Anyone use sugar surfing techniques?

[Shivles]

Shivles I'm really not sure if you will like my post but I am writing it after many weeks of consideration. I have been diabetic since I was two years old. At that time it was only one injection a day and no finger prick tests. Yet it must have destroyed my mum's heart when she found me trying to drown all of the injection stuff in the sink because I hated injections so much. I know that you don't like the thought of pumps, I know that you don't want to feel that you are imposing a pump on your daughter but OMG I so wish that this option had been available to me when I was two. It truly was the best thing that happened to me when I got my pump 42 years later. Personalky if I'd had that many injections and finger prick tests at 2 I dread to think how much I would have rebelled. I'm sorry I don't like writing this post but in my heart I feel that I had to write it.

I really appreciate what you're saying, I just don't think I could trust a pump to manage her when she can't even talk to me. The thought of something going wrong and her not being able to let me know in any way is very scary. Also the practicality of the tubing with a toddler... I see her and her big sister rolling around on the floor and that would have to stop along with other general toddler things. She would mess with it and pull it out. We're just about getting away with the CGM but that's much smaller and it's not really a problem if it got knocked off but if it was her pump then obviously that's a big deal. At her age I just don't think it's right, when she is starting school I think I'll give it some serious thought but I feel like being attached to a pump now would impact her quality of life.

 

[Shivles]

Watch the itv programme, just saw a preview on the news talking about slow release carbohydrate. So might be worth a look. The GL diet is supported by UK dieticians and my Endo and DSN. So might be worth thinking about, not radical, not over restrictive and gives some good tricks to even out spikes.

Thanks I will have a look at that!

 

[Mini-Vicki]

I don't have children myself, so I really have no idea of what a balanced diet for a toddler is, but I don't eat any carbs in the morning. I'm so more more carb sensitive in the morning, so my breakfast every day is 2 eggs in one form or another. I still have to give 1iu of humalog even with those! I used to enjoy porridge, but I've given up on it on the mornings at least!

 

[stephknits]

I think your scrambled eggs would be a fine breakfast, especially if she is having a sandwich for lunch. If you could iron out those big rises mid morning rises I am sure you would both feel better! By the way, you don't fancy coming and managing my diabetes do you?! You are doing such a great job.

For much later, when you are beginning to explore pump options, you could always look at a patch pump ( omni pod) which sticks on, you change every three days (so no worries re rough and tumble) and no tubing.

 

[trophywench]

Pump tubing comes in different lengths - eg Insight ones are 40cm, 70cm and I think, 90cm. I wouldn't need one that long unless I wore it on my shin! LOL Since my pump is usually in my pocket and the cannula is on belly, bum or the top of my thigh, I need the 70cm cos it enables me to go to the loo in trousers without removing the pump before I pull my trousers down - but obviously for a little person you'd have the littlest length. I hardly ever need to touch the pump between cartridge changes except when getting dressed/undressed since everything is done with the handset - the remote control and meter, which obviously - mum/dad holds. If anything goes awry the pump alarms, getting louder and louder until someone sorts it out.

Reliability - I've been pumping now since 2009 and only one thing has gone wrong - the piston jammed in the first one because I wasn't attaching the tubing to the reservoir before I loaded it. My own fault - not the pump's. So I had to revert to jabs overnight until the couriered replacement arrived next day. I've had roughly the same failure rate with pens - the piston gives up at some stage and some last longer than others. I had exactly the same experience with both glass syringes and disposable ones - sometimes the plunger gives up either because it wasn't quite the exact size it should have been (they plastic mould millions of the things, there will always be the odd one that's a bit off and it's just your own luck whether you happen to get it) or in the case of the old glass ones - the rubber eventually perished and shrank! Pumps have been regularly in use in USA since the early 1980s - and please note Shivles - it wasn't until the same-ish time or a bit later that PENS were commonly in use in the UK!) - but weren't introduced to NHS patients until about the turn of the century.

Nothing manufactured will EVER be infallible - and neither are you or will your daughter be in future, since we are all human.

 

[SB2015]

Hi Shivles, I know that you are being bombarded with lots of advice, and it is good to see that you are taking out of it what you need at the moment. Use the CGM to see if you can sort out that morning rise, through no carbs, earlier injection, ... That would be a giant step forward.

Just keep asking and use all the help on here. It is from people who are successfully managing the condition day by day. The DSNs might not be keen on the low carb breakfast but if it works for your little one then it works.

 

[Martin Canty]

The DSNs might not be keen on the low carb breakfast but if it works for your little one then it works

Makes me angry that they are making your little one suffer such spikes by the insistence of carbs at every meal, especially when you can demonstrate positive results without the carbs. On the other hand I suspect you may have to tread carefully otherwise they may make Social Services step in.

 

[AlisonM]

The only thing I can suggest @Shivles, is keeping copious notes of the way it was when you did what they said and how it is doing it your way. Every diabetic is different, age not withstanding, and there is NO one size fits all solution. In the end you have to do what works best for your little one regardless of what the DSN insists on. Persevere m'dear, you're doing a wonderful job, you'll get there.

 

[Shivles]

Thank you all for your help, I appreciate it!

