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[IPk] RE: Bad Day Today

Hi Barbara,


Sorry to hear that things haven't gone so well today - we had some
similar experiences in the early days.  It actually helped us to know
that things can change so fast - it has made us much more vigilant.


A couple of points/queries:


I wouldn't expect Humalog (I assume that's what you're using) to be gone
in only 3/4 hour.  We usually find it takes about 2 hours with Sam & can
take up to 4 hours in adults.  Also bear in mind that you may not yet
have the right basal rates set right through the day.  It took us a few
weeks before we had finished tweaking.  Another thought - what did
Danielle actually eat that you calculated the 4 units for?  Was it
something that digested slowly and therefore peaked after the insulin
was most active?  And another one - are you bolusing before or after
Danielle eats?  We always let Sam eat, count as we go and bolus when
he's finished, sometimes 2 or 3 times during the course of a meal.  That
way we never get the problem that he decides he's not hungry after the
insulin has gone in - with Humalog that can lead to very quick hypos.


I'm also a bit surprised that the nurse didn't suggest that you change
the infusion set when Danielle went up to 28.9.  A series of such high
readings can be the first indication that there is an infusion set
problem and it's usually safest to assume the worst, correct by syringe
and change the set.  We had just such an occurrence with Sam a week ago.
Julie got a call when school did his morning BG test at 10.30 to say the
meter read "HI", so she went in to double check and had the same result
on our other meter (i.e. BG probably well over 30!).  She corrected by
syringe, changed the set and he was down to single figures within 3
hours.  I'm not suggesting that anyone has done anything wrong in your
case, but it's important to be aware how quickly things can go wrong and
need attention.


We've always used Silhouettes, which I prefer (although I'm not the one
wearing them!) as you can always see that they've gone in OK.  In 15
months, we've only once had an actual canulla problem, when the plastic
tube ruptured somehow and we had a "no delivery" alarm just after
breakfast.  That was very much a one-off, but again shows that you have
to be on your toes!


Don't give up, it will get better.  You've all done really well so far.


Hope the weekend is more relaxing.





-----Original Message-----
From: email @ redacted [mailto:email @ redacted] 
Sent: 08 November 2002 21:55
To: email @ redacted
Cc: email @ redacted
Subject: Bad Day Today


Hello everyone

I promised you all that I would be honest about the pump trial.  Well, I
was on such a high yesterday that I thought nothing could possibly go
wrong.  I was wrong!

It all started at tea time last night when I over-treated her meal.  I
counted the carbohydrate and then gave her 4 units.  The insulin is
supposed to have done its job and gone around 3/4 hour so I thought I
was safe when she went to bed.  She dropped to 1.8.

I wasn't as bothered about that than I was about what happened today.
OK, it was scarey but I dealt with it and she actually remembers it
which meant she was aware a bit.  The good thing about being on the pump
is that she didn't need to eat as well to sustain her blood sugar level;
she just needed the sugary drink.  Well, she rebounded and this morning
she was 16.8.  I wasn't so bothered because I could do a correction
bolus and a bolus for her breakfast, but I was worried because she
wanted to go back to school today and wouldn't hear of having another
day off, so I let her go.  Before she went to school she was 20.9 but I
didn't do a correction because I was leaving her at school and wouldn't
be able to monitor what was happening close enough.

I went into school at 12 noon while she was eating her sandwiches and
tested her blood.  It was 24.9.  I gave her a correction bolus of 3.0
and then half an hour later, I gave her a meal bolus of 2.0.  At 1
o'clock, I tested her blood again and it was 28.9 so I brought her home.
The pump nurse (who rings all day regularly for the results) recommended
that I increase the basal rate from 0.3 to 0.5 for 4 hours and also
correct with another bolus.  This worked out well and she has gone to
bed at 9 o'clock with a reading of 9.9.

We also changed the site tonight and tried the sof-set.  She became very
distressed with it because she tried 4 or 5 times to get the needle into
her skin manually and it would pierce but wouldn't go right in so Pete
tried it on him and found the same problem.  We went back to the
silhouette because we have had no problems with that one so it wasn't
worth changing anything for us.

I am shattered.  All I have done today is test blood and make notes in
the diary, hang around school and watch Countdown!

I'm not giving up yet though.

Babs x
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