Re: [IPp] fluctuation in daily insuline doses
I agree! I know 2 children with Type 1 and celiac and it is no walk in the
park! One with celiac only - a tough disease by itself, let alone with
another autoimmune disease. Suzanne
----- Original Message -----
From: <email @ redacted>
To: <email @ redacted>
Sent: Wednesday, January 07, 2009 10:32 AM
Subject: Re: [IPp] fluctuation in daily insuline doses
>
> thanks so much!!!? We are not using sugar-free foods. I'm holding my
> breath on
> the celiac.? That would be really tough.
> Susan
>
>
>
>
>
>
>
> -----Original Message-----
> From: Suzanne Henbest <email @ redacted>
> To: email @ redacted
> Sent: Wed, 7 Jan 2009 10:01 am
> Subject: Re: [IPp] fluctuation in daily insuline doses
> ?
>
> When Megan was 4 -5 she often had muscle cramps in her legs at night and
> in
> the morning. She would fall to the floor in tears complaining. When I
> asked
> about it her endo actually thought it had to do with low bs - muscle
> fatigue - sometimes when they get really low and it is undetected and not
> treated with a quick acting sugar the liver will secrete glucagon which
> could then cause the diabetic child to have a higher blood sugar reading.
> (rebounding). As for the stomach pains and gas/loose stools, certainly
> makes sense to check for celiac but also remember if you are using sugar
> free items (drinks/jello/popscicles/candy, etc) some of the sweetners have
> a
> side effect of these sames symptoms. Not sure if you use any sugar free
> items but I wanted to mention it in case your son is responding to that.
> Megan is going through another bout of high blood sugars. It is almost as
> if she isn't responding to basal and we keep increasing it a little at a
> time but she is going on 3 weeks of BS in the low 200's.! Part of the
> disease is that we are constantly chasing a moving target. Hang in there,
> Suzanne?
>
> ----- Original Message -----
> From: <email @ redacted>?
>
> To: <email @ redacted>?
>
> Sent: Wednesday, January 07, 2009 9:44 AM?
>
> Subject: Re: [IPp] fluctuation in daily insuline doses?
>
>>?
>
>> 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???
>
>>?
>
>>>??
>
>>?
>
>>> .???
>
>>?
>
>>> .??
>
>>?
>
>> .??
>
>> .?
>
> .?
> .
.
----------------------------------------------------------
for HELP or to subscribe/unsubscribe/change list versions,
contact: HELP@insulin-pumpers.org
