Quote from Twinmom06
also the dawn phenomenon (as its been explained to me) is usually hyperglycemia rather than hypo...
Hypo- @ 0200-0400, with rebound hyper- on waking.
Why is he on TPN? We need a full con-com/con-med to evaluate. If TPN is the primary nutritional source, the issue is establishing an adequate pump basal-regimine. This sounds like it should be a fairly rigid maintenance program, i.e., junior should not be po-intaking as much as he is, perhaps, or the TPN needs some modulation.
Is someone checking the pump administration log, verifying that manual boluses are correctly administered? I had a pt, on the pump x2 years, who though that if his BS was high before a meal, he should only take a corrective bolus, and nothing for the meal
. I only saw him briefly, so I didn't figure out whether this was manipulative (vis-a-vis family) or strictly educational.
Definitely get the Doc on it.
But, for you:
1) Get a copy of the users' manual for the pump (if you don't have one), and learn how to check the bolus history. Junior should be
keeping a PO diary to correlate with this.
2) Trend the BS readings. What activities are the hi's and lows related to?
It almost sounds like this kid is bedridden. If not, and if he has periods of typical explosive 12 yo activity, those 800s may be symptomatic of rebound hyperglycemia. I.e., during play, he may be hitting those 30-50 ranges, adrenal dumping, then spiking. They could also be rebound r/excess insulin administration, if the bolus calculations aren't accurate, based on his current condition. Or, they could be hyper because the bolus rates/basal aren't high enough.
I'm 39, DMI x37.5 years, pump-using x8. I still have hair on my toes, and intend to keep them that way.