Hi All, Kennedy is 11 and im middle school, omnipod, still in honeymoon, 9 months out from diagnosis,
she is having lots of trouble in her math class, which is right when her blood sugar peaks after lunch. We do have in her 504 plan an upper limit she must be below to test. So she missed lots of her tests due to high blood sugars, and then also there is just the regular work daily s=when she doesn't test, that also she is having a hard time with.
Her teacher has been completely not helpful with her and we have been working with the pricipal to make special arrangements to get her work done outside of class time. But she is missing key concepts, due to hyperglycemia and partially due to being out of school for illness ( last week she wiped out in gym and got a contusion on her foot BS 330, btw) and had to miss math that day.
I guess I thought having the 504 would make everything easy to make up, but there is still that problem of the HYPERGLYCEMIA which is persistent and really keeping her from learning...
we do pod changes every third day in the morning before school, so every third day there is a decent chance of a spike right during the class. Lunch is a problem, as we have been unable to figure out how to bolus enough time for her insulin to kick in, so her peak is even higher than it should be.
To top it off her teacher has type two and makes comments to her like " are you sure you're going to eat that" in front of her peers.
Kennedy is just starting to be able to tell her highs and starts to feel bad upwards of 200 now.
Ideas? I'm toying with the idea of a carb free lunch, that is about the only thing that will probably work here, but the poor kid, she's already restricted so much... ( celiac too)
We went through something similar the year my son was diagnosed. Honestly, my best advice is to tell them you want her removed from that teachers class. This is what we did and it was my sons saving grace. His old math teacher was an idiot. I would explain to this teacher that if my son isnt in class, he doesnt learn how to do the work, so how is he expected to do the work and turn it in. The teacher would harp on my son for missing work and my son was so stressed over it all.
Thanks! I did think about that earlier in the year, but they were going to have to switch every other class just to switch that one class. I have worked with our principal for next year, because i figure that right after lunch there wil always be the best chance to be out of range, so maybe she needs some easy blow off class then... the principle is aware of the situation and the teacher is actually getting in some trouble over it, so I want to be careful, because if I push her she may give her worse grades just to spite me... I did download this ap called infinite campus which my school uses, so I get all her grades texted to me so at least I can find out sooner when a bad grade comes in. For example yesterday, she was 330 at 3 at home, and she made a 74 on a math grade that day...
usually she tests at lunch at noon then again around three when she's home from school and ready for a snack, so she never waits the five hours our endo wants to see between meals, so we usually don't know whether sh'd be back down by five. But she is on apidra, so it's super fast, and by three hours ( really two) we she where she is. She always boluses before, and other meals she waits 15 minutes with apidra now. At lunch she has to eat so fast she doesn't have time to wait.
She's having a hard time with kids making fun of her for eating indian food ( she has celiac) and sometimes if she forgets lunch she'll just sit there and not eat at all, she is afraid of doing anything to look different. Her principal is keeping an eye out for her, but he just doesnt seem to be able to catch this while it is going on...
So when she tests at three, is she in range? Maybe I misunderstood - is that when she is high?
Caleb uses OmniPod and Apidra. He boluses before lunch too, but just before lunch. He doesn't normally see a spike and when he checks at dismissal he is typically in range (about 2.5 hours after lunch bolus).
Within the last couple of weeks, I saw a spike into the 200s and then he would come back down. The quick rise makes him feel not himself. What I did to counter that was to add an hour of his basal to the bolus and turn off his bolus for an hour (modified super bolus). He went up only to about 150 and stayed there. It helped a great deal with how he felt.
a "modified super bolus" seems like a good idea, give the lunch plus the hours basal all at once... for her that would be a 3.5 unit bolus rather than three... I wonder if that would keep her post lunch peak a little lower, without getting low three hours later, did your endo tell you about that? I have read something about 'super bolus' in some book, was it John Walsh? pumping insulin?
some days she just needs more insulin with her lunch it seems, but it is definitely variable, which leads me to think it's sometimes just her carb counts are off ( tortilla chips before the 330)
I'll talk to her endo about it! thanks! she is really liking apidra, by the way... at first she really went on the low side and we had to go down on everything by about 10% or so. so far our third day has been ok, but were watching out for third day highs!
The Super Bolus will only work if she is in range for her post prandial check because it only moves the insulin around with the purpose of flattening the peak.
Yes, it's John Walsh's creation. It's not in my Pumping Insulin, but I don't have the just released copy. There are a number of uses for it. It's particularly helpful for many for breakfast as that is notorious for its post meal peak. We used it for that purpose for quite a while.
The new Tandem pump was suppose to be programmed with the option to deliver a super bolus so you don't have to do the math. I'm not sure if that made it to the final model. I look forward to the day when that is standard in all pumps.
Here is my write up on it with links to John's:
Oh and for exams, Caleb is not to take them if he is over 200. He needs to be provided accommodations to take exams after his blood sugar is in range. We just exercised this a couple weeks ago during standardized testing. He was 209 or something and I would have encouraged him to take the test since it's not terribly high, but he expressed not feeling well, so we opted out. He went to the nurses office for about a half hour, started to improve, was 175, and took the exam in the principal's office. It went very smoothly and I was glad that we had provisions to allow him to feel well and thus perform his best.
so you can do the " superbolus" with the 2 hour basal ront loaded, or the " modified superbolus" with just one hour of basal frontloaded, depending on the situation? How do you decide which one to use then?
I just used the one hour to be on the safe side. He has recess after lunch and I didn't want to risk a low. The small spike was acceptable. The two hour likely would have avoided the spike altogether, but that was cutting it a little too close for my liking.
Great! Read the post, come to think of it, why not do this with all meals ?? in a perfect world... I see what you're saying about that one hour later being 109, worried that he'll end up low... so if she's 150 before lunch, we'll correct .5 give 3 u for a 60 carb lunch, then two hours basal which would be .9
oh crap, that's 4.4 units! wow! quite a lot for her! it makes perfect sense. Right! I think walsh is on advisory board of the new tslim company, I wonder if it will have that feature?? ( has tubing, so kennedy would never go for it, but, just sayin!)
I hope it does have it anyway and the other pumps follow suit. I don't think it should be used going into a meal on the low side or even for smaller or low glycemic meals. Like lentil soup for Caleb - he would absolutely go low first with a super bolus. In that case the normal meal bolus works. Yes! 4.4 I'm sure sounds scary! But you have to remember to turn that basal off. That's why the automation will be great bc you won't have to worry about remembering. Starting with just an hour of basal instead of two will soften the blow and allow you to see if it will help.