|
This is all completely valid and useful advice, but just not really for infants or young children. You can weigh out to the gram every carb on the plate, and dose 15 minutes before eating, but you never know how much they'll actually eat. So then there's things like planning the "backup food" you are going to bribe them with to cover the carbs they've already been dosed for. Similarly, you can pack a lunch and instruct the nurse on how to dose it, but unless they're bringing their empty plate back to the school nurse for inspection, it's all just guessing and hoping. Clearly there are different phases to the disease. There is no amount of testing, diet, and routine that will keep my 4 year old within 100-150 range for 24 hours straight, let alone a week. Yesterday I saw him fall from 423 to 72 in 45 minutes with no bolus and only .25 units IOB. Activity level alone doesn't explain it, and the doctors even at Joslin Diabetes Center are not particular great. For example, a couple months back my son was having persistent lows even after what we were certain were accurate tests and dosing. We called to discuss adjusting carb ratios, and they tried to tell us to go from 1 unit for 30grams to 1 unit for 25 grams. It took 30 minutes on the phone to explain they were telling us to go the wrong way. We ended up going all the way up to 1 unit for 60 grams to stop the lows that week, and then gradually brought it back down to 1 unit for 30 over the next month. Was it a virus? Growth spurt? No idea... Another common occurrence, testing before dinner and being in range, dosing 18 carbs for a meal of chicken, broccoli, and peas, testing before bed and seeing slightly above range but with IOB (insulin on board, meaning he's still burning through insulin that was previously dosed) and the calculations saying he should end up near a 150 target. Then test again 2 hours later (e.g. 10pm) when he's at 0 IOB, and some days he's at 420, other days 60. Same meal, same portion sizes, etc. We've also had "fun" watching blood sugar plummet in the middle of the night even with 0 IOB and the basal fully suspended. How can blood sugar fall below 60 while he's sleeping with zero basal insulin AND zero bolus insulin in his system whatsoever? Haven't heard a good answer to that one yet... The point is, T1D for kids means constant vigilance, make no assumptions, don't trust numbers from a doctor you don't understand and agree with, and be ready to question and adjust expectations month-to-month. |