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Permalink Reply by acidrock23 on March 8, 2012 at 5:36am

I presume that Jacob is the son upon whom this is being "enforced"? If my BG is at 280, I will bolus and wait like 30-45 minutes before I'll even think about eating. A lot of times, I'll "cheat" by bolusing and taking the dog for a walk, 15 minutes, to help nudge the insulin into action faster. I know that exercise is counterindicated for highs but highs are counterindicated for me and I've seen no evidence that I've done anything too dangerous by doing this. It's probably harder with a kid who has 1) expectations of "breakfast/lunch/ dinner". If by "he does not do this..." you are meaning Mr. Jacob's mom doesn't do what you think (and I'd agree...) he's supposed to, I think the issue of why he thinks he doesn't need to take care of Jacob? I can't quite place how old Jacob is either but I'd think that he is getting to an age where he'd want to be taking care of himself or at least able to discern and vocalize the difference between how he's feeling running up to the 200-300 range and how he'd feel at a more normalized BG or at least working towards that, rather than playing "slot machine" with a BG meter?

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Permalink Reply by Jacob's mom on March 8, 2012 at 6:29am

Hello, Jacob is 13 and feels totally fine to be honest unless his bs is consistently over 300 for a bit, he is ussually under good control, yes mr jacobs mom does not want to be told different! this is why i am asking for solid advise here whether the timing of the bolus is indeed important as you and I both seem to know it is! still learning all the tricks and yes it is hard to tell a hungry 13 year old that he needs to wait to eat, hence why i try to test him while i am cooking to get an idea of where he is at, he is on board with his plan but also a teen and has some sadness over his D so i try to be the primary decision maker for now he will have his whole life to deal with it! thanks for your input! amy ( aka jacobs mom!)

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Permalink Reply by earthling on March 8, 2012 at 11:02am

How bout a protein snack if the BG is high, so the hungry teen gets something tasty and tummy warming while he waits for his numbers to improve?

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Permalink Reply by Kim on March 8, 2012 at 7:06am

Hi Amy-Even when my blood sugar is in a normal range I have to bolus 45-60 minutes before I eat breakfast to prevent huge spikes, and 20 or so minutes the rest of the day. Depending on Jacob's appetite, one thing you don't want to do is have him bolus in advance for something he may not eat. Could this be what your husband is concerned about?

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Permalink Reply by Jacob's mom on March 8, 2012 at 7:53am

thanks kim, the issue of him not eating is not the problem, the issue is getting my husband and jacob to do something different that they ussually do not do that would take extra effort and thought! it seems like from what eveyone is saying so far it does make a big difference so i should get them on board with this... diabetes is overwhelming as we all know i've tried to dumb it down so to speak for jacob and my husband but they need to be on board with what is going to work best! holger good advise but asking a 13 year old to skip a meal is not an option he is aways hungry and tries to go for noncarb snacks when he cannot wait like cheese sticks, pickles, cerlery, i can hold him off but not skip! thanks so much for your thoughts! amy

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Permalink Reply by Holger Schmeken on March 8, 2012 at 7:43am

With 280 I would just bolus the correction without the meal bolus ([280-120]/40 = 4 IE for me). Then I would at least wait one hour and test again to check how this develops. If the situation improves I would bolus for the meal and eat it. If not I will skip the meal completely. If this happes more often then he should test 2 hours before the dinner to catch it earlier with a correction. He will then have normal numbers when he is coming home. This additional test is a small price to pay for a good dinner.

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Permalink Reply by Zoe on March 8, 2012 at 10:39am

Yes, that was my thought as well, that you did not mention either just correcting first and waiting or adding a correction to the bolus. Do you know his ISF? (How much one unit of insulin lowers his blood sugar for corrections)

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Permalink Reply by Jacob's mom on March 8, 2012 at 11:26am

his correction is bs-100/50 he has an omnipod and ISF is not one of his setting options, so i'm not really sure, the issue is for jacob, and most people i would assume, if he is high it takes 1 hour/15 minutes for him to show some downward progress, i'm honestly having a tough emotional day thinking about him in general ( he was pretty down about his D last night " i feel not in control of my body, i would be 5 X happier if i didnt have D, i would be more confident without it.. so hard to hear what is a mom to say!) but asking him to wait that long to eat would be a tough one, he honestly is always hungry .. i guess i just wanted to get a feel for how long others wait to eat when they are running high ..

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Permalink Reply by Zoe on March 8, 2012 at 12:12pm

I'm sorry you (and Jacob) are having a rough time. I can only imagine how hard it must be both for a mom and for a kid that age to integrate Type 1 into their lives. I'm sorry I don't know what you mean by his correction is bs-100/50. Your omnipod may call the ISF something else but I'm sure it has some setting for correction factor. It's usually expressed like this: Mine is 40 during the day and 60 at night which means one unit of insulin will drop me 40 points during the day and 60 at night. So let's say my target goal is 110 and I am 190 during the day. My pump will compute that 190 minus 110 means I'm 80 points high which means I need two units to correct on its own or it will add 2 units into my bolus when I get ready to eat.

I'm a lot older than Jacob and I don't like waiting to long to eat either. I try and do a correction earlier but I always add a correction to my bolus if I'm over target before eating. I actually believe correcting for highs both before and after meals is one of the most important things I do to keep from spending too much time high.

Can Jacob connect with some other young Type 1's, at a group or diabetes camp? I've heard so many Type 1's say how much this helped their self image when they were his age.

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Permalink Reply by Jacob's mom on March 8, 2012 at 12:50pm

Hi Zoe, his ISF is 50 then, and it ussually seems to work pretty well, yesterday probably was just an off day all around! but i do think the testing early and bolusing is smart, now to get my husband on board with that, he thinks i am over the top with jacob's management! jacob is definitely not a joiner, so camp is pretty much out, good idea though, he is starting high school with a lot more kids next year so we are hoping he branches out, perhaps he will meet some kids with type 1 there, although there are some kids at his school now with D that he doesnt really talk with, he is a take care of it and move on kind of boy, i am just glad he takes care of it if you know what i mean! my husband and i were thinking maybe an empatheic girlfriend may ease his anxiety about his D.. time will tell, he really is a great kid with high hopes for his future and a good heart.. maybe i try to protect him too much ..just doing my best to deal with his D myself and help him live a normal life despite it! thanks for your concern amy

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Permalink Reply by Zoe on March 8, 2012 at 1:09pm

I actually try to always bolus 15-20 minutes before my meal and find that works best. The only exception is if I'm low or borderline low. In addition, sometimes if I've been running on the high side, I will do exactly what you said and test even earlier so I can correct first and wait longer, 1/2 hour to one hour depending on the high, as long as I can wait, then I test again and depending on the IOB will add a correction to the bolus as well.

I think it must be a hard balance between protecting too much and just enough. If he is taking on the responsibility for his own care, then that's great and you can just nudge a little from the sidelines like you do as he integrates new skills. There's so much to learn! I think you're doing great, and Jacob's good heart and hopes for the future will carry him through and make him an even stronger adult - despite, and maybe because of his Type 1.

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Permalink Reply by Jacob's mom on March 8, 2012 at 1:40pm

thanks zoe, somedays are harder than others, i appreciate the kind words! amy

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