Decided to just go with eggs for breakfast, it makes sense after all and pretty much all T1s struggle with carbs in the morning. On waking she was 4.2mmol and we had low alert from the CGM, I give a quarter of a rich tea just to give her a little boost and went ahead with scrambled eggs with butter which LO wolfed down. Now I didn't give her any insulin as I didn't really know what would happen, she's had a slow steady rise up to 9.2 over the course of an hour and a half and the CGM is reading flat so I think it will turn soon but if it doesn't I can just give her a half unit and knock it back down 🙂 either way it's so much better than her shooting up to 14+ in half an hour!

 

[Shivles]

Okay she's been holding steady around 9mmol for almost an hour, I reckon it's safe to give her half a unit to nudge her down?

 

[pottersusan]

scrambled eggs sounds like a good plan to me.

To pump or not to pump? ... that is the question. Since I've been pumping I can actually forget about diabetes for a while, especially with a cgm/libre, and live a 'normal' life. The control it gives you is far better than mdi. You can adjust your basal by the hour and your boluses I suspect as much as you like. You can give tiddly tiny amounts of insulin, which you cant with a pen. Using the libre and pump together you can improve your control amazingly and must reduce the long term possibilities of complications from diabetes. Where you live, you might be lucky enough to get a pump and cgm that talk to each other and suspend insulin if necessary.
As to tubing - lots of children have pumps and I'm sure it doesn't stop them doing what children do. There's very little in this world that stops children being children and pump tubing is not one of them.
Although I don't have children I have worked with them for many years - it will be a long time before she can make an informed decision. In the 'short' term a pump would improve her life (and yours!) and then she can still decide in the future. When she is at school she will appear 'normal' to her peers - very important to children. Children can be very cruel to someone who is 'different'.
Very, very few people with pumps would give them back, as they have an extremely positive effect on diabetes and quality of life.

 

[Radders]

Okay she's been holding steady around 9mmol for almost an hour, I reckon it's safe to give her half a unit to nudge her down?

Hi Shivies, what results have you had from corrections before? Just asking because I realise you can only do half units being on injections and you don't want to get into yo yo-ing levels. As it's the first time you've tried the no carb breakfast would you consider leaving the correction out, just so you can see what the longer term effect is? A 9 is below the renal threshold so probably won't be causing too much discomfort, especially if she normally peaks higher.

I find that even protein can cause my levels to go up sometimes but it's quite a slow rise so it's a bit of a juggling act to know how much and when to bolus. That might be why they are saying she needs toast with the eggs; so that she gets insulin but you don't need to work out a whole new ratio!

 

[Shivles]

Hi Shivies, what results have you had from corrections before? Just asking because I realise you can only do half units being on injections and you don't want to get into yo yo-ing levels. As it's the first time you've tried the no carb breakfast would you consider leaving the correction out, just so you can see what the longer term effect is? A 9 is below the renal threshold so probably won't be causing too much discomfort, especially if she normally peaks higher.

I find that even protein can cause my levels to go up sometimes but it's quite a slow rise so it's a bit of a juggling act to know how much and when to bolus. That might be why they are saying she needs toast with the eggs; so that she gets insulin but you don't need to work out a whole new ratio!

I know that once she hits 9 half a unit will bring her to the 4-5 range, I did give it and it worked beautifully 🙂 so same breakfast again tomorrow, will wait until she starts to rise after eating to give the bolus and should be perfect!

 

[trophywench]

Shame her basal insulin doesn't match her body's requirements.

Oh well that won't get any easier whilst using MDI of course, because of the built-in shortcomings of all basal insulins. So correct it - but myself - I'd far rather you prevented it in the first place, but you won't.

 

[Radders]

I know that once she hits 9 half a unit will bring her to the 4-5 range, I did give it and it worked beautifully 🙂 so same breakfast again tomorrow, will wait until she starts to rise after eating to give the bolus and should be perfect!

Fingers crossed!

 

[Shivles]

Shame her basal insulin doesn't match her body's requirements.

Oh well that won't get any easier whilst using MDI of course, because of the built-in shortcomings of all basal insulins. So correct it - but myself - I'd far rather you prevented it in the first place, but you won't.

Her basal is fine? I don't understand what you're getting at

 

[AJLang]

Hi Shivles I think what Trophywench means is that if your daughter's BG is going up to 9.2 after a carb free meal of eggs then it is a basal problem. Usually if the basal is correct then a carb free meal shouldn't need any Bolus at all. I know that some people find that they need to bolus for protein but a lot of people, including me, only have to bolus for carbohydrates and this is what is taught on the DAFNE course. If my basal is correct and I only eat carb free all day then my BG levels will stay stable all day which is what should happen. Obviously your daughter's BG would have gone up a little for the quarter of a rich tea, and it was good that you gave her that, but if the basal was correct her levels shouldn't have risen this much. This is one of the limitations of MDI but it is still much better than just two injections a day for control.

 

[Shivles]

From what I've read lots of people need to bolus for protein? If it's a basal issue though then her dose needs to change

 

[Radders]

From what I've read lots of people need to bolus for protein? If it's a basal issue though then her dose needs to change

I do if I have a protein only meal. I'm still working out how much and when!

 

[SB2015]

I also have to bolus for protein if I eat no carbs at all. But it is a lot less than for carbs.
It does mean that for basal rate testing I simply fast completely to avoid any confusion.