basal rate, I'd have to give
> him
> more bolus and might see a two hour postprandial of 150, BUT two hours
> after
> that he would have crept up to 280 or higher...SO 'd be correcting high
> BG's
> with the next meal that cuold have been prevented with a steady basal rate
> or long-acting insulin.?
> ?
>
> ALSO, what is his carb to insulin ratio and how are you managing the
> difficulty of have to guesstimate what anything less than 1/2 a unit is by
> syringe? Are you diluting??
> ?
>
> Tracy?
> ?
>
> I have never heard of treating only with s/t insulin by injection.?
>
> ----- Original Message -----
> From: <email @ redacted>?
>
> To: <email @ redacted>?
>
> Sent: Friday, December 26, 2008 1:56 PM?
>
> Subject: Re: [IPp] fluctuation in daily insuline doses?
>
> >?
>
> > Thanks for your feedback about the pumps and small doses. B We have an?
>
> > appointment with the endo in jan and I'll see what we can do. B I think
> > that?
>
> > part of the issue was that he was diagnosed very early and had a good
> deal
> > of?
>
> > function left. B The endo says that his needs still don't warrant even
> > having?
>
> > the long acting insulin--she said to wait for that until his fasting
> > levels?
>
> > are consistently above 120. B We cover foods with novolog and he takes
> > about?
>
> > 3-5unit/day. She said before that the smallest basal dose on the animas
> > was?
>
> > too much for him. B Does this make sense to you??
>
> >?
>
> >?
>
> >?
>
> > Happy New Year!?
>
> >?
>
> > Susan?
>
> >?
>
> >?
>
> > -----Original Message-----?
>
> > From: Joy Simon <email @ redacted>?
>
> > To: email @ redacted?
>
> > <email @ redacted>?
>
> > Sent: Thu, 25 Dec 2008 3:00 pm?
>
> > Subject: RE: [IPp] fluctuation in daily insuline doses?
>
> >?
>
> > My son Jake was put on a pump at 15 months old (diagnosed at 12 months).
> > The?
>
> > pump SAVED our lives. We had to convince our doctor to let us use the
> pump
> > at?
>
> > such a young age. Now - they put almost all toddlers on pumps at our
> > hospital.?
>
> > I?
>
> > would question your endo! In=2?
>
> > 0our opinion, it is impossible to use syringes on a?
>
> > young toddler due to small insulin levels. The pump is the only thing
> that?
>
> > can?
>
> > deliver such small doses of insulin.?
>
> >?
>
> > Joy - mom to jake (age 4) dxd at 12 months 11/05, pumping medtronics
> 5/06,?
>
> > cgms?
>
> > 7/06?
>
> > -----Original Message-----?
>
> > From: email @ redacted?
>
> > [mailto:email @ redacted] On Behalf Of
> > email @ redacted?
>
> > Sent: Wednesday, December 24, 2008 9:23 PM?
>
> > To: email @ redacted?
>
> > Subject: Re: [IPp] fluctuation in daily insuline doses?
>
> >?
>
> > David,?
>
> >?
>
> > I'm curious about your comment about the "fat effect".? It sounds like
> > you?
>
> > need?
>
> > more insulin to cover foods with fat and I thought that fat in foods
> would?
>
> > slow?
>
> > down the absorption of the carbs? Could you explain that more?? Is it?
>
> > something?
>
> > that is specific to pumping?? (My son was diagnosed last spring and is
> now
> > 4?
>
> > years old. We are not yet on the pump because our endo says that he
> > doesn't?
>
> > need?
>
> > enough insulin yet to have one.)?
>
> >?
>
> > Thanks,?
>
> > Susan (Mom of Miko)?
>
> >?
>
> >?
>
> >?
>
> >?
>
> >?
>
> >?
>
> >?
>
> >?
>
> > -----Original Message-----?
>
> > From: David Jensen <email @ redacted>?
>
> > To: email @ redacted?
>
> > Cc: email @ redacted?
>
> > Sent: Sun, 21 Dec 2008 11:52 am?
>
> > Subject: Re: [IPp] fluctuation in daily insuline doses?
>
> > ??
>
> >?
>
> > Robert,??
>
> > ??
>
> >?
>
> > I know what you're going through, Sigrid was diagnosed at 11 months and
> > her?
>
> > BGs?
