[foosheedebbi]

I have a question....my teenage daughter is on minimed pump for bolus. Takes Levemir injections for basal. She is very active and prefers not to wear pump at all times. When she eats she just counts carbs hook up pump bolus and remove pump. My question is she is bad to put in carbs and leave bs blank and pump boluses. What is the pump calculating her bs at if she is leaving it blank? She only checks he bs 2 or 3 times a day and does correction if necessary. I stay on her all time to ce]heck BS before she eats and enter it but she does not. You know how teenagers can be.

[Nifr]

I'm not on minimed, but I believe it works the same as mine (Omnipod). If she's not inputting her bs when she boluses, then it's not giving her any correction, if she needs it. To me, this (easy correction) is one of the great things about being on a pump.

[xMenace]

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At least she's bolusing.

What's her A1C?

[foosheedebbi]

She was dx in 2007 with 12 A1c. In Jan it was 7.1, Then in March had went back up to 8. She had began birth control pills during that time that really screwed her BS's up ended up almost doubling all her Insulin requirements.

[Subby]

I agree that just bolusing in the first place is relieving news.

Looking at it practically for a moment, there can be two reasons for putting in a BG reasons.
1) To allow the pump to factor in a correction in the final bolus and
2) If you want meaningful BG data from your pump, (as you might normally use your tester BG). For example Carelink progam from Minimed.

Looking at 2) first: if this doesn't apply, forget it. From the sounds of it this is unlikely to apply in the situation. It's not something you need to even think about IMHO, putting useful BG results into the pump, compared to just using a meter data, is unwieldy anyway.

Looking at 1), corrections, the question becomes when is this needed? Or, the best times are:

- If you are out of target range and about to bolus for a meal, this is a good time to put in BG and get correction added
- some time after a meal when you've checked and you are high. Say the 2 - 5 hour mark.
- Any other time you are high and you feel the correction will be appropriate.

Then times when is it not needed... (IMHO)
- you're bang on your target BG range
- you're a little high but you don't want a correction, for many reasons (eg exercise might be a reason)
- Straight after a bolus, whether meal or correction where you have already assessed your BG, and it's "too soon" to know how the forces are playing out anyway.
eg. You bolus for a meal (let's say you did the right thing and corrected a slightly high BG, too). You decide to have some extra food ten minutes later. There's nothing to be gained by telling it again, that you are high: it's already acted on that and it will take a while before it can act on that again.

Hope that makes sense. In general, I feel that putting you BG in all the time (ie, when not needed for corrections) is a waste of time, I spend enough time with the pump (and I suspect your daughter would feel similar with useless/redundant effort being put in). BUt if BG's are high, putting it in and getting a correction is what you want to do.

[Subby]

Ah, something I wanted to add too: of course it's an option to use a long acting injection for basal. I understand it might be a comfort thing, not wanting to be hooked up.

But I just wanted to run it by you that many of us find that variable basal rates through the day are the #1 feature of the pump that helps us keep better control. I wonder if her insulin requirement "landscape" has changed and using the pump for basals may afford the finer basal control she might need.

It's just a heads up, keep it in mind.

[foosheedebbi]

I agree 100%, she had much better control when she wore the pump, but she swims ALOT in the summer and it was really a problem unhooking all the time and for hours at a time with no basal. Things we really hay wire. At least this way she still have some insulin in here. Maybe when summer is over she will go back to wearing it and stopping the Levemir. I wish she would check her BS though and put it in the pump but she does not check it very often. 2-3 days only. Always gets fasting and maybe if I am lucky 2 more times through out day.

[mortis505]

If she is not getting her Basal, then her BG will rise between Boluses. If her A1C's continue to rise, you may want to have a sit down with her, and the Endo to see if you can figure out an alternative. I doubt that she wants to go back on MDI, but it may be necessary if she wont wear the thing to get her much needed Basal.

[foosheedebbi]

She takes Levemir 22 units at hs for her basal.

[xMenace]

Originally Posted by foosheedebbi

She was dx in 2007 with 12 A1c. In Jan it was 7.1, Then in March had went back up to 8. She had began birth control pills during that time that really screwed her BS's up ended up almost doubling all her Insulin requirements.

Not bad for a teen.

Teens grow too. That could be the cause too. Stabilizing them is problematic.

I've known many type 1's that hardly test. I usedto be one of them.

When she's ready, she'll come around.

[Subby]

Something worth considering is getting a new tester that might fit in with using and carrying it more. Convenience can be high on the list for some people. I'm definitely one of them.

I've got 5 or 6 here but I only want to use 2 of them, and one is the very old Accuchek active - because it's got a great "wetsuit" case that doesn't need opening, you can whip out a strip from the barrel, chuck it in, prick, and put the blood on, in about 12 seconds flat. I love that tester and will happily test with it when others make me pause.

But in other ways it's so outdated: uses a heap of blood, less accuracy than many, it's pretty big too. I say all this to show that some testers are easy and convenient, some are a pain in the backside. And it's not just a matter of marketing feature spiel that spells the difference. I have a Papilon mini, you have to open a zipper case, lay it out, turn it on manually (instead of auto activating with strip), then press something else, then ... and by this stage it's jacked me off bigtime. Likewise with the foil wrapped test strips. Hate them on a daily basis, even if they are actually more accurate.

Testers are pretty cheap these days and if you are in the US I get the impression you just have to blink at a company and they will rush a free one to your door. It might be worth trying a few different models, or at least having them around.

[Funnygrl]

I guess I wouldn't push it too much. She's taking her insulin, she's bolusing, she's correcting highs when she finds them, and she's testing (though not quite often enough). Her a1cs aren't great, but decent. She's probably doing better than most teenagers. I might ask her to test a minimum of 4-6 times a day, but if she's doing the correction when she catches the high, I wouldn't worry about it when giving the meal bolus.

[mortis505]

At this point I would say to wait on her next A1C. Then just go from there. Good luck and keep us posted.