Okay, lets start with... back in March, our insurance informed us that they will no longer cover Novolog (the short acting insulin he had been on since diagnosis in July '17). This was poor timing as we were starting the insulin pump and I wanted to have a good control on his numbers with the pump before changing insulin kinds because it's like changing any other type of medication you are on. Not all people can just switch back and forth and have it all be okay. The pump is different from the injections and it's complicated to just jump in and start using it. There are conversions that have to happen when switching from long acting insulin to short acting consistently throughout the day. This means that his meal time doses need to be adjusted to compensate and many, many, many other complicated issues. So to be sure that the dosing issues was just switching to pump or insulin change, I tried to just change one thing at a time.
Well... by the time we ran out of Novolog and had to start using Humalog, we did not have a good handle on his numbers for long. Then, simultaneously, school let out for summer and his activity levels, sleeping and eating patterns have changed and... quite frankly... It's all messed up.
Unfortunately, our current endo team has been less than helpful with changes to his dosing in the past (taking 2-3 weeks to get back to me) and I didn't even want to bother with them anymore since we are switching endos next month. We have an appointment on July 18th with an endo office that is about an hour away. We have heard lots of good things about this office and I hope they don't disappoint.
The week before switching to Humalog, his average time spent above range was 15%. The 1st week on Humalog he was above range 20% of the time, and the week after he went up to being above range 25% of the time. The last 7 days he has been above range 41% of the time.
But.... the Humalog was started with two and a half days left of school.... so... we have to figure out why he's been higher. Is it the Humalog, or is it the summer activity/sleep/food patterns? I decided to adjust his dosing based on past doses. I did this without the involvement of doctors.
Oh, but in addition to this.... corrections are being adjusted because the pump has calculations for insulin given throughout the day to prevent overdosing on the insulin and causing severe low blood sugar episodes. So his correction factor does not seem to be effective anymore because it's smarter than me. So when he DOES go high.... we have a hard time getting him back down again. I say this as he sits at 276 after lunch about an hour and 20 minutes ago. There was no adjusting for insulin already given as he had breakfast over 3 hours before lunch so any insulin he had at breakfast would be completely out of his system by then. Hopefully the new programming I did is effective and he comes to a good number by dinner.
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