Just by asking the questions you are asking, and doing all of the steps required to tailor your son’s therapy, I (we) can tell your son is very lucky and in good hands.
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Yes, THANK YOU! Right now it all still seems overwhelming, but I hope someday we’ll feel that diabetes is there, just in the background. I’ve already gained so much reading some of the threads here, so you all have already been tremendously helpful. I’ve essentially “quit” calling with issues because I know I won’t get the guidance I’m looking for- it’ll all just be about numbers. I’m dreading our first illness, and that does make me nervous, but I suppose I’ll cross that bridge when I get to it.
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As a general rule (for our son), we use at least double insulin during the sick days for Liam. Sometimes even as much as 3x. But there are other times where more insulin makes him go LOWER so we have to back off…each sickness will be different but, for us, most times he’s sick we can count on at least doubling all insulin requirements.
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There is a little bit of an overlap. Since Lantus is probably only lasting 18-20 hours, splitting it into 2 shots means that there is a little bit of an overlap. But the benefit is there is no gap like you probably have with a single shot. Doing 2 shots means you get coverage for the whole day.
But yes, you would need to adjust the mealtime boluses a bit, once you get it all dialed in.
This is a very rough illustration to compare the two systems. Nothing exact here, just an ideal of what the difference might look like if you were to do Lantus twice - 8am and 8pm - instead of once.
It depends on how soon he eats after waking up. Like if he wakes up and eats soon after waking up, you do the rapid insulin right when he wakes up. And the amount of the rapid is enough for the meal and to recover from the basal drop.
But if he eats an hour after waking up, then you might do it as 2 different shots.
All of that make sense?
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Thank you, Chris, that really means a lot. We are doing our best, and it certainly still is an emotionall roller coaster for me!
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Regular illness is pretty easy and you will pick it up super fast (increase basal), pukey illness is to be watched out for and respected. If your son tends to get pukey sick, then by all means read and bookmark the threads on here talking about mini-glucagon.
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I know you said you are on a pump. With my son on Lantus, would I adjust basal as well, or just be adjusting his fast acting insulin?
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We only use Novolog now in our pump so we have the ability to set “temp overrides” which allows us to double ALL insulin given (for basal / bolus). When we were MDI, we struggled through increasing both. The correct answer is that you may see an increase in both basal and bolus requirements…the bad part is that it’s REALLY tough to dial in the correct dose during sick days so we just did the best we could and gave more boluses to combat the high BGs that were caused by the basal rates just not being enough to keep him level outside of meal times. MDI wasn’t a fun time in our life and I can’t wait for you to be able to get onto pump management…it really is night and day and your son will like not having to get stuck so many times during the day.
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yes, thank you! He’s usually up for about 45 min -1 hour before eating, so I’m guessing it would be best in a correction dose, then a meal dose. (a full bolus 45 min before eating would certainly be way too soon for him).
I definitely like this idea, and so much appreciate the clarification. I just have to get the courage to try it!
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I’m sorry to hear that. It’s an old (and I would say obsolete) technique: force the BG high overnight to guard against the possibility of a dangerous hypo. But you have a CGM! You don’t need to tolerate high BG overnight.
Snacking before bed can be difficult to manage because bolusing insulin for eating always is difficult. The meal bolus generally is never perfect which is fine, because we watch what happens and correct with additional carbs (if going low) or more insulin (if going high). BG management is much easier when no food is involved: if the basal is right then the BG will generally stay steady. (Common exceptions include special stress, illness, or during hormone spurts in adolescence.)
Don’t be intimidated by medical staff. You are in a much better position to manage the dosing than they can be, because you have the direct experience of seeing cause and effect. And also, you are in a much better position to make good decisions: you can try pretty much anything because you are right there to adjust it if it starts to go wrong, whereas they always have to assume the worst plausible circumstances and give advice that will lead to high BG but no lawsuits.
It already sounds like you’re getting the hang of it and people here will be happy to help.
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Things can be very worrisome where our kids are concerned, but as long as you are watching when testing, only good things can come from the testing. If nothing else, you’ll have 1 more thing that you know DOESN’T WORK…but I know you want to do anything/everything you can to help improve your sons diabetes so all of the recommendations for testing are critical so that you can check those boxes and help you make better decisions for your son.
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That is kind of what I figured with potential basal adjustments. And I kinda figured I’d be doing that with the fast acting insulin- just try to keep up with his needs/corrections as best as possible.
It is very frustrating to me to have to wait. I get the idea- they want to make sure we’ve developed the knowledge/skill/discipline to handle things when pumps and such go awry. But to me if we’ve demonstrated knowledge, involvement, willingess to learn the new tech, then why not??? Everyone seems to indicate such better control and peace of mind with pump therapy- I’m ready!!!
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I believe we were able to pump before a year of MDI was up…I could probably find the old post here on FUD somewhere. lol. We have always been very vocal with our Endo on what we want, and what we EXPECT and our Endo understands we have a handle on what’s best for our son and they’ll support our decisions or we’ll find a new Endo what will. If your Endo checks off on it, you can get it early.
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mini glucagon! oh no, now that’s a new one. 
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i asked about it at his last (tele) appointment (thanks covid). She said she’d put me on a “wait list” for the education classes- whatever that meant. We have another appointment in mid April that I fully intend to implore more on the subject.
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With a vial of shelf-stable glucagon, it’s possible to give a microdose to raise the BG a modest amount. It’s a useful tool when illness prevents eating carbs but the BG is going too low.
http://www.bcchildrens.ca/endocrinology-diabetes-site/documents/minigluc.pdf
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So there are “educators” that you get linked up with when transitioning to the pump who meet with you, show you how to use the pump correctly, how to use the PDM, etc.,…all valuable instruction that we appreciated being new at pumping. Also, before that, they should offer you a Pump vendor day (at least we had this) where you can talk too each vendor about their pump technologies, hold them, etc., But with Covid here not sure how we would do this today as we’re not getting that close to anyone until we’re all vaccinated (including Liam) who will have the longest wait being only 7 and no vaccines approved yet for them…as I’m hearing, it could be early 2022 before kids our kids ages begin getting vaccinated.
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I figured that is what the education meant, I just didn’t understand the wait list. I think COVID has to do with it as they are holding much smaller groups, or even just individual families, for the education.
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wow, thanks. I had no idea this existed.
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Yeah, I’m not sure what that means either, but you’re probably right with Covid being the cause. You should ask what’s the hold-up? Truly try to understand the bottleneck and see if you can’t get pushed up on the list if possible. I am a firm believer in “the squeaky wheel gets the oil.” If a pump can help me improve my child’s quality of life, A1C, etc., AND help me sleep easier and better at nights, I’m the kind who doesn’t mind bugging the hell out of everyone until they get so sick of hearing from me they do it just to shut me up. 
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