Frequent ketones

My 4 year old daughter was diagnosed with T1D 2 years ago. She is on Dexcom 6 and an Omnipod pump. She frequently struggles with high bg and ketones. I’m considering changing her to Tandem Slim, but I’m concerned with the tubing, as she is a typical 4 yr old. Depending upon the placement of the pods, often times the pod gets pulled off when dressing or undressing. I’d like to hear from parents of little kids using theTandem Slim pump.

I’m not a parent and don’t use the pods but I was wondering if you’ve tried any of the over patches? I use one called Simpatch for my Dexcom and I like the added security. They make them for the pods as well and you can get them with or without a strap.

Thank you for responding. The main issue is the high bg and frequent ketones, that’s why her endo is suggesting that I consider a different pump.

I understand. The nice thing about tubed pumps is, if the infusion set is pulled out you can insert a new one without losing any insulin remaining in the cartridge. It’s very rare for me to have one pull out, even with the occasional “door snag.”
Hopefully you will get feedback from parents whose little ones use one of the various pumps and can give you ideas for securing them; but if I might suggest another option, have you and her doctor discussed going on injections? I know the idea is unpleasant - no one wants to put their child through shots multiple times a day - even with the fine gauge needles we have now there may be a bit of pain. I started taking them at age 3, when the needles were a much larger gauge - I’m sure there was some drama at first but I found the pain didn’t last long and I adjusted; hopefully the process is easier now with the finer needles.
You will know she’s getting her insulin although you will need to learn the skills of managing via injection, which involves more than simply giving a shot.
When I first started on a pump - mid back in the mid 90s, as I recall, my doctor said it would provide much greater control than injections - not just for me but for diabetics in general. That may be largely true but some people do just as well and in some cases even better on shots. You can still use the CGM, with either its own handheld receiver or a cell phone. It might be an option to consider at least for the time being.

@MamaSharon. Sharon, I am not a parent. I am a brainstormer and 20+ year pumper with experience of pumping while doing DIY, active outdoor activites, etc.

I have some thoughts if you elect the Tandem t:Slim X2 (X2)with Control-IQ technology (CIQ):

  1. CIQ is a software added to the basic pump so it can adjust basal insulin in response to the G6 CGM.

  2. I have used 43" tubing for my 20+ years of pumping. In a wee lass, you could place the site almost anywhere and clip the pump in the yoke (neck) of her top, in the back, between her shoulder blades with the tubing under her clothing to almost any body site. You would have access when you needed to enter the carbs for what she is eating. Watch some SWAT team type police videos. That is a frequent place for their radios with microphones draped.

  3. As she gets older and demonstrates pump skills (physical, knowledge, maturity, etc), family guidance could allow for trials of other locations. I am aware of an apparently mature 6 or 7 year old causing a major stir in a school classroom just before lunch by pulling out a meter, vial, syringe - doing a finger stick and then self-administering a sliding scale dose. This occured before 504 plans, insulin pens, and CGMs.

  4. The X2 with CIQ (I have forgotten if the X2 without CIQ) has a lock requiring a PIN number to access the pump. BTW, the security PIN is the first six digits of Pi, the math constant used in equations about circles.

  5. Both the G6 & CIQ are approved in the USA by the FDA for children age 2 and up.

  6. You may find much said about the Tandem system. I believe the best place is the ‘source’. Here are links to the Tandem support document cache.

Tandem Document Site

CIQ User Guide (350+ pages and is best put on a tablet or computer for easier searching)

These two PDF files are short - - 2 to 4 pages about the feature.
CIQ Technology PDF

Sleep & Exercise PDF

Sharon, I do hope this helps and gives you and your daughter a solution. Please share the course you choose. Your sharing will help us all to learn more.

Thank you so much for your suggestions. I Ann hoping that some parents of little kids who use Tandem Slim will reply to my text. Her endo gave m that as an assignment before our next appointment. She endo is thinking about reducing her basal and having me give her some Tresiba via a syringe. I’m not too excited about that, but we’ll see. Thanks again!

Hi @MamaSharon in the event you don’t get a response I urge you to seek out your local JDRF chapter to try to network with others nearby.

In my opinion, a pump is a pump. If you have trouble with a pod and you use the same settings you will very likely have trouble with tslim or Medtronic. I am only guessing that the doctor wants her on control IQ which means she’ll also need a dexcom CGM. While really nice, I can assure you that tuning a basal rate is possible with or without a CGM.

The infusion set on the Tslim is very low profile and so there is extra stuff to snag with the tslim but the set itself is hard to “bump off”. So it’s a trade. Plenty of children used tubing pumps long before pods were available.

Hope you find some help. Good luck :four_leaf_clover:

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You might try updating your topic title to indicate you would like feedback on pumps for young kids - it could draw more attention. Not sure if you would need to start a new topic🤔…

Hello! I am a parent of a child with T1D. She has been on the tslim since she was 4 but using a pump since she was a 2 year old. Always had a tube. We used pump pouches and bundled up the tubing gently into the pump pouch. She doesn’t weigh enough yet to use all of the awesome functions of the pump technology. She only uses basal IQ. Required to weigh 55 lbs for control IQ. We have had a couple of times when the tubing caused a new infusion set over the years. She is a typical rambunctious 7 year old and has not been hindered by the tubing. In regards to the high blood sugars and ketones we have had this on a few occasions but the pump allows for increases of basal rates temporarily which helps. She also uses fiasp insulin with helps prevent extreme spikes after eating too. She also gets a pump site change every 2 to 3 days depending on higher blood sugar trends because of saturation in certain spots. We have only ever had pump sites on her abdomen area but I have heard of other placement. My daughter will only do it on her belly. So overall, she is happy with her pump, tubing doesn’t cause an issue for her, and there are a lot of variables to consider when she has higher blood sugars and ketones.

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Hi! I am a mom of a T1 D 10 year boy. We have only had the Tslim pump for a short amount of time. He also has the Dexcom G6. He typically has the CGM on an arm and prefers the pump on his legs. His abdomen is a bit more sensitive. We love the pump as it has really helped control his levels. However we went through several insertion sets in the beginning because the needle bent or he accidentally pulled it out. He has gotten better at removing the pump when he is rough housing and typically removes it for sports practices/games. We are not pros by any means, but we do recommend the Tslim pump as it also works so well with the Dexcom.

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