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FinleysMum

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Ok, I need advice from some of you lovely D experts. Fin (aged 3) started pumping on Thursday with the Accu Chek Combo. They set his basals at 3.49 per 24 hours and carb ratio 1:22, insulin sensitivity 1:20. In the following 24 hours he had 5 hypos so we went back to hospital and basals were reduced by 10% to 3.08. That was Friday afternoon and over the weekend we have had another 9 hypos (mostly after meals) despite upping the carb ratio to 1:40. Now, this is the bit where I'm struggling. Fin was on Novomix 30 - 4 units in the morning and 1 in the afternoon before pumping so TDD was 5 units. According to John Walsh's book his background on that basis and his weight of 2 stone 12 should be 2.4 units in 24 hours or 0.01 unit of basal per hour and carb ratio should be 1:22 and insulin sensitivity 1:21. What I can't get my head around is that if he is hypoing after meals on a 1:40 carb ratio, if I change to 1:22 and only reduce the background by 0.6 units (3.08 to 2.4) in 24 hours surely that's gonna make him lower?? Or do basal / bolus not work like that?? Help!!
 
FinleysMum said:
Ok, I need advice from some of you lovely D experts. Fin (aged 3) started pumping on Thursday with the Accu Chek Combo. They set his basals at 3.49 per 24 hours and carb ratio 1:22, insulin sensitivity 1:20. In the following 24 hours he had 5 hypos so we went back to hospital and basals were reduced by 10% to 3.08. That was Friday afternoon and over the weekend we have had another 9 hypos (mostly after meals) despite upping the carb ratio to 1:40. Now, this is the bit where I'm struggling. Fin was on Novomix 30 - 4 units in the morning and 1 in the afternoon before pumping so TDD was 5 units. According to John Walsh's book his background on that basis and his weight of 2 stone 12 should be 2.4 units in 24 hours or 0.01 unit of basal per hour and carb ratio should be 1:22 and insulin sensitivity 1:21. What I can't get my head around is that if he is hypoing after meals on a 1:40 carb ratio, if I change to 1:22 and only reduce the background by 0.6 units (3.08 to 2.4) in 24 hours surely that's gonna make him lower?? Or do basal / bolus not work like that?? Help!!
Click to expand...

Hiya. Can you give a bit more detail? How about Saturdays readings with carbs and activity levels? There may be too much insulin going in but if weekends are more active you may need to use temp basal rates.

The John Walsh calculations are just a starting point as no one is really this average diabetic
 
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Hi FinlaysMum

Don't panic - it's a big change moving to a pump and you are doing all the right things by tweaking settings early on. It will take a little while to settle - but in 3 months... or 6 months... or a year... or whatever, his pump will have *really* begun to earn its stripes - it just takes a bit of juggling to begin with!

Can I ask what happens overnight? What level does he go to bed on, and what is the first reading in the morning (before breakfast). If you are the sort of parent who usually tests during the night, that reading would be useful info too.

Nightimes are a good long stretch where no meal doses are active, so they are often a pretty good indicator of how his basal is behaving. Ideally (if he can stand it) running some BG tests every 2-3 hours overnight can allow you to set a more precise pattern - in case he needs less insulin in the early hours for example.

I'm sure your team had good reasons to start with the settings they did, but people often find their TDD reduces on a pump, so I would almost expect his basal to be only in the mid 2's for 24 hours as you have suggested.

Hang in there - I'm sure things will settle for you (and him!) soon. In the mean time, stock up on his hypotreatment of choice :D
 
Mmmmmmmmm.

This works - ish for adults but I have no idea whatsoever what you do with children - growth hormones and all that jazz that us old uns don't have to cope with.

And of course John Walsh doesn't mean set it at an equal amount every hour, and that's cast in stone - so what you gonna do about that? Also there's a piece of Pump Configuration software that my DSN has so once she's established your start-off TDD basal, she runs that prog* and it tells her what rates to apply at each hour. Again it ain't set in stone, far from it - it IS just a start point.

If you can't get hold of your DSN, personally I'd just reduce the basal again. Looks like minus 20% might be the answer to get down to JW's level, but I'd probably try 10% again and wait and see,

The basal runs independently of the bolus. If you never ate or got up off your bum and didn't have any illness etc blah blah blah, your BG should remain rock steady on JUST basal. Due to throwing up after an op with GA, I was on a glucose etc drip and a sliding scale for a whole week. Rate - 0.5u per hour throughout. BG between 5 and 6 constantly - confined to bed virtually the entire time. Best BGs I've ever had (for such a long time in one stretch) in over 40 years. See what I mean?



( * I've tried getting that bit of software cos it adds on to the 360 degrees software which I have, and it would be 'interesting' - but Roche won't let me ! They said - Because it can make changes to your pump settings - ie if you have your pump and it, attached via the infra-red cable, it will automatically alter your pump settings. I said well - not if you didn't have your pump attached at the time and even if you had, if you didn't press the right sequence of buttons to make it do it, then it wouldn't ! To no avail.)
 
well been back to clinic and basals have beed reduced to 1.8 over a 24 hour period. They are not in equal amounts and range from 0.05 to 0.08 per hour.
This is our date so far. Grateful for any criticisms (am sure there will be loads)


Date/Time. . . . . . Bloods . . Carbs . . . Carb Bolus . . . CarbRatio . . . Correction
14/02/2013 11:36 . . 18.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5u
14/02/2013 12:26 . . . . . . . 15g . . . . . 0.7u . . . . . . 01:22
14/02/2013 13:41 . . 3.6
14/02/2013 13:52 . . 4.6
14/02/2013 14:21 . . 22g . . . . . . . . . . 1u . . . . . . . 01:22
14/02/2013 16:14 . . 3.6
14/02/2013 16:33 . . 4
14/02/2013 16:44 . . 4.1
14/02/2013 17:31 . . . . . . . 13g . . . . . 0.6u . . . . . . 01:22
14/02/2013 18:27 . . 4.4
14/02/2013 18:50 . . . . . . . 30g . . . . . 1.4u . . . . . . 01:22
14/02/2013 20:13 . . 3.4
14/02/2013 20:32 . . 5
14/02/2013 21:56 . . 9.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2u
14/02/2013 23:09 . . 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1u
14/02/2013 23:59 . . 8.5
15/02/2013 01:02 . . 7.9
15/02/2013 02:02 . . 9.7 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2u
15/02/2013 02:57 . . 9.8
15/02/2013 05:02 . . 4.9
15/02/2013 06:02 . . 3.1
15/02/2013 07:03 . . 6.3
15/02/2013 08:09 . . 4.1
15/02/2013 08:31 . . . . . . . 22g . . . . . .1g . . . . . . . . 01:22
15/02/2013 10:15 . . 3.1
15/02/2013 10:40 . . 5.7
15/02/2013 10:48 . . . . . . . . 5g . . . . . 0.2u . . . . . . . 01:22
15/02/2013 11:24 . . . . . . . . 9g . . . . . 0.4u . . . . . . . 01:22
15/02/2013 Spoke to Julie and explained about hypos, increased carb ratio to 1:24
15/02/2013 12:04 . . 11
15/02/2013 12:50 . . . . . . . . 29g . . . . . 1.2u . . . . . . . 01:24
15/02/2013 14:04 . . 8.7
15/02/2013 Went to RGH and basals reduced by 10%
15/02/2013 14:28 . . . . . . . . 5g . . . . . . 0.