Are spikes inevitable?

[Adrienne]

Correcting after two hours is a pump thing. The general rule of thumb on a pump is that you cannot give more insulin (for a correction only not food) within 90 minutes (1 1/2 hours) of have insulin. With Jessica we soon worked it out to be 2 hours.

Pumping is what I presume DAFNE call micro managing, you can fine tune to that amount every two hours. The pump works out the insulin on board (IOB) and it features in the bolus wizard. So if you try and correct at the two hour mark for a high (ie a correction bolus rather than a food bolus) it will take into account the IOB and only allow you to give what your sensitivity ratio is.

So Jessica's IOB is set at 3 hours, that is the amount we have decided NR is in her body for approximately.

If she was say 15.0 two hours after her insulin at breakfast we put that reading into the pump via the wizard. Her sensitivity at that time of day is set to 1 unit brings her down by 6.5mmol so it will take that into consideration. We have set the pump to bring her down to 7.5 mmol with each correction so the pump works to that number. The pump will also tell you how much IOB there is. So if the pump says there is 1.2 u IOB and she needs a 1.4 u to bring her down to 7.5 mmol then it minus' the IOB and will only give her 0.2 u so that an hour later in theory she will be 7.5 mmol.

I think maybe we are all working from a different song sheet because of the different regimes. Pumping can be soooooo micro managing which is brilliant for these children as it gives them that chance in life not to have the problems later which is the whole point of pumps.

 

[Adrienne]

Interesting thread,

I seems that what each person considers a spike is different. I would generally say that apart from my after evening meal reading I will be below 10 at 2 hours so would consider anything over 10 as a spike. I don't tend to correct at 2 hours anymore, but I believe that i could as novorpaid lasts less than 4 hours for me.

For those like Adrienne who say that they can correct at 2 hours for a spike then the pump must allow them to do so by working out how much insulin is on board and if it's going to be enough. If there was only a moderate spike it wouldn't allow a correction because it would know that there will be enough insulin to bring back to target. I think John Walsh gives a good example in using insulin where someone is high at 2 hours but if you work it out then no correction is needed and the person will end up low by 4 hours, took me several re-reads to understand it.

If the blood sugar is back in range at 4 hours but high at 2 then it's a timing issue and probably the insulin needs to be given a bit earlier before eating. Adrienne explained well how to get over difficult spikes by giving too much insulin than needed then mopping it up later. You just have to remember that it needs mopping up.

Yes that 's right and your message got in before mine where I have just explained about pumps and IOB.

Also I have a friend (as does Becca and Bev) who for her child corrects over 7.5 or 8 (can't remember which) so her child is in perfect range. On a pump of course but the basals must be spot on for that to work. They have bad times as we all do but it is possible.

We also have another friend whose 6 or 7 year old has been on a pump for a few years now and full time sensors and the sensors work fantastically for him and she has his HbA1c down to about 5.6 % purely through hard work but using those sensors like you would not believe. The closed loop system would work well for them I think. They do less testing and use the sensor instead. They still have hypos and highs but far less. With Jessica I can't do that and use the sensor a different way.

 

[aymes]

Pumping is what I presume DAFNE call micro managing, you can fine tune to that amount every two hours. The pump works out the insulin on board (IOB) and it features in the bolus wizard. So if you try and correct at the two hour mark for a high (ie a correction bolus rather than a food bolus) it will take into account the IOB and only allow you to give what your sensitivity ratio is.

So Jessica's IOB is set at 3 hours, that is the amount we have decided NR is in her body for approximately.

If she was say 15.0 two hours after her insulin at breakfast we put that reading into the pump via the wizard. Her sensitivity at that time of day is set to 1 unit brings her down by 6.5mmol so it will take that into consideration. We have set the pump to bring her down to 7.5 mmol with each correction so the pump works to that number. The pump will also tell you how much IOB there is. So if the pump says there is 1.2 u IOB and she needs a 1.4 u to bring her down to 7.5 mmol then it minus' the IOB and will only give her 0.2 u so that an hour later in theory she will be 7.5 mmol.

Thanks, that make a lot of sense and explains why those on a pump can correct at an earlier stage then maybe you can on MDI. It's very precise measurements to take into account which I suppose technically you could do on MDI if you have a good ides of insulin profiles but you're unlikely to be able to get the level of precision right as you can inject in such precise units as a pump allows you to. Really fascinating stuff, I really want a pump!!!

 

[randomange]

What an interesting thread! 🙂

I think it's very much a personal thing. I know that my quick acting only lasts about three hours, and if I test and I'm at 20 at two hours, then I will correct, mainly because I know from experience that there's no way I'll come back down within range if I'm that high. I will be cautious in my corrections though, i.e. I'll only give half the correction I would normally.

I did a Dafne course abut six weeks ago, and I still test in between meals. I understand that they're worried about micromanaging and over-correcting, but personally I feel much better if I know what is gong on between meals as my routine can be quite variable and I can have quite large gaps between meals.

I did ask on my course about spikes, because one girl spiked to 15 after lunch, and came back down without a correction in the four hours. I asked what would happen if you were doing that regularly, and the doctor said they would see that reflected in your HbA1c, and *then* they would ask you to test between meals and help you sort out what's going on. 🙂

 

[NiVZ]

Hi Adrienne,

That was a really good reply about the pump. When I start talking diabetes I'm always stuck in MDI mode and sometimes forget to take off the blinkers and remember all the different types of regimes we're all using 😉

I never realised that on the pump you could do two hour corerctions, and that it can administer very small (ie 0.2 of a unit) of insulin. The wizard to do some of the calculations sounds very useful as well.

NiVZ

 

[Adrienne]

Hi Adrienne,

That was a really good reply about the pump. When I start talking diabetes I'm always stuck in MDI mode and sometimes forget to take off the blinkers and remember all the different types of regimes we're all using 😉

I never realised that on the pump you could do two hour corerctions, and that it can administer very small (ie 0.2 of a unit) of insulin. The wizard to do some of the calculations sounds very useful as well.

NiVZ

All I can say is its fabulous. Once people experience a pump there is no going back.

 

[Twitchy]

All I can say is its fabulous. Once people experience a pump there is no going back.

Ooooo you're getting me so excited!!! Roll on Tuesday HURRAH!!!