Debate about pumps/corrections

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novorapidboi26

novorapidboi26

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Relationship to Diabetes
Type 1
All previous comments are true................

If your on Multiple Daily Injections, ie. fast acting insulin before meals then corrections should only be done when you have tested before a meal.

If it was done after a meal or more so inbetween meals then you are just adding to the insulin that is already there resulting in hypo.

Do you correct at pre meal tests?

If that was my pre meal test, then 1 unit on top of your meal insulin would bring it on target.
 
novorapidboi26 said:
All previous comments are true................

If your on Multiple Daily Injections, ie. fast acting insulin before meals then corrections should only be done when you have tested before a meal.

Hi, just puzzled as to why you say that corrections should only be done when you have tested before a meal? If levels post meal are higher than expected at the 2 hour check then you can correct at this time - you dont have to wait until the next meal time.

If it was done after a meal or more so inbetween meals then you are just adding to the insulin that is already there resulting in hypo.

If correcting after a meal - it is fine to do it after the 2 hour mark. Insulin and food generally peak at 2 hours and any insulin left has past its peak so it would be fine to correct at this time.

Do you correct at pre meal tests?

If that was my pre meal test, then 1 unit on top of your meal insulin would bring it on target.
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If Alex is over 6mmols then it would depend how long since his last bolus whether we would correct or not. If he wakes on 7.9 - then yes we would do a correction straight away. But if he was 7.9 after 1 hour of eating we wouldnt correct as there is still active insulin from the meal bolus. If he was 7.9 pre-meal then yes definately we would correct. We have his pump set to 6mmols so if we leave it to the pump then it would correct down to 6.🙂Bev
 
Hi, just puzzled as to why you say that corrections should only be done when you have tested before a meal? If levels post meal are higher than expected at the 2 hour check then you can correct at this time - you dont have to wait until the next meal time.

My theory behind this is because there is till insulin inside working away, all insulin has different reaction times, and I am not sure what goes in pumps, but novorapid and other quick acting insulins peak at 1.5 -2 hours, so correcting at that time shouldnt be done.

If correcting after a meal - it is fine to do it after the 2 hour mark. Insulin and food generally peak at 2 hours and any insulin left has past its peak so it would be fine to correct at this time

As i said above the insulin has peaked so blood sugars will be at there lowest, so adding to this could lower them further, and there could also be an overlapping effect, which I have experienced personally. These are the principles DAFNE teach, which is required to some degree to obtain a pump
 
novorapidboi26 said:
Hi, just puzzled as to why you say that corrections should only be done when you have tested before a meal? If levels post meal are higher than expected at the 2 hour check then you can correct at this time - you dont have to wait until the next meal time.

My theory behind this is because there is till insulin inside working away, all insulin has different reaction times, and I am not sure what goes in pumps, but novorapid and other quick acting insulins peak at 1.5 -2 hours, so correcting at that time shouldnt be done.

Pumps all use fast acting like novo or humalog - they dont need background insulin like levemir etc. Correcting after the 2 hour mark is perfectly fine, as you have said the insulin has already peaked.If correcting after a meal - it is fine to do it after the 2 hour mark. Insulin and food generally peak at 2 hours and any insulin left has past its peak so it would be fine to correct at this time

As i said above the insulin has peaked so blood sugars will be at there lowest, so adding to this could lower them further, and there could also be an overlapping effect, which I have experienced personally. These are the principles DAFNE teach, which is required to some degree to obtain a pump
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If blood sugars are at their lowest then there wouldnt be a need to correct at this stage so not sure what you mean? If sugars are too high at the 2 hour mark then it is fine to make a correction using fast acting. The only reason you wouldnt do it is if you have lumpy sites and are not sure about the absorption rate of the insulin - but as you say - all insulins peak at 2 hours - so once past the peak it is ok to correct as long as there are no other variables that might make you feel that the insulin is just sitting there (lumpy sites) - or if you have had a huge amount of exercise and you *know* that you will drop anyway.
You dont have to do DAFNE to get a pump - you need to understand how to carb count. Alex nor myself have ever been offered DAFNE as this is for adults. There is something similar called KICKOFF for children - but getting a place on one of these courses is more than difficult.🙂Bev
 
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bev said:
If blood sugars are at their lowest then there wouldnt be a need to correct at this stage so not sure what you mean? If sugars are too high at the 2 hour mark then it is fine to make a correction using fast acting. The only reason you wouldnt do it is if you have lumpy sites and are not sure about the absorption rate of the insulin - but as you say - all insulins peak at 2 hours - so once past the peak it is ok to correct as long as there are no other variables that might make you feel that the insulin is just sitting there (lumpy sites) - or if you have had a huge amount of exercise and you *know* that you will drop anyway.
You dont have to do DAFNE to get a pump - you need to understand how to carb count. Alex nor myself have ever been offered DAFNE as this is for adults. There is something similar called KICKOFF for children - but getting a place on one of these courses is more than difficult.🙂Bev
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I understand, there are many different names for the course, which is basically carb counting and the effects of insulin.

