As a follow up to the last post, we have continued to uncover many campers with Mystery Boluses. Some are rather startling. In one case, as much as 50 units bolused through a pump, or repeated boluses totaling 50 units or more at odd times of the day, even during the middle of the night. Not surprisingly, lots of lows. When the pump history was reviewed for the past few weeks, I found several days where NO bolus was given. This camper’s pre-camp A1C was in the double digits.

The reasons for this phenomenon are undoubtedly complex. I wish there was more study behind the drivers of these behaviors, or what characteristics these folks have in common. Given the fact that more and more kids are going on insulin pumps, this will only continue to be a serious problem with potential life-threatening consequences. In my practice, I require patients considering pump therapy to go through pre-pump training that spans several visits. It’s not my intent to slow down getting a pump, but simply acknowledging the fact that these are sophisticated machines with potential for great good, or great “bad” if not started properly and educationally “maintained”.

I ask kids to sign a behavioral contract regarding their pumps. That allows me the chance to re-visit promises almost all insulin pump patients make before starting a pump. These vows are often kept as long as a New Year’s resolution by January 15th.

At camp this week, my Mystery Bolusers come from every corner of the great state of Texas. All are teens and “tweens”. I don’t typically see this behavior in the pre-teen age groups since most parents still play such active roles in their day to day pump management. I’ve contacted these camper’s diabetes doctors and shared our findings to determine the best course of action in each case.

My advice to parents of teen insulin pumpers is simple: don’t back off from your involvement in their diabetes care. Dr. Barbara Anderson has clearly defined the age of 16 years as the earliest age where greater diabetes self care independence is justified. To do otherwise invites problems like the Mystery Bolus and their cousins, the Omitted Boluses.

Last 5 posts by Steve

• Day 15 - Sixtieth Camp Blog Entry - August 3rd, 2008
• Day 13 - Fifty-Ninth Camp Blog Entry - August 1st, 2008
• Day 11 - Fifty-Seventh Camp Blog Entry - July 30th, 2008
• Day 11 - Fifty-Sixth Camp Blog Entry - July 30th, 2008
• Day 11 - Fifty-Fifth Camp Blog Entry - July 30th, 2008

This entry was posted on Thursday, July 31st, 2008 at 8:41 am and is filed under Camp. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.