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RE: [IPk] 4 year old child new to insulin pump



Hi John

 As you know Sasha is not a pumper yet, and I might be barking up the wrong
tree. Is there a possibility
 that the basal rates are not correct. I believe if the basal rates are not
right then it's difficult to
 get the bolus right. Also Novorapid does not work as fast as some people think
and if the blood sugar is
 already high before a meal it would take a while for the blood sugar to
normalise. When Novorapid is
 injected subcutaneously, the onset of action will occur within 10-20 minutes of
injection. The maximum
 effect is exerted between 1 and 3 hours after injection. The duration of action
is 3 to 5 hours. It
 shouldn't make any difference to how quickly it works whether it's given by
injection or pump (providing
 that there isn't a site/canular or pump problem. Many people are under the
impression that it works
 instantly but it doesn't. It was designed to match the approximate digestion
and absorption of an
 average meal. So if you start off high you would either have to bolus before
hand and wait a bit, or if
 you decide not to wait to eat, you may have to accept that the blood sugars
will increase rapidly after
 the meal. Of course if this is only occurring now and then it may not matter
but it all the pre meal BG
 levels are high then, like you say something is not right. Maybe you are just
not bolusing enough for
each meal.

 When Sasha is high before a meal, for instance wakes up at 7.00 am and tests
and is over 10 mmols, we
 would usually give half, to one unit immediately. Then by the time breakfast is
ready, some of the
 Novorapid will already be working. Of course Andrew is much smaller than Sasha,
so you would obviously
 have to review the dose. During the holidays and at school Sasha checks her BG
before lunch, partly
 because she is sometimes too low at 12.00 at school and the school then have 15
minutes of play time
 before eating lunch. She rings us each day. If she is high she takes one unit
of insulin immediately.
 If low she eats a snack or glucose tablets. After lunch, depending on what she
eats, which is usually
 only 30 carbs as she usually hates the gluten free rolls, she decides whether
she needs anymore insulin
 or not. If she eats all her lunch she will then go and have 1.5 units of
Novorapid. Of course all this
 back and forth to the reception to get the insulin is a pain and a pump would
be handy!! But so far we
have rarely had hypos in the afternoon using this method.

 You may be having problems due to the infection and also the asthma treatment.
Even the Ventolin
 increases Sasha's BG even though we were told this doesn't happen, that only
the steroid puffer would do
that.

 I am sure its early days and everything will fall into place. I can remember
when I was a regular
 subscriber and poster to the American parents diabetes support list and when
parents started their child
 on a pump it was sometime weeks before they started getting the results they
wanted. Many an email I
 have read where the parents have despaired of getting it right and have talked
of chucking the pump out
 of the window. A few thought that they were going to have to go back to
injections. Of course in the
end they got there.  Hang on in there John you're doing a great job.

 Also have a lot on Diabetes Mall for things like the "unused insulin rule" and
other tips

 http://www.diabetesnet.com/diabetes_control_tips/unused_insulin_rule.php

http://www.diabetesnet.com/diabetes_control_tips/1800rule.php



Jackie

I am sure that you will get better advice from the other pumpers.



> I wonder if anyone can help?
>
> My youngest son, now aged 4 years has now moved from MDI to the
> (mini-med)insulin pump. We have been pumping for about 2 months now, steep
> learning curve for for parents and little Andrew!
>
> We have had a few problems, but by and large are getting to grips with the
> new regime.
> However, there are a number of problems we are repeatedly causing concern:
> particularly high blood sugars before meals. For example, we struggled with
> Andrews levels yesterday, looks like he has a little chest infection/asthma
> at the mo' and levels are a little unstable. Last night I thought I had a
> reasonable grip overnight, but they crept up and he awoke with bg's in the
> 14's.
> Here is the problem: whenever Andrew's levels are raised before meals, we
> have a great deal of trouble getting him back down into 'range' before he
> eats.I realise the cells become insulin resistant when out of ange. Our DSN
> has advised that the insulin is very fast acting on the pump. We have done
> repeat testing but cannot seem to work out how fast acting, exactly. Has
> anyone on the pump had a continuous blood glucose monitor fitted at the same
> time to see the profile of insulin when bolused? We have been encouraged to
> bolus the appropriate amount of insulin after meals. However we have found
> we have repeatedly lost control of bg's, with post meals 2 hour tests being
> repeatedly in the 20's, which is a little worrying.
>
> Can anyone help? Obviously everyone is different, but does anyone out there
> have any knowledge of how quickly the bolused insulin (novorapid) 'kicks'
> into action and lowers bg's? Today, we waited 5 mins after bolusing .5 (half
> a unit) before the meal, in an attempt to lower bg's into range. We failed
> (again), Andrew had blood sugars of 24 mmols 2hours post food.
>
> Not too good. Has anyone any advice, please?
>
> Best Wishes
>
> John NEAL (not to be confused with John Neale!!)
> Andrews dad.
> > >chooses to adhere
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