Thursday, June 9, 2011

To pump or not to pump #2

The other day in the car - (on the way to the cemetary to visit my deceased Grandma, who we infact couldnt locate within the cemetary, on the way home from the fresh fruit/vege markets, where we didnt actually buy anything)  ..... Reuben was car sick. 

A big stinky vomit.   All I can think about is the insulin in his little body.

He had a hypo - without symptoms-  we treated it with a small chocolate bar, and later on, something else.

Then,   dun dun dun dun....   he vomitted all that !

He then promptly dropped off to sleep so we high tailed it home.

Glucose gel administered.

I layed next to a droopy Reuben in bed and breastfed him, hoping he could take some milk to soothe his stomach, then process SOME sugar.   Another test.    Still low.   15 mins later, still low.   Even after a tube of glucose gel, still too low for my liking.

Hubby was designated hypo-sargeant and me, I ran to the store for our fruit/vege supplies.

He hypo-ed twice more. 

Was it a tummy bug? We still dont know.   But we brushed up on the mini glucagon dosing and I made sure my husband knew how to use glucagon.   Never too late for a refresher on the big needle in the orange box.   Because of his body weight, Reuben only gets a half dose to treat an unconsious hypo.   So we talked about the event of needing to use it... hope not.  But there it is, maybe one day.

He finally woke from his sleep and he was coming up into range again.   (Thankyou coca cola).

After this frightening morning (just one of many threads in this crazy tapestry that is diabetes) we discussed a pump.    Realistically, discussed it.   

We couldve adjusted his basal or suspended the pump?

With MDI the insulin is injected in the AM.    It doesnt care if hes not hungry or vomits, it keeps on keeping on!  Its why we came off the 24 hour Lantus.   Kids are too unpredictable.    What hes on now,  Protaphane,  is an agressive insulin that runs all day, peaking at 6-8 hours after injection.    Its fine if you have a good appetite and want to eat.   It enables you to be flexible through the day with food choices.    If we drop that dose back one unit, its not enough.    If we increase it, its too much and dangerous for the lunchtimes we get food refusal or vomitting. ARG.  Today we are trying a half unit less to see if it makes a significant difference.   I hate to leave the house between 10-2pm.   I just know Im going to be stressed about food.   Reuben must be getting this 'vibe' about food and I hate it.

Please, pumping persons and  pumping mummys - tell me what you would do with your childs pump on a vomit or food refusal day!  Please tell me how much better this would make our lives.


  1. aww Jules! I'm so sorry you had to go through that today! Poor Reuben! :o( We just started pumping 3 weeks I'm no expert by any means, but I do know that during sick vomitting times we can just suspend the pump to prevent the lows. I remember many a battle against Lantus over the years when Emma was ill and it was BRUTAL to say the least. I hope he is feeling better and that maybe others who have been pumping longer will have better advice than me. :o)

  2. Aww, poor baby. :( I would have disconnected my son's pump until I got the BG in range. Then since he was sick, OII would have reduced the basal insulin as low as it would go (because they need SOME insulin to avoid DKA) until he was able to keep food down.
    -Trish from "Brandan Is A Superhero"
    (I'm not being allowed to comment with my profile)

  3. It would depend if he had ketones (for me). If so, I would initiate mini-gluc and keep the pump running to rid the ketones. If no ketones, then I would disconnect or run a decreased basal of 40-50%.

    I love the pump for the smaller increments of insulin you can work in. For a guy Reubs' size this would help you out a lot. You can work in 0.05units! That is a huge difference than with MDIs (unless you use diluted insulin).

    Love you Jules!

  4. Sorry you had to deal with all that. We only had to deal with tummy troubles when Julia was still on shots. I wish I could give you advice but I am still learning.

  5. I feel for you Jules, I'm on shots and sick days are always really scary. I'm glad you opened up this discussion because it gives me info about how sick days on the pump would be. Hope the little guy is all better!

  6. Oh, yuck! Jules that totally sucks!
    We are fortunate that Bean hasn't ever been 'vomit' sick in all of her 7 years.
    That being said, I would totally rather have vomit issues with a pump or pod than shots. You can disconnect, you can reduce basals, you can more effectively manage what insulin is going in and use much smaller increments.
    Especially with Reub being little, being able to dose in 0.05u would be so nice!

  7. We don't have the pump...YET!! Still working on it :) I just wanted you to know that I read your post and I feel your pain.

    The one reason we decided that we want the pump was because we need smaller increments of insulin for Cara. A .5 increase is sometimes way too much and she will go low because of it but a .5 decrease will have her high in the sky for the rest of the day until I can correct it at meal time. Good luck and HUGS!!

  8. Sorry you have to deal with this. I don't have any insight. Have you heard anything about a loan CGM?

    Has Reubs been vomiting at home or only the car?
    Maybe it really is carsickness. Not sure what you can do for that though either.

  9. I have to agree with Reyna about the ketones. If ketones are present, insulin is necessary...if there are no ketones, then I'd totally program a temp basal/suspend.

    I hope he's feeling better by now...and his Mama too :)

  10. My hubby used to use a lantus shot at night and he would always go way high at night, no matter what they did with the dose, he would go too high or too low. Now with theump, it is much easier controlled!!

  11. I'd give you advice if I only knew answers. To new for me yet. But, I'm sorry you had another rough time. I know things have been so hard lately. Roselady

  12. Jules, I know I've said it before, and I'll say it again and again and again. (And I'll keep saying it) : You need to get a pump. My son Alexander has had 5 stomach bugs in the year he's been diagnosed with D (at 11 months old). He went straight on the pump, and each time the tummy bugs came, the pump allowed me to control his insulin to what he needed. Temp basals and controlling the background insulin to what he needs according to the illness means he can have a less D risky illness. He's had high BG's sometimes when he's had colds etc. Again, temp basals meant I could control the problem more. Stop debating, get the pump.

  13. It was the force feeding when he didn't want to eat that made up our minds to put Andy on a pump. We had to practically beg our Endo because he was so young but I did my research and brought in articles about babies on pumps and how much better they were on them. It broke my heart every time we would have to hold him and force food into his mouth even though he was obviously not hungry. Lots of tears. Not that a pump was perfect, but we stopped having scary lows at least. I would have to go back and check my logs to be certain but I don't think we had anything lower than a 60 on the pump. He also got car sick when we were driving in the mountains one time and we just suspended the pump for a couple of hours till we were sure he wasn't going low.

  14. My husband and I went through the exact same scenario a week or so ago with our 2-year-old. Two days in a row she wouldn't eat when she was hypo. She goes on the pump next week. Hopefully we made the right decision. Best of luck!