The Switch to MDI: Part 3–Intensive Tracking Puts You on the Right Track

If your child has Type 1 Diabetes and you’re thinking about making the switch to MDI (multiple daily injections), here’s what you can expect during the first few weeks of the switch:

• Doing a minimum of 10 blood glucose checks per day: At every meal and again 2 hours after every meal, at bedtime snack and 2 hours later, at midnight and at 3 a.m. This is to see how well the rapid insulin (bolus) is working each time your child eats, and how well the long-term insulin (basal) is working in between.
• Adhering to precise carb counting for breakfast, lunch, dinner and bedtime snack: So precise that V.’s nurse recommended we keep a lot of grapes on-hand. The reason? One grape= 1 gram of carbs. So if V.’s lunch was supposed to be 60 grams of carbs and it only worked out to be 58, we needed to put 2 grapes on her plate to make up the difference.
• Ensuring your child eats only carb-free snacks in between meals: To properly assess how the switch to MDI is working, your child cannot eat any carb-containing foods other than those amounts specified at scheduled mealtimes. We made sure to stock up on raw veggies, cheese sticks, deli meat and sugar-free Jell-O for snacking.
• Keeping a detailed food log: Not just what your child consumes (say, “bread”), but the specific item, the amount by weight and the exact carb count (for example, “Dempter’s whole wheat bread, 2 slices, 71 g by weight=28 grams of available carbs: 32 g of carbs minus 4 g of fibre”).
• Completing a daily report: Including all blood glucose readings, meal carb counts, insulin doses, insulin adjustments, exercise or other notes (such as hypoglycemia treatments). This needs to be submitted to the consulting nurse every 2-3 days so that he or she can figure out if your child’s insulin doses need to be tweaked to deal with patterns of blood sugar highs or lows.
• Gradually moving towards using insulin-to-carbohydrate ratios: As you and your child’s nurse figure out how much insulin your child’s body needs to deal with specific amounts of carbs at different times of the day, you will gradually have more flexibility in how much your child eats by starting to work with ratios. Now, instead of forcing V. to eat a 60 g dinner every single night whether she’s hungry or not (which is what we had to do on the old insulin regimen), we can let her eat as much or as little as she’s hungry for and dose her insulin accordingly.
• Getting used to a new way of administering insulin: By making the switch to MDI, we’ve had to adjust not only to the number of shots per day (5 now instead of 2, including one at school at lunchtime, and 2 at bedtime) but also to the system (we switched from having to mix insulin in syringes to using individual insulin pens).

Yes, it will be overwhelming at first. Yes, there is a pretty steep learning curve. And yes, you will be tired…as much from the middle of the night glucose checks as from the endless tracking, noting, weighing, measuring and calculating.

But the good news is: it’s doable.

We’re already four weeks into the switch and there is light at the end of this tunnel. We’re used to the insulin pens and we no longer have to check V. in the middle of the night because her basal dose has been established. We’re learning more about insulin-to-carb ratios every day, to the point that we can treat V. to a carb-containing after-school snack, simply by giving her an extra insulin shot based on how big the snack is and what her ratio is for that time of day. We’ve even found a few shortcuts for carb counting (more on that in a future post!).

We’re on the right track. Gearing up for the switch was relatively easy. Taking the first step was frightening. But making the full transition to MDI is just another leg on this often exhausting journey.

Image courtesy of Sura Nualpradid/ FreeDigitalPhotos.net