Questions


(Jessica L) #1

I want to push to get Riley on a flex meal plan asap. She is sick of the stupid fixed plan and frankly so am I. I am available to go and give her shots before lunch at school because she is not ready to do that herself yet. So I dont see a problem with it but I have a few questions.

One if I get it right you give the fast acting insulin before they eat correct? Or is it if they are in normal you dont? Because they take a long lasting one as well still right? haha my one question turns into 3.

This is something I have been thinking about but am not sure of. Like is she eats lunch at noon and then they have a class party a hour later do you give more insulin for what she is going to eat at the party? Or do you wait and correct only if their numbers shoot up?

 

I really want to understand all of this before I ask to change it. I also want Riley to understand what it all means before deciding if this is the change she wants. More shots isnt something I really think she wants but she might if she has the freedom to eat more or less and when she wants.

also does this help with numbers? Hers are all over the place. She was running low for almost 24 hours and then shot up into the 300's before dinner last night. I dont get it the only change was she had some chips yesterday instead of crackers with her snack. I weighed them out and they were still only 15 carbs. So yeah no clue why unless it was the chips.


(MM Mom) #2

You have to count the carbs in her meal before deciding how much insulin she will need.  Her activities will also play a role in how much insulin she will need.  A diabetic nutritionist and a diabetic teacher would really be able to help you with a plan for her and her meals and snacks.  You may need a referral from your physician so your insurance will pay for a visit with one of these professionals.  Many hospitals employ a diabetic teacher.  You may need to correct later if your dosage was not adequate.  Riley will like having more freedom with the foods she chooses. 

I think it is fair to say, unless on a pump, you are going to have lows and highs with Riley's blood sugars.  Just keep doing the best you can - sounds like you are doing great and Riley is very lucky to have you!  And know that you will have good days and ones that mistify you. 

 


(sarahslp) #3

Maybe you and Riley can meet with a diabetes educator to help make the decision? It will involve more shots b/c she'd inject short-acting each time she eats carbs. But, it will give her more freedom to eat what she wants. So, if there's a birthday party at school in the afternoon, she'd count carbs and inject short acting. It means the teacher will have to warn you if a special event is coming up, though. Honestly, you'll probably move to carb-counting / a flexible plan eventually b/c that's the most modern and best practice for T1. It's just a question of if it's overwhelming now so soon after diagnosis to learn something new, and when you're ready to make the switch.

MM, you have a good point that there tend to be fewer highs & lows w/ a pump than MDI. But, I've been on both and want to make it clear it occurs with BOTH. Sadly, it's just part of T1. Pumps can be helpful in the long run if it's the preference of the family (they're unlikely to put Riley on yet b/c she was just diagnosed). But, they aren't a cure...


(Jessica L) #4

Yeah we are going to wait for a pump. She doesnt think she is ready for one and we really want a good hold on how to do it this way first. That way if her pump breaks we know what to do.

She doesnt want more shots everyday after explaining it all to her she would rather be stuck with the fixed plan. So I guess all my questions were for nothing. Well not really. Thanks for replying.


(Sarah Romaine) #5

The school is legally obligated to administer injections according your doctor's plan.  If they do not they are in violation of federal law, and most likely, state law as well.  It is better to try to work through your sdisttrict's 504 team before threatening them, or infoming them of the law.  There is a sample school plan on the JDRF website. 

To answer your questions, judging from my carb counting experience:  depending on what type of long acting insulin she is on and how her body reacts to it, she may or may not take an injection at every eating.  As for when, with children, you never know how much they will eat.  In the district I work in, they do bolus before the meal, and then have the child increase carb load (drink milk or juice) if necessary to meet the insulin dosage.

She will likely have to bolus for a class party, and someone will have to figure out the carb load for what she is eating.  I don't think it is a good idea to wait and only correct.  When there is something that I am not sure of served, I may estimate the carb load low, and bolus for that, correcting later.  This is done only when I fear I will go low.

Watching my husband and a child at the school where I work, I think some people's sugars are just harder to control.  I firmly believe that a pump is the easiest and best way to make the very small variations necessary for some people to better control their sugars. 

Types of carbs do affect my blood sugars.  Sometimes fats raise my blood sugars beyond the carb load of a meal.  Pizza, chips, dips, etc.

Good luck.

PS, age 9 is not too young to give an injection.  It is my judgement, not knowing you or your daughter at all, that she should be giving her  own shots by now (so I am open to the possibility that I may be completely wrong).  She should be guided through calculating her boluses and supervised drawing her injections.  My husband was diagnosed at 3 and learned to do shots at 8 or 10.  I was older, 12 and NO ONE ever gave me my shots except for fellow campers at church camp (I realize that there is a world of difference between 9 and 12).


(Jessica L) #6

Thanks Sarah. We have a plan but right now she only gets the insulin at night and in the mornings. I am not sure if she would let the people at school give her injections or not even. We have yet even gone to school since she was dxed. Monday will be her first day back.

I figured the types of carbs did. I am glad I do not buy chips often.


(Sarah Romaine) #7

oh crap, didn't see the Dx date!  WOW.  This is new.  Be strong.  It will be OK.


(Jessica L) #8

lol yeah really new at this all and thanks.


(tombeatson) #9

Jessica, let me compliment you on the way you are getting on top of this! It's still less than 3 weeks, and it seems like you have been here on Juvenation for most of that time! I believe you have made a wise decision to not be in too much of a hurry to start pumping. Don't get me wrong, pump treatment is much better than injections, but injection therapy is the basic treatment that needs to be learned before advancing to pump therapy. I used injections for 52 years before switching to the pump, 14 years ago. I lost count of how many times I had to be taken to the ER for severe hypoglycemia while I was injecting. In the 14 years using pumps there hasn't been even one trip to the ER for severe hypoglycemia. I was 10 when I was diagnosed, and there were no pumps back then. I did my own injections in my legs right from the start, and my mother did the injections in my arms. Back in those days the needles were larger than they are today. Also, I have observed that T1 kids seem to mature mentally rather quickly after they are diagnosed, and become capable of doing their own injections and starting to manage their carbs. It's rather likely that Riley is like you, and will recognize the need to learn these things.

Tom


(Jessica L) #10

Thanks Tom. She has already learned so much and does not fight the injections at all. She has been so much braver and involved than I even thought she was capable of. Our case worker said she doesnt even have to start the injections herself until this summer. So I am not going to push her on it. I will offer for her to do it herself often but make no big deal of it until the summer. I am very happy to hear you have not gone to the er for it since starting the pump! I do fear it.