Our son Matthew was diagnosed with diabetes when he was 11 months old. He was just getting over an ear infection, and all of a sudden started to vomit after he ate. Insatiable thirst and heavy urination (we were changing his crib several times during the night) followed this. After 3 days of this, we took him to see his doctor. We explained the thirst, lack of appetite, vomiting, and the doctor told us to switch him to soy formula. The next day he was not any better, so we took him back. A different doctor (we belong to an HMO) told us not to give him food/water so his stomach would settle.
He looked so weak, pale, and sick but we thought that maybe this is some kind of viral bug, so we took him home, and hoped for the best (we still gave him water!). The next morning he vomited 5 times in 1/2 hour, so we took him in for the third day in a row. We told the doctor he saw the first day that there was really something wrong, that this wasn't an ear infection or the flu. The doctor examined Matthew again and then all of a sudden smelled his breath. He called another doctor in and she did the same. Then they told us he would have to have blood work done and needed to be hooked up to an iv. Not knowing what to expect, we waited for the results to come back. His sugar level came back at 850 mg/dl [47 mmol/l]. We were told that he had a very high sugar level, and they were going to draw more blood to see if this was a fluke. Diabetes never entered our minds because Matthew was 11 months old. When the test results came back, we were sent to the hospital to start the whirlwind week of diabetes education, meal planning, counseling etc.
As all you parents know this is a crazy time! It was very difficult with a baby, then a toddler, and then a preschooler to get blood sugars in a target range - for us at least. We would have our good days, then our bad days. Some days we didn't know what happened and why it happened. We were worried when he started school about lows/highs and everything in between. We are fortunate to attend a school who not only has a clinic, but several other children with diabetes and a very supportive administration and staff.
We realized after kindergarten that we felt pump therapy would provide better overall control and flexibility. In school - schedules can change and with NPH you are set to eat at certain times. Once he was in first grade we broached the idea to his doctors who were not very receptive - due to his age. At our visit in January 2001 they had hired a diabetes educator who is very pro-pump and helped our cause along. If this educator hadn't come along we were ready to find a practice that would support our diligence and willingness to do the hard work to get ready for the pump.
It is now June 2001 and we are only five days into the pump but absolutely love it! It is hard work - you have to do more blood sugar tests (which we did before) and be very detailed in note taking to see what basal rates worked and what did not. You also have to be very good about carb counting and figuring out the carb/insulin ratio to bolus. But the first day on the pump - we ate breakfast, lunch, and dinner when we wanted to! It was wonderful! (Please note when first starting pump therapy try to keep all meals the same carb intake to help with your bolusing)
Still we have a ways to go. We have our areas we need to work on - post meal breakfast, and having Matthew get used to the pump being attached at the top of his buttocks. We have had the infusion set come out (you know this by two high blood sugar readings in a row AND by disconnecting the pump and inspecting it) and Matthew having some itching with the adhesives (you have to try different combinations (skin preps/tapes). But we are confident that after a month we will have worked some of this out.
I can only say that the two days before we went on the pump (using humalog/regular) and once we went on the pump, for us at least, it made a HUGE difference. The lack of NPH made his numbers more consistent.
I will add more to this article as we go along. We as parents are very happy that we went to the pump and hope that parents who want to do so are successful in their endeavors with their doctors.
Pump Update - July 2001
We are now almost two months into the pump. I am so pleased to say that it is the best thing we ever did. We have learned so much, have made mistakes, and have been amazed at the difference between this and our "old" way of life. Most of the time it feels like Matthew doesn't have diabetes. Some things we have learned:
- Matthew does better on the MiniMed Silhouette infusion set vs. the Soft Set Micro. He can go three days with the Silhouette but only two days with the Soft Set Micro. We have no doubt that the Silhouette absorbs insulin better for him.
- Pizza, pasta, and Stromboli are the only complex carbs that will give him a high post meal (4 hours after eating) IF we do not do a dual wave bolus. Potatoes, rice, rolls, do not affect him in this manner so we do not have to do a dual wave bolus. We only knew this by testing him 2 - 4 hours after his dinner. We do our dual bolus as such: 70% bolus now and 30% over a 4 - 5 hour time period. A two-hour time period dropped him pretty good and he was not even active those nights.
- We have learned our lesson on taking the blood sugar right before he eats instead of 1/2 hour before meals.
- We also learned our lesson about not counting carbs properly. One week was pretty tough. We did not count carbs for a few days as diligently as we had been doing and the results were high blood sugars.
- We still have to use a different sensitivity factor at night vs. during the day.
- We need to remind ourselves that if he is on a dual wave bolus then we can't disconnect him in the middle of the square wave delivery so he can go swimming. This will mess everything up!
- We are still trying to get out of NPH mode. What we mean by this is if he is 100 going to bed, he doesn't need juice! We have done enough checks prior to test the overnight basal rate but sometimes we forget about this!
- Unless something funky happens we usually can go to bed at 11:00 p.m. and not check him again until 6:30 a.m. Of course old habits die hard, so if I have to get up in the middle of the night I will sometimes test him. He has been waking up between 70 -120 (most of the time) for the past two months so the overnight basal is doing its job.
- Once the dual wave is done remember to turn the child block back on!
Pam and Clark Polk
If you're interested in an insulin pump, be sure to see Matthew Polk's Getting Started page.
Updated June 30, 2003
Last Updated: Sunday December 05, 2004 10:15:53
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