I'm wary of that whole "insulin on board" bit. I've found, a number of times over the last year and a half, that Pump tells me I've got I.O.B. and I don't correct a high based on that, only to freaking skyrocket and end up feeling like shit. I've since decided that if I ring in at 235 mg/dl or similar, Pump says "2.5 units to correct" and it claims to have 2.0 units on board, if the bolus is more than an hour and a 1/2 old, I bolus the 2.5 units. Otherwise, I keep cruising upwards. I'm not sure if I.O.B. is realistic all the time.
On the air bubbles in the pump tube bit, I experienced that last week. Bolused for lunch, probably scored two units worth of air, and enjoyed a 265 mg/dl post-lunch.
(sigh)... Five more years until that cure, right? : )
Yeah, we've been screwed by I.O.B. in the past, too. I hear that insulin is used in a 70-40-10 pattern, meaning after 1 hour, 70% of the dosed insulin is in the system, after 2 hours, 40% is in the system, and after 3 hours, 10% is still in the system. But the pump calculates each hour equally.
Also, our son is usually insulin sensitive, meaning a correction will bring him down quickly. If that's the case I'll bet the majority of the insulin he's been dosed is used in the first hour after it's been given.
Another theory I heard from my parents group today is that the 362 was a rebound high... that kids can rebound from numbers like 50, not from severe lows.
Five years! I will take it. Hell, I'll even be thrilled with a continuous glucose monitor (summer 2006, I hear...)
Thanks for your thoughts.
I still can't quite get that IOB theory to work correctly for us, either. I'd bet the bubbles had a lot to do with it. I know when Olivia's resevoir gets low, her numbers are all over. Of course, her numbers have been all over since Saturday. A day of grazing at a party plus a day of the pukies and an ear ache make for some lovely (roll eyes) numbers. Oy.
Two possible theories:
1.) Since the cartridge was low, I'll hazard a guess that it had been a few days since the last infusion change. The longer you go between infusion changes, the less effective the site is. Usually it's not enough to matter, but sometimes it is.
2.) You mentioned the main course was supper, but if there was anything else with a higher fat content, that can create higher blood sugars later in the evening.
*
It's one long marathon, Mom - not a sprint. Breathe Deep. And this is coming from a 21 year-long diabetic.
I've always found if I've had a few lows during the day, my body overreacts to "normal" amounts of carbs later on. Also, I ignore the IOB if it's been 3 hrs from the last bolus... but what works for me will not necessarily work for you -- or even for me a second time : (
Hi Martha, Allison from Lemonade here.
In my personal opinion, feeding a 100 when there is insulin on board was not the smart idea.
First, the Insulin On Board means that the body has not yet finished utilizing the insulin from the previous meal's bolus. Which means your son still had glucose floating around his system that needed to be taken care of. That's what the 1.2 units was for. It would not have dropped him that many points.
I do agree that having him have a small snack (like 15 carbs) would have been appropriate because his blood sugar is only 100, regardless of if he's got insulin on board or not.
If this happens again, where he's around 90-110 and has insulin on board, try just giving him enough to bounce him up to the higher 100s (not to the 200s) and then test him at midnight. As hard as this is, sometimes you have to play scientist with diabetes, and that means performing experiements.
Also- Insulin on Board is only accurate if the pump is set right! Ask your endo or diabetes educator what his "active insulin" time should be. Mine was set at 6 hrs. for the longest time, and it never gave me accurate readings. But my CDE had me change it to 4, and now it works wonderfully! Well most of the time, there are a half billion other factors to BG readings... Your pump doesn't come automatically set to your/your child's needs. You have to double-check to make sure all the little nitty-gritty's are taken care of.
TTYL!!
Oh sweetie Martha, what a lot to handle. I hope you guys all get good sleep tonight!
Hey Martha,
Nights like the one you describe are so damn hard.
From what you write here, it sounds like rebounding is (at least in part) behind the persistent high overnight (if Joseph has any PM lows, it never bodes well for the overnight).
Also, I agree with your thoughts on IOB. We too have found that it isn't always a good indicator of what is still active -- really depends on how far out we are from when he bolused last. Also, we've found that Joseph is often less insulin sensitive overnight than he is during the day (when his ISF is 1:175). Don't know if you're seeing this at all with your guy...
One question comes to mind-- did your son take an extended bolus for his pasta? I know you said you haven't had problems in the past with that meal, but pasta (esp. whole grain) can take a while to raise the bg. Joseph will usually experience a spike 4-5 hours after that kind of meal.
And those pistachios could also have contributed here -- not just the protein -- 1/4 cup contains 14 grams of fat! Depending on how many he ate, the fat from those nuts may have interfered with the absorption of the insulin.
Good luck, and here's hoping you don't see another night like that one for a long while .
Hang in there,
Sandra
p.s. Glad to hear you're making good progress on the book-- really looking forward to reading it!
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