>
> > were all over the place until a few things happened. So, some quick
> points
> > to?
>
> > help you through the next couple of years.??
>
> > ??
>
> >?
>
> > 1) Stop adjusting your basals and carb ratios so freq?
>
> > uently. My experience is?
>
> > that those ratios last a good 3-4 months before they need to be adjusted?
>
> > again.?
>
> > What you are seeing is the normal variation of food intake and insulin
> > usage?
>
> > in?
>
> > a toddler.??
>
> > ??
>
> >?
>
> > 2) Dilute the insulin. It only comes in U100 and U500 (in America).
> > However,?
>
> > your son is still very sensitive and it will be easier to control his
> > blood?
>
> > sugars if you use U10 or U25. Get a prescription for Humalog (from
> Lilly).?
>
> > Then?
>
> > go to your Pharmacist and ask them to contact Lilly and get some diluent?
>
> > (Novo?
>
> > will not give the pharmacist its diluent; I don't know about Apidra).
> It's?
>
> > free?
>
> > (and they - the pharmacy - cannot sell it to you) and they can then
> either?
>
> > dilute the insulin for you or, as I do, I take it home and dilute the
> > insulin?
>
> > myself. I make U50 and then adjust the pump settings to compensate (e.g.
> > her?
>
> > basal rate is 2X higher than it would be on U100). If you want details,?
>
> > contact?
>
> > me. NOTE: for reasons that no doctor can/will tell me, they hate that I?
>
> > dilute?
>
> > the insulin. You will probably run into this as well if you chose to
> > dilute.?
>
> > Others on the list also dilute.??
>
> > ??
>
> >?
>
> > Why dilute? Because 0.05 U of insulin is, in volume, 1/2 of a milliliter
> -?
>
> > think half of a poppy seed. While the engineering on the pumps will
> allow?
>
> > them?
>
> > to deliver 0.05 U/hr (some smaller), the "on the ground" reality is that?
>
> > delivering that volume into a body doesn't actually work that well (in
> my?
>
> > opinion). Example, take a straw, fill it with water and hold one end to
> a?
>
> > paper0Atowel. Now try to deliver one drop of water to the paper towel
> over
> > the?
>
> > next?
>
> > hour. You get the paper towel wicking the water out of the straw. Then?
>
> > trying?
>
> > to?
>
> > deliver another drop over the next hour doesn't re-fill the straw, then,?
>
> > later?
>
> > you get the straw filled and it delivers that drop but more than a drop
> is?
>
> > delivered, etc. You can see what that would mean for insulin in the body
> > and?
>
> > BG?
>
> > control. By moving "out" into the larger volumes the pump can deliver,
> it?
>
> > delivers insulin more uniformly and one gets smoother control of blood
> > sugars?
>
> > -?
>
> > I certainly do. Sigrid is 7 and we're still diluting.??
>
> > ??
>
> >?
>
> > 3) Make sure he is tested routinely for Celiac. Sigrid's was doing ok,
> her?
>
> > A1c's were in the 8's (this was, in retrospect, a function of me and my?
>
> > wife's?
>
> > learning curve. It took us a while to get over the fear of killing her
> > with?
>
> > insulin). Then about age 3-1/2, the doc's noticed that she wasn't growing
> > or?
>
> > putting on weight. We tested her and she was positive for the antibody
> > test?
>
> > (a?
>
> > blood test), but was "well, maybe" by the GI biopsy test (the gold
> > standard).?
>
> > The GI doctor wanted us to stay on a normal diet for another 6 months to
> a?
>
> > year?
>
> > and THEN have another biopsy to see if she really did get Celiac. My wife
> > and?
>
> > I?
>
> > are scientists and we understood the dynamics of the blood tests and so?
>
> > decided?
>
> > right then to put her on a gluten-free diet. Her BGs settled right down?
>
> > within?
>
> > 4?
>
> > weeks. We've been doing well since then; A1c's in the 7's.??
>
> > ??
>
> >?
>
> > My last soap?
>
> > box: Fat in food. This aspect of diabetes can put Sigrid all over?
>
> > the place in terms of her BGs (this last month as we've started the
> > holidays?
>
> > has?
>
> > been horrendous!). Sigrid goes to the high 200s or 300s if we bolus?
>
> > "straight"?
