Wednesday, October 27, 2010

Naked Pancreas

Reyna over at Beta Buddies had a great post that revealed - oh my! - her son Joe's rates and settings and such. Such daring Reyna!!! I LOVE IT, so how could I not join in? I have enjoyed reading all of your posts out there about your kiddos settings and the like. So, without further ado, here is Grace's Naked Pancreas...

***Disclaimer: I'm not a doctor. I don't play one on TV. I don't even play one at home. I'm a mom trying to be a pancreas. Your child is different than mine. This is not medical advice folks. 

1. What kind of insulin management mode do you use?
Grace uses the OmniPod insulin pump. 24/7/365.

2. How often do you inject/change pump sites?
Every 3 days, like clockwork. With Unisolve.

3. What type of insulin do you use?

4. What are your basal settings?
Ok folks, I like basal rates and I use a lot of them. I tweak. And then I tweak some more. Then I get a good run of great, fabulous basal rates and I hold steady for a good long time. Then comes time for tweaking some more. I have both weekday and weekend rates and I switch them on Friday and Sunday nights. Then she can sleep in for an hour or so more on Saturdays and Sundays. Yes, I am that tight on her basal rates. 

I should let you all know, Grace uses A LOT of insulin. So, don't be freaked by her basal rates. The girl uses a lot, as in an average of 26 to 28 units a day. I guess this means she has the 'betes real bad, huh? I thought you would get a kick out of that statement :0)

Weekday basal rates:
12a - 1a    .50
1a - 3a     .55
3a - 7a     .45
7a - 2p     .50
2p-9p      .45
9p - 12a   .50

Weekend basal rates:
12a - 1a    .50
1a - 3a     .55
3a - 8a     .40
8a - 2p    .50
2p - 9p    .45
9p - 12a  .50

5. What are your correction factors?

12a - 8a   1:90
8a - 8p    1:70
8p - 12a   1:90

6. What are your meal ratios?

These I correct after I get a wonderful basal rate that's proven through basal testing. So, my rule is that the basal rate should pass the 'Yom Kippur' test - in other words, can you not eat and maintain a stable blood sugar? If Grace's basal rates pass that test, then I tweak the carb ratios when I get crazy numbers and I already know her basal rates are good.

12a - 6:30a   1:25
6:30a - 11a  1:14
11a - 12a     1:21

7. What do you do for activity or PE?
Swimming I do a -30% temp basal rate for the duration of swimming, then also cut -30% for 4-6 hours after swimming, as she tends to tank after she is done.
PE class - I cut her basal by -40 % for one hour

8. How do you manage pizza, macaroni and cheese, or any other 'difficult to manage' foods?
OK gals, I learned from trial and error and also from the uber-fabulous Gary Scheiner, who is our CDE. The man ROCKS on things like this - he knows when to temp basal and when to extend a bolus. He knows for how long. He knows why. He tells me why and how and how to fix it. And frankly, when I follow what he does with Grace, she has stellar numbers. The man is good. And here is what I do...

Pizza - Bolus about 35 a slice (depends on size) and then +50% temp basal for 3-4 hours
McD's (Yes, we go. She gets a Happy Meal cheeseburger and fries and milk. Yes, I know. Get over it.)
Bolus 70 for the meal and then +50% temp basal for 4 hours
Popcorn - Bolus for 15g of carbs for 3 cups, then +40% for 3 hours
Mac and cheese - Alas, the girl does not eat it 
Pasta - Bolus for amount of carbs, them I give 30% of that bolus now and extend 70% over 2 hours
Over 70g of carbs at once - I give 50% bolus amount now, then I extend 50% over 4 hours
Slow digestable foods  (low GI foods like berries, peanuts, beans) - 30% now and then 70% extend 2-3 hours

Ok, does that exhaust you or what? And yes, I have a cheat 'index card' in her OmniPod case that details all this so I can easily look it up. There are more foods that I do a temp basal or extended bolus amount for, but I thought that was enough to put in the blog post. Can you tell I like temp basal and extended boluses? They allow her to eat anything and I truly mean it, everything. 

9. How do you prefer to manage your logs/data?
Oh I wish Insulet would get their act together and make their PDM software compatible with Mac!!! We are a Mac family, we own no PC. The PDM is downloadable to a PC. It produces wonderful data spreadsheets. Gary does the downloading for me and prints them for me. I see him every 3 months. So, instead of downloading, I use log books. Little ole spiral notebooks that fit into my purse and I dutifully record everything we do regarding the D. Then I circle the highs and the lows that fall out of range. And I go back at the end of each week and re-examine what is happening. 

I then write down plain English sentences to myself in another 3 ring notebook that keeps all of her current rates in it. I write 'high at 10:30 am in school 3 times this week' or 'low before bedtime once this week' and I go back and try to find the answers. Then I might make changes. Or do a basal test. Or tweak a carb ratio.  Is it time-consuming? Yeah, I guess it is. Does it show that I am a data-hound? Sure does. I like data, I like what it tells me, I like that it tells me where to go and what to do. So, time-consuming, but worth every minute in the end.

And that's Grace's Naked Pancreas!


LaLa said...

Awesome! I need to make a cheat sheet from your nakedness!! thanks for sharing!!

Unknown said...

OK...I have read his book...but damn I wish I could meet him. I love your cheat sheet for the hard to manage foods. I may start tweaking what we currently do for Joe using your info as a starting point. AND.I.PROMISE. I know you are not a MD and I am not going to sue you for malpractice - LOL!!!

Penny this is great information. Thank you for revealing your naked pancreatic self Girl Friend!!!

Heidi =) said...

Great info Penny! Being new to all of this I might just have to try some of your tips. (like Reyna said I promise I won't sue if it doesn't work) I love Gary's book! I read it once but had to turn it back in to the library so I asked for my own copy for Christmas so I could read it again.

Alexis Nicole said...

Awesome post! I am soo glad I read yours cause I know see Justice is not the only one who uses insane amounts of insulin. I worried about that for so long! Theyre basals are pretty similiar actually :)

Denise said...

Mac family here too. Dexcom isn't compatible either. Had to get some PC/Windows software to run the Dexcom one. Seriously!?! When are these companies going to get with the 21st century?

Anyhow, I too may try out your difficult food tips.

Anonymous said...

Thanks for sharing...I'm totally loving this!!!

Heather said...

I'm loving reading about everyone's nakedness! Thanks for sharing. :)

Jamie said...

Wow. Reyna started something really awesome here! Great stuff.

Jen said...

Great Penny! I think I need to take your advice and contact your Endo..he sounds amazing.

We are a mac family too and our EZ max software supposedly mac compatible does not work! Get with program pump companies..mac's need love too!!