Newly Diagnosed 12 Year Old - I'm Scared

Here’s some info on Omnipod’s system - I think it’s so in the works but I know you will be checking for yourself.
One nice thing about Omnipod is you can get a sample to try for yourself. It doesn’t deliver but you can see fit yourself how it feels and looks on.

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Thank you for the info! We received the Omnipod sample a while back. My son really wasn’t interested at the time as he was coming to terms with everything. In time I’m sure he’ll realize the benefits.

Glad to share.
Regarding your concern about how long your son’s numbers are higher than you would like, let me share my story. I won’t give my numbers since I don’t want you to focus on them - as you know we are all individuals - but just consider the overall idea:
For quite a while (this was before I started on CIQ) I would look at my numbers an hour or so after eating and they were “###” - higher than I wanted and perhaps even rising. So I would take a correction bolus to bring them down (the term “stacking insulin” had my picture next to it​:crazy_face:), and later would get the dreaded :arrow_down::arrow_down: artows. My doctor told me to wait “#” hours before taking a correction bolus - no more insulin until the time elapsed unless I realized I had forgotten to account for something in my meal. I forced myself not to press that bolus sequence in my pump and tried to avoid even looking at my CGM until the time had elapsed. Lo and behold, when I waited the prescribed number of hours my numbers started to level off and return to normal. I had failed to consider that I already had insulin on board that should cover what I ate (if calculated correctly) so it was a matter of giving the insulin time to do its thing.
That led to the question of why I was getting to “###” in the first place, which in turn led to tweaking of my pump settings. In my case - and again this is me so discuss the specifics about your son’s injections with your doctor - a slight increase in my basal rate plus tweaking my carb ratio improved my numbers between meals and worked with my meal boluses to keep me at a better level after eating. I also find that bolusing a little while before meals helps - previously I did it just as I was starting to eat, which was recommended with my insulin formulation. I hope that makes sense.
Being on my pump with Control IQ has helped greatly, but hopefully your doctor can help you find the combination of settings that will keep him from being too high for too long (a definition I know you’re searching for).

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I believe our Endo said wait at least 3-4 hours for correction. For now, if he’s over 199 at next mealtime, we are to give a correction.

We were told, and also try to give his insulin at least 10 minutes before eating, but optimally 15-20. Sometimes that just doesn’t happen though.

I’m just wondering, let’s say for bedtime, if he’s elevated above his range (180) for several hours after eating and we hit the 4 hour after dinner mark and still high, what is the decision point we should use to give a correction? I guess we can use the 199 mealtime tipping point. So if he’s above 200 for 2-3 hours after eating or at bedtime, I’m guessing its a good idea to correct.

It can be hard to dose before meals sometimes. If I’m out I might get something “on the fly” and can’t plan ahead. For specifics such as a “tipping point” it’s best to consult with your physician. What works for and of us on the forum may not be what’s best for your son.

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Hi. Yes that’s probably ok. How are the overnight sugars when you don’t need to correct? Steady?

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Yes, usually at bedtime, he tends to go lower and he needs some type of snack to fight off a low. After that, his BS overnight is fairly steady.

Matt, as you know, there is NOT “a one-size fits all” with diabetes; each of us needs to figure out what works better, by trial and error, under different conditions.

Knowing that my meal-time bolus of Humalog will remain active in my body for at least four hours, I wait 3++ hours before taking a correction - unless I do a recalculation of carbs eaten at the meal and find out that I grossly undercounted; in that circumstance my “correction” would be carbs NOT counted divided by carb ratio factor.

As far as amount of correction, I always calculate the same way - the method I developed 40-45 years ago. I use a meal-time target of 110 mg/dl, and a non-meal time target of 120. So, for a general correction if my BGL was 225, the formula would be (225 - 120) / 70 = 1.5 units estimated correction. [70 is my ISF - insulin sensitivity factor, or correction factor during much of the day]. I then need to make the decision, based on what I have been doing and what I intend to be doing, how much of that ESTIMATED correction I should take; I very rarely take the entire estimate - I’d rather make another correction later than go too low.

Need to bolus before beginning a meal? for me, depends on a couple of factors, chiefly my per-meal BGL, and my activities over the previous couple of hours. If my BGL is less than 90 mg/dl, I bolus just before eating. If my BGL is below 80, I delay my bolus until I’m either eating, or finished eating - depending on “how Low”. If I have engaged in “heavy” activity in the hour before eating, I look closely at the trend-line of my G6 and will not pre-bolus if I see that I might drop too low before my food / carbs take effect.

I didn’t give any hard-n-fast rules here; what your son [and you] decide is what he has observed to work for him. And one thing that I’ve learned over the years, just because something he did yesterday worked well, doesn’t mean the same [correction] will work today.

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I realize that everyone is different and what might work for one most likely will not work for others. The crux of my question is how long do you wait when above your upper range boundary before becoming concerned.

It always seems that my son gets down in range around his target and sometimes lower at the 4 hour mark. I just get concerned when he’s over 200 for an extended period of time.

As far as the premeal dosing, we pretty much try to do the same thing. If he’s on the lower side, we’ll wait until right before or a bit after the start of the meal. If he’s on the higher side, we’ll try the 10-20 minutes beforehand dosing.

I guess it all boils down to the fact that is unnerving for me when he’s running high for extended periods of time. I always wonder what that is doing to his long term health. Maybe I’m worrying ore than I should.

@mawa316, Matt, I believe I am seeing three questions in your latest post.
First. You are concerned about the long term impact of your son cruising above 200 for an extended period of time. My gut says look at his A1C at the endo’s office when they are measured. Discuss the results with the endo. If I am reading and remembering, you son is on a Dexcom G6. Keep that uploaded to the Dexcom cloud and scout out the Glucose Management Index (GMI). This is a ‘magical’ number using all of the CGM data points over a period of time to approximate the anticipated A1C.

Second, I am sensing your son’s body is doing something with the insulin so it seems like it lasts almost 4 hours. Answer: This is not unheard of. The Tandem CIQ software has a 5 hour duration hard wired in the software. We are all individuals and our bodies don’t always respond according to the same timer.

Third, Same meal, same routine, different outcomes. Adding in trying to second guess the impact time between insulin administration, meal consumption, and where CGM data point will be in your comfort zone at a pre-determined point after the meal. Answer: “It ain’t gonna work.” I ate the same meal 3 evenings in a row at the same sit-down Italian fast food restaurant. I counted carbs from the menu. I was wearing a pump. I dialed in the carbs and pulled the trigger for my insulin. In no particular order, one evening I was HI, next LOW, and third, like Goldie Locks, perfect. I asked my CDE what gives. She told my wife and me, SWAG. Don’t try to project diabetes. It is its own thing. SWAG = Scientific Wise Ass Guess.

Hope this helps, keep sharing. We are learning with you. Please, don’t pull your hair out… yet… GRIN.