>
> > after she has whole milk, whipped cream, ice cream, full milk yogurt,
> > cheese,?
>
> > etc. We give her a lot of extra insulin to cover the "fat effect" to
> keep?
>
> > her?
>
> > in?
>
> > the 100s. We use a combo bolus covering ALL carbs up front and then
> > extending?
>
> > another 40% of the carbs over the next 6 hours (e.g. ice cream for 18g?
>
> > carbs.?
>
> > We?
>
> > set up a combo for 30g of carbs, 60% immediate, 40% extended over 6
> > hours).?
>
> > This?
>
> > works well for her.??
>
> > ??
>
> >?
>
> > Keep working at it, you really are doing great. The last thing that has?
>
> > helped?
>
> > Sigrid's BGs is the fact that she is now bigger. A missed carb here or
> > there?
>
> > doesn't affect her as much as it used to. You will get there/here too.??
>
> > ??
>
> >?
>
> > If you want to talk more, contact me off list.??
>
> > ??
>
> >?
>
> > David Jensen??
>
> >?
>
> > Dad to 7 yo Sigrid (dx'd 11 mos; pumping Cozmo since 17 mos.) and 4 yo?
>
> > Vibeka.??
>
> > ??
>
> >?
>
> > ??
>
> >?
>
> >?
>
> > On Dec 20, 2008, at 5:57 PM, pop-digest wrote:??
>
> > ??
>
> >?
>
> >> Date: Sat, 20 Dec 2008 23:57:12 +0100??
>
> >?
>
> >> From: "Robert Felicijan" <email @ redacted>??
>
> >?
>
> >> Subject: [IPp] fluctuation in daily insuline doses??
>
> >?
>
> >>??
>
> >?
>
> >> Hello??
>
> >?
>
> >>??
>
> >?
>
> > > I am new on this forum, so I do apologize if the topic was allready >?
>
> > covered??
>
> >?
>
> >> recently... but just don't have the energy to deep into the > archives,?
>
> > and??
>
> >?
>
> > > can't get any go?
>
> > od info from our doctors. First, shortly on basic > data. My?
>
> > son??
>
> >?
>
> > > Matic, was diagnosed with type I in august this year, as he was 20 >
> > > month?
>
> > old.??
>
> >?
>
> > > In september we got Paradigm 522 insulin pump, and are very happy >
> with?
>
> > it?
>
> > (??
>
> >?
>
> > > actually, I just can't imagine life without it, as those novopen >?
>
> > treatment?
>
> > was??
>
> >?
>
> > > killing us ). The next step was getting Paradigm RT CGM in october, >
> > > and?
>
> > that??
>
> >?
>
> > > also was a very good decision. It is of a enormous value, especially >
> > > in?
>
> > those??
>
> >?
>
> >> "wild" up and down days. On last check, we had HbA1c at 6,8%, and >?
>
> > couldn't??
>
> >?
>
> >> make it without CGM.??
>
> >?
>
> > > Now to the problem. Matic's daily consuption of insuline, with the >
> > > same?
>
> > amount??
>
> >?
>
> > > of food eaten (let's say around 150g OH), and not being ill changes >?
>
> > rapidly??
>
> >?
>
> > > from day to day. One day it would take 5 units of Novorapid, to have >
> > > his?
>
> > sugar??
>
> >?
>
> > > levels ok, than consumption would rise 20% per day to reach 10 units >
> > > in?
>
> > five??
>
> >?
>
> > > day. Than again down to 7 units and up to 12 and all this in ten >
> days.?
>
> > It?
>
> > is??
>
> >?
>
> >> very hard to keep up the changes and it takes constant adjustment of >?
>
> > basal??
>
> >?
>
> > > levels and OH ratio. We asked some other parents on that, and is >
> seems?
>
> > they??
>
> >?
>
> >> don't have this problem. But they all have older kids.??
>
> >?
>
> > > So I wonder, are these fluctuations present only at very young kids? >
> > > Do?
>
> > they??
>
> >?
>
> > > fade away and when? To what extreme can they go? What is the reason >
> (?
>
> > growth,??
>
> >?
>
> >>?
>
> > hormons,...). Any shared experience and useful information is >
> > appreciated.??
>
> >?
>
> >>??
>
> >?
>
> >> Robert??
>
> >?
>
> > .??
>
> > .?
>
> .?
> .
.
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