If blood sugars where at 7.9, which is the given example, then a correction would not be neccesary anyway as its not far away from acceptable targets and blood sugars must be allowed to fluctuate as any non diabetic individual would experience.

If however after the 2 hours mark the blood sugar is really high then a dose change at the previous meal time would have to be considered only if the same result appeared again and again.

However as you have said, your child is on a pump, which is a much more effective tool in terms of doses, release rates and all that........
 
novorapidboi26 said:
I understand, there are many different names for the course, which is basically carb counting and the effects of insulin.

If blood sugars where at 7.9, which is the given example, then a correction would not be neccesary anyway as its not far away from acceptable targets and blood sugars must be allowed to fluctuate as any non diabetic individual would experience.

If however after the 2 hours mark the blood sugar is really high then a dose change at the previous meal time would have to be considered only if the same result appeared again and again.

Yes , your right - but it could also indicate that you might need a split injection for particular meals (pizza pasta and all fatty foods) - so changing the dose wouldnt be right - but changing the timing of insulin would. When Alex was on MDI we very often did split injections as if we didnt he would be hypo at 2 hours and then very high 4 or 5 hours later. So its best to work out whether its the ratio or the timing that is out.

However as you have said, your child is on a pump, which is a much more effective tool in terms of doses, release rates and all that........
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Right again! But the priciples are exactly the same. If you dont have your ratios or timing right - then it doesnt matter whether you are on MDI or a pump - you will still get levels that need correcting. When we were on MDI we found that we needed to use lots of split injections over a few hours to gain some sort of stability - the only difference on the pump is that it slowly trickles insulin in when you need it and so, in theory, you shouldnt spike - which is what we were trying to do on MDI - without a lot of success because Alex is very insulin sensitive and we only had half unit pens! Now on the pump we can do 1/40th of a unit - which is something that Alex needs - but we could never have got that on MDI.🙂Bev
 
Again all valid, but we cant discuss all the variables in ones thread.

In any post I put on here I can only assume that the doses and timings are correct, if they were not we could be here all day.

So making that assumption I would say you dont correct between meals as I am assuming the dose is correct or that the dose has been split.

I too need to split my lunchtime injection in order to avoid peaks, I however am resistant to insulin.......

Both our arguments are valid, one from a MDI bias and one from a PUMP bias, but a pump should only be considered at the last hurdle if as you say, there is high sensitivity, varying sensitvities....

Out of curiosity, what were the spikes like when on MDI and what was the effect on HbA1c
 
As I have said, it doesnt matter whether you are talking about MDI or a pump - all the same principles apply. Just because we now use the pump doesnt mean that we know little about MDI - we know a lot about MDI - but we now know that it wasnt right for Alex.🙂

The reasons for going on a pump are varied - but the pump shouldnt be seen as a something that is a last resort, or because there are sensitivities. From our point of view, going on a pump was essentaial due to needing tiny amounts of insulin. But there are lots of people who benefit from pump therapy simply because it is a more accurate way of delivering insulin than any other method - so it is not a last hurdle - it is a pro-active approach to diabetic management and has been proved to improve ones quality of life in many many cases.

When Alex was on MDI his last hba1c was 9.6%!😱This was after 9 months hard slog trying to work out what we were doing wrong.

After 4 months his hba1c was 7.1%.:D

We had exactly the same knowledge using MDI as we do on the pump - so we werent actually *doing* anything wrong at all - we were doing everything right - but Alex was sensitive and injections just werent delivering the right amounts of insulin required - it was a bit like 'russian roulette'! He didnt have one lumpy site and so we have concluded that pump therapy is the way to go for us as its far more effective and accurate than MDI could ever have been.

I think it is important to question whether the doses or the ratios are correct - because this could be the reason for the high levels - so assuming that they are all correct could be very misleading to the OP as it might lead her to believe one set of rules applies - when in fact - it doesnt - because her ratios or timings might be wrong - so its always best to question these just in case.🙂Bev

p.s. I forgot to mention the spikes. If eating something like breakfast cereal or pizza - Alex could easily spike up to 18 or 20!
 
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bev said:
The reasons for going on a pump are varied - but the pump shouldnt be seen as a something that is a last resort, or because there are sensitivities. From our point of view, going on a pump was essentaial due to needing tiny amounts of insulin.
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This the same thing, over sensitivity.................and I think only with these circumstances should a pump be considered.......

