9 yr old moving onto QDS insulin.

[FindingNemo]

Hi, not been around for a long time,but I hope some of you may be able to give me some practical advice?
My son was diagnosed type 1 in June, just before his 9th birthday. He has been managing very well, highlighted by his first post diagnoses of 7.3 (baseline was 13.something), so good drop in under 4 months. His day to day contril is not as good as we would like it to be, mostly because like most 9 year old boys, his activity level varies hugely, he can spend a day at school, followed by chilling out at home, or every waking hour on his blades, skateboard, bike etc!

I think because I have been so non compliant myself, I am quite wary of being too rigid with hime as well, as I don't want him to rebel because he is constant being told he can't have, not that I let him have what he wants when he wants and he is generally sensible and happy to check his BG beofore deciding what snack he wants/needs and we don't use sweets as hypo treatment, simply as a 'treat' when appropriate and not too often, just as before diagnoses and no different from our daughter.

He had his check up appointment today and it has been discussed and agreed with my son that a qds regime may give us more flexibility to plan ahead and react to his varying activity levels and means that when on the odd occasion we do go out for meals, the timings don't have to be as specific and he can choose a pudding he wants, rather than always going for the sensible option, basic normailty really.

A dsn is doing a home visit a week next Friday to get him started up, but i was thinking tht we would start CHO counting his meals and snacks from now, to give him some idea of the concept. On the practical front, is there anything else we should/ could be doing? We have some literature frm the clinic, but want to make this transistion as easy as possible for him, as he as a lot of other stuff going on at the moment.

Many thanks in advance.

 

[Jen&Khaleb]

Sorry, but what is "qds" and what regime have you got at the moment?

 

[FindingNemo]

qds refers to 4 injections per day, with seperate long acting once, and 3 short acting with meals based on CHO counting. He is curretly on twice daily mixed insulin.

 

[Jen&Khaleb]

I thought so but it is generally referred to as MDI (multi daily injections) or Basal/Bolus. My son is on Levemir X 2 and Novorapid X 3 a day. He has always been on this regime so I actually have no experience with a mixed insulin.

Carb counting works well with MDI. My son also has a 20gm carb morning tea, 15gm carb afternoon tea and 20gm carb supper that he is not given Novorapid. His meals can vary and he usually has 1u Novorapid to 10gm carb in the morning and 1u to 15gm carb at lunch and dinner. By trial and error I also know that 1u of insulin will drop Khaleb's blood sugar by 8mmol and 10-15gm carb will raise it by 8mmol.

There are still pitfalls. One example would be eating too closely together and stacking insulin - causing hypos. Another would be that he would have to inject at school. You will be facing some massive growth and hormones in the next few years that will seriously impact his levels where he may need varying insulin amounts and possibly more injections than you expect. It may still be difficult for children to skip/delay meals even on this regime.

The biggest pros are that it is easier to eat normal everyday things at meal times, sick days can be a little better to manage and it can be a way of getting good levels. Khaleb's hba1c is currently 6.2%. He does have periods of instability but the majority of the time he is in a range of 4.0 - 10.5mmol. You still have to remember that diabetes management involves insulin/diet/exercise and, with kids, growth, all staying in balance at the same time. Never easy, especially when the effects of exercise might show up at anytime!

Have you also been offered a pump? If you were able to get a pump on a child subsidy scheme it would be worth pursuing as it can be difficult for adults to get them.

Hope you have a smooth change over if you decide to go ahead but you might have to expect a few sleepless nights checking the basal overnight.

 

[semarroy]

My 9 year old son was diagnosed on Oct 4 last year (wow, nearly a year - that's gone fast!) We moved from twice daily to MDI in June and have never looked back. He feels like he has got his life back and gets on really well with the new regime. We also have much better control of his BS. He hasn't complained once about the extra injections and is happy to do them at school. I work out how many units he needs for this school meal and write it in a book, my son has a TA that confirms that he has injected the right amount each day. So it all works very nicely. I've also found that it is much easier for him to go to friend's houses etc for tea. They just text me what they are preparing and I tell him how much to inject. Much easier than having to stick with strict meal times etc. He doesn't like the idea of the permanent reminder of a pump so to be able to jab and then get on with life, works great for him. Less of a reminder that he has diabetes. Plus our consultant said he has great control so no need to a pump (lovely to hear). Go for it, it's working well for us

 

[FindingNemo]

Thank you for your replies.
He has been offered the pump, but really doesn't like the idea of it and he has reasonable awareness of what it involves as I was on it for a few years myself. But he feels that as most of his activities involve him flying mid-air and crashing about or involve water that it might be too restricting. If given access to a pool he would actually stay in it all day long and water fights and jumping in and out of lakes, streams and fountains etc are a big part of his life.(no matter the weather or time of year) From a control point of view I would love him to have the pump but also feel it is important for him to have a degree of autonomy about his care, something which I lacked as a child and contributed in part to my rebellion and non-compliance.

 

[Jen&Khaleb]

I don't actually like the pump either for all the reasons mentioned but to get one at some stage as a child could give him more options as he reaches adulthood. It isn't compulsory to stay on the pump full time. Something better might also come along, fingers crossed!

Glad that you are easy going. I am also and don't stop my son eating anything but I do control the portion to some degree. I'd be the same without diabetes. I read a newletter from our States diabetes group that quotes-

For example, 20 years after being diagnosed of type 1, the incidence of diabetic neuropathy was:

23% in those diagnosed in 1974 or earlier
33% in those diagnosed between 1975 and 1979
18 % in those diagnosed between 1980 and 1984
6.4% in those diagnosed in 1985 or later

I think the lower figure for the pre 1974 might be because the life expectancy was reduced. I wish they also had the milestones of meters and new types of insulins with these age groups. Anyway, we all deserve a pat on the back for taking such good care of our kids and showing them how to life a long and healthy life.