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[IPp] What the heck....


There are a lot of reasons why Emma's sugars could be too high.  The 
insulin could be bad, the site could be bad, the pump could be 
malfunctioning, or she could be getting sick.

BUT - since you just started pumping, I think the MOST LIKELY CAUSE is 
that her basal and/or bolus ratios were set too low for what she really 
needs.  When starting someone on a pump, especially a little one, it's 
safest to give a little less insulin than you think they really need - 
since it's impossible to know exactly what the right ratios will be 
(and better too little insulin than too much!).  BUT - it's also 
crucial that whoever is helping you (endo/CDE) should monitor how 
Emma's sugars are doing, and help you adjust her ratios in response to 
what ***her actual results*** are telling you.

Start, if you can, with getting the basals straightened out.  The book 
"Pumping Insulin" will be a huge help.  Ideally, you want the basal 
insulin set so that your daughter can go without food and her blood 
sugars should remain stable (unless she's sick).  This will take a lot 
of time; we've been doing this six months and we change Sigrid's ratios 
at least every month - whenever it hits us that her numbers are showing 
a pattern we need to do something about.  Then again, with a rapidly 
growing child, we are trying to hit a moving target (and you are, too).

Your email seems to assume that the basal/bolus ratios you started with 
"should have been just right", and that there must be some other 
problem.  On the contrary - your daughter is starting with a new 
insulin, and she's very small so there isn't a lot of data out there on 
how to deal with her, and anyway the standard practice is to use the 
"rules" to figure out what the basal/bolus ratios are likely to be - 
and then give a little less insulin than that, to be on the safe side.  
I would be extraordinarily surprised if the numbers you started with 
were, in fact, the numbers you would need.  Best wishes and chin up - 
this is SO much better than shots, once you get the hang of it!

Note, too, that Emma may have been OK with these numbers for the first 
days because she would still have had Lantus hanging around in her 
system for awhile.  The graphs you're used to seeing only show when 
insulin is present in the blood - but from the blood, it goes to the 
cells of your body, where it continues to be active for quite awhile 
longer.  This fact is not well-known.

- Maria

mom to Sigrid, dx'd @11 mos., pumping since 17 mos., will be 2 yo this 

Date: Fri, 3 Oct 2003 21:14:10 -0700
From: "Catherine Schulz" <email @ redacted>
Subject: [IPp] What the heck...

I cannot get Emma's numbers down on the pump (we've been pumping 2 weeks
She was just fine with the new basals and boluses, now, she's over 250 
check, and lots of times over 300.  I'm checking and correcting every 
about, and her numbers won't budge. (etc.)
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