Thursday, July 1, 2010

A lesson to learn...

To say it has been a long week would be an understatement. Maybe if I wasn't an endocrinologically challenged control freak... I wouldn't be exhausted right now :)

Today... we are on pump day 11. From the way things are going... site changes are glucose crashing monsters. Those have been the days with the most issue around here. That leads me to my mistake.

Yesterday, Justin had a birthday party to go to at my favorite place E.V.E.R (sarcasm inserted)!
Chuck-E-Cheese has made my head hurt before I even get there on many occasions. It's not the snotty nose little kids all touching the same games... it's not the tube system polluted with food that parents let their little darling take in there or the fact that if you walk in your white sox's... they will look like you just played in the dirt with them(oh wait- that IS what you did).
Aside from all that loveliness... MAN IS IT LOUD!!! I do not like chaos... never have! And it doesn't get much more chaotic than a birthday celebration in the mouse house.

Before I go... I prepare. Chuck-E is nice enough to list his nutritional value on his website. I made sure to write it all down ahead of time. AND the soda is easily accessible so I could fill Justin's party cup with some carb free diet.

Get to the point Lora...

Okay, so for the pizza I figure Justin would eat 2 pieces... they were not real big. So I go ahead and bolus for that thinking there would be play time in between pizza and cake... um NOPE!
The girl just dished out the cake like it was part of the meal. So in my unsure mind I decided to wait a bit to see what his BS would do before I bolus more. Besides, he has been running hard for almost 3 hours straight and his BS held pretty steady the whole time.

When it was over...(still no bolus for cake) the kids turn their tickets in to Mr. Munchy and we head over to the counter full of prize "stuff". Five hours later (not really, but it felt like it) we emerge with our trinkets and head home.

When we get home (2 hours after eating) I have Justin check his BS... 268. Okay, correction it is. I gave a little less than it said because it is night time.

Oh yeah, we also needed to do a site change... Magic cream + 45 min... easy!

Until... the bedtime check.
9:42pm - 53 + 18c
9:59pm - 64 (did I not wait long enough?)
10:22pm - 53 + 38c (pb&j with a little bit if juice to quick boost)
11:01pm - 133
3:00am - 74 + 15c
6:30am - 57 +15c
8:00am - 46

Dear lord what did I do???? Should I not have corrected at all??

What would you have done??


Heidi =) said...

Oh Lora I have no clue what went wrong there. It looks to me like you gave it your best shot and D was just throwing you a curve ball. You are an awesome mom!

:) Tracie said...

It sounds like you did everything right. What might be going on is the basal rates at certain times may need to be reduced. That's what happened with Jessi on her Ping. (she's been MDI for 4 months now)
Let the Dr. know about the lows and see what he says about changing the basal night especially.

The pump is an amazing device, but a little frustrating in that it takes some tweaking to get things straight sometimes.

You're doing fine, sleep deprived I'm sure, but this has a learning curve as well. :)

Heather said...

Exactly what I would have done, along with pulling my hair out and being horribly frustrated! :)

I would agree, some basal rates at night might need to change. Wait a day though because the lows could have been caused by all the excitement from the party. Don't be surprised that you might have to make some more tweeks in the coming weeks. It takes a while to get all those basal rates right sometimes. You are doing great!

Pam said...

Boy, it's never easy, is it? Site changes make Grace trend down as well. It's the cold insulin. Maybe lower his basal rate for 6 (12?) hours after the change to adjust for the "more potent" insulin. It may also be his correction factor is too high (when you corrected he went too low). Then again, it could've been all the exercise catching up with him.

Clearly, I have no idea either! These are all the things that bounce around in my head when we're in a similar situation. Good Luck!

PS - I am your sister in hatred for Chuck-E-Cheese.

Jen said...

I would have done the exact same thing Lora. It is so hard to know if the lows were from the site change or activity or combo of both. I have been making use of temp basals in these situations..sometimes with success and sometimes not! It is a lot of trial and error in the beginning of pumping isn't it? I seriously was pulling my hair out a couple of weeks ago..Hang in there!

Hallie Addington said...

Ok - things I've found pumping with the ping...
When I don't bolus for food and then try to correct later - it ALWAYS results in a horrible low. I don't know why. It just does. Like if I forget to bolus for a snack - then realize later that I did and she's high - a correction always equals a massive crash. No matter if it's a correction one, two, or more hours after missed bolus.

What I do is a) sometimes bolus for the missed carbs b) figure out what the correction would be and give less or c) just know that I'm screwed no matter what I do because I've never handled this with much success.

We also went thru a period of time when site changes led to lows the first night. For some reason, that happened a few times and then *poof* as quickly as it happened, it disappeared.

I'd probably only mess with the overnight basal if you see a problem EVERY night. If it's just site change nights, you can always do a -10% (or more) basal reduction and see what happens. Or you can turn the pump off for a bit. You'll have to play around a little to see what is going to work best for Justin.

That's my 2 cents about what has worked and what I've found has happened to us! Hang in there - you're doing GREAT! And once you get a Dexie, it will MUCH easier to see what you need to do overnight! :)

AjsMommy82 said...

I don't correct at the 2 hour mark anymore it ALWAYS ended with a low. Maybe only correct 3-3.5 hours after eating??? And a basal rate change is probably also in need of a change!

Meri said...

Do these lows only occur on set changing days? I think that is what I got...IF that is the case, and you see a crash after every site change, then maybe lower the basal rate 50% for 3 hours after each change and see what happens. (Maybe double check that the fill canula setting is at the correct dosage...obvious I know, but we have had that problem before.)

Another thing is it is summer. And it just may happen that set changes coincide with more active days. My boys don't go low on swimming days in the evening after swimming...they go low at night, 8:00pm and on.

Why does diabetes have to be so freakin complicated???? There are a MILLION senarios...somehow you'll figure it out. We always do! Good luck friend!

Wendy said...

I just want to tell you that you're doing a great job....there are so many many scenarios....AHHHHHH!!!!!

I think you're doing great :)

Sending lots of hugs from AZ!

Unknown said...


A TON of variables there for sure. I would have totally done the same...I would have even given more insulin for the 268 just because Joe is a runaway freight train with pizza on board (I usually have to bump up the basal too in addition to combo bolusing etc).

You could double check the cannula fill amount, but man, that would be such a SMALL amount of cause that many lows. I remember Joe doing the same thing when we first started pumping. I am wondering if since the tissue is new to receiving insulin, if it absorbs it at a different rate or more wholey as compared to those of us pumping for a year or more. The only solution in that case is the decrease basal on set change days for a few hours. Unfortunately, with the pump...and with D in general is to study, log, tweak and REPEAT.


phonelady said...

I was going to say that maybe his correction is too high . That was my first thought . Last night I was at 283 . I dont know why .

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