We are both on the same hymn sheet, its just I think I am not commicating it well enough..........

And I still think, if not on a pump, that you shouldnt correct, especially if the doses have not been established.........🙂

Its been fun......
 
novorapidboi26 said:
This the same thing, over sensitivity.................and I think only with these circumstances should a pump be considered.......

We are both on the same hymn sheet, its just I think I am not commicating it well enough..........

And I still think, if not on a pump, that you shouldnt correct, especially if the doses have not been established.........🙂

Its been fun......
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groundhog day............................................😱
 
I just wanted to also add that I think your perception of pumps is really rather outdated and you should do some research to fully understand how they work and why people find them of benefit. You seem to think (wrongly) that going on a pump is some sort of *failure* because you werent good enough to use MDI - which is ridiculous and quite insulting to lots of people who use a pump.:confused:
 
bev said:
I just wanted to also add that I think your perception of pumps is really rather outdated and you should do some research to fully understand how they work and why people find them of benefit. You seem to think (wrongly) that going on a pump is some sort of *failure* because you werent good enough to use MDI - which is ridiculous and quite insulting to lots of people who use a pump.:confused:
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I would say that going on a pump is because MDI is a failure.........not the indivudual........

I did used to think negatively but since coming here my thought have changed as I have learned about how the pump has functions that allow slow release in order to combat peaks, and how it can deliver minute doses for those who are extrememly sensitive, as in your case........

If anyone else has these problems then the pump is for them..........

What criteria do you think should be met for a pump?:D
 
It looks like there is quite a lot of useful information here too.
 
Thanks guys.............I can get carried away sometimes.......but if I cant do it here, where can I do it..................
 
Northerner said:
I moved this into a separate thread as it veered away from the original post.
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Thankkyou Northerner - but I dont see this as *my* debate - and I dont feel that NRB is being entirely serious or genuine asking what criteria to get a pump etc so could you please remove my name from the title.🙂Bev
 
novorapidboi26 said:
Thanks guys.............I can get carried away sometimes.......but if I cant do it here, where can I do it..................
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It's all about learning from each other and seeing how things might apply in our situation. There are guidelines to help us manage diabetes, but unfortunately no hard and fast rules! 🙂
 
It wasnt actually a debate on pumps, it was opinions on wether to correct........

I thought not..................

You thought you could, which may be the case, FOR A PUMPER........

Not everyone is on pumps, if we all could that would be brilliant, but its not possible, hence my asking about what you think should be good enough reasons to get one, as I think you think everyone should be on it because of your good experiences so far..............

And I am serious about my opinions, thankfully I am not easily offended...

I welcome any opinion you have on any subject as it can only add to my own knowledge and understanding.
 
Adding my tuppence worth... :D

I completely disagree that the pump should be seen as a last resort, although I understand that many in the NHS view it that way. In places like the US, the pump is seen as merely another treatment option, and IMO that's what it is. I understand that there are money issues in the NHS, but I personally think that not providing pumps is a very short term view. Yes, its more money now, but compare that to the money that is spent treating diabetic complications - dialysis/kidney transplants/laser treatment etc is not cheap. Think of the money you could save in the long term if you reduce the amount of people suffering from complications! I know lots of people who "make do" on MDI who could probably have far better control on the pump simply because it is a much more efficient way of delivering insulin and managing your diabetes. For what it's worth, I was put on a pump because of issues with hypos and dawn phenomenon, nothing to do with sensitivity!

Also, I correct in between meals if required, and I used to do so on MDI as well. I knew what my duration of insulin action was, which meant I could calculate how much insulin I had on board at two hours, and correct back down to target with that in mind. There is no way I'd let a BG sit at 15 (for example) if that was my two hour reading and I knew I didn't have enough insulin left to bring that down. I appreciate not everyone may feel that way, but I think the important thing to remember about things like DAFNE is that they're meant to be flexible, and we were encouraged in my DAFNE course to adjust things so that they worked for us, even if it meant not sticking rigidly to DAFNE protocols.

Wow, that became more of a ramble than I intended! 😛
 
Im glad were getting more opinions........thats what its all about........

Unfortunately the NHS does have financial constraints........so thats why everyone cant have a pump, who can change that over night.....

So on MDI, you say you calculated what was left in you and corrected if needed...........please tell me how that is possible.........how do you know how much glucose has been released........how do you know what insulin is left and what its doing..........I cant see any HCP saying correct.....

With a pump anything is possible but for this case in question this wasnt the case.....

If a BG was abnormally high then something is wrong with the dose or there is another outside variable which is not constant.

I agree with what you said about DAFNE, but focus on the main discussion has been lost, should you correct, on MDI, after a meal?

I think not.......
 
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