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Hi Barbara

As you know Sasha is not a pumper, but I started counting carbs when I saw
how much difference it made to the children of parents in the US and the
people here in the UK who told me about it.  Also we were going through a
horrendous period when for seemingly no reason Sasha would hypo in the
middle of a meals.  Anyway that turned out to be coeliac but we didn't know
for over eight months!!  As the symptoms were not recognised by the clinic.
So we had thought at least if we counted what she ate in would be one less

In the beginning I started with snacks so I could swap a snack of the same
carb amount when I knew a particular snack size was "working well".
Breakfast was nearly always the same size but I didn't realise how much the
carb count varied between different cereals until I weighed the amounts.
Lunch was easy to work out because it always had to be small and only about
one slice of bread and a yoghurt of packet of crisps.  Anymore and her bg
was sky high by 3.30 pm.  For a while we weighed the food for the evening
meal and wrote down amounts i.e. four roast potatoes = x amount, or one
baked potato average size 50 carbs or baked beans on toast 61 carbs.  So I
had a lot of combinations written down.   I could then see whether 2.5 , 3
units or 4 units were needed by trial and error to a certain extent.  Its
difficult to work out the insulin to carb ratio when there is so much
unpredictable NPH in the body.  Also one of the main factors I have found is
that an awful lot depends on the what the blood sugars were in previous
hours.  If you have had really good stable non diabetic levels then much
less insulin is needed to deal with that meal.  conversely if the blood
sugar level has been higher or high, much more short acting insulin is
needed to deal with that next meal.  That is one on the reasons for the big
overall reduction in insulin needs when pumping.  Stable bg leading to
needing less insulin.

When Sasha was on Mixtard I tended to stick to roughly the same amounts for
each meal.  When we split doses and had separate evening injections I could
vary the amounts of carb given though many meals worked out around the same
carb amount.  Its difficult to vary too much and say just give salad and
chicken and barely any carb, as although I could give less Novorapid I would
still have the set ratio of Insulard that would need "feeding" during the
night.  I never vary the NPH except if I am making permanent changes to the
regimen or when Terry gives an overdose;-).!!!  If you are using true MDI
three or four doses of short acting and a long acting insulin at night I
believe you can eat just salad if you want.  Not ever having done this I am
not sure.  I am sure other people using MDI will tell us.

After spending a considerable amount of time weighing and measuring and
making notes I am probably fairly good at estimating how much short acting
to give for each meal taking into account if its fatty or pasta or pizza.
Of course even sometimes when I have measured accurately I still find from
time to time things haven't gone to plan.  I don't weigh and measure  much
now as I can guestimate quite well.  Though I do check the backs of new
foods and write it down.  It also pays every now and again to recheck what
your estimates are for a meal as after a time things start to drift and kids
are growing and there food requirements increase.

I have read that as well as basal rates needing to be different at different
times of day that sometime the insulin to carb rate varies with the time its
eaten.  i.e. a bowl of cereal in the morning may need more insulin than the
same size bowl of cereal eaten at supper time.  Perhaps some pumpers could
tell you if this is true for them.

I am so -pleased that things are going so well.

Mum of Sasha aged 8

  -----Original Message-----
  From: email @ redacted [mailto:email @ redacted]
  Sent: 24 November 2002 22:50
  To: email @ redacted
  Cc: email @ redacted

  Hello everyone

  I have found that I only need to give 1.0 unit through the pump per 20g
CHO eaten.  For an apple, Danielle only needs 0.5 units.  I count the carbs
in her meals and if I get to, say 60g, you would probably work out that I
need to bolus 4 units for her, but I tried that and she went hypo, so I
tried 3.5 and that was still too much, so I tried 3.0 and she was coming
home from school around 2.5 mmols.  I now never do more than 3.0 for her
meals but for sandwiches, yoghurt and biscuit, I just give 2.5.

  Does everybody on this list weigh their food and count every single gramme
of CHO?  I don't weigh the food unless I am unsure about the type of food
(ie, she had grape nuts the other morning and I had to weigh them to see how
much to give her).  The grape nuts actually kept her quite high all morning.

  Does anybody else find that they stick to a certain number of units for
each meal?  I do an extra bolus for Danielle if she has something out of the
ordinary.  She stayed at her friend's house for tea last night and they ate
chips and burger.  This sent her sugars all over the place by midnight and I
couldn't control them.  She never has chips or burgers normally.

  Although I use a lot of guess work for CHO, Danielle's sugars have been
really good and I give myself a pat on the back for estimating correctly.
Does everyone else weigh the food and get it precise?

  Mum to Danielle aged 8 on pump trial and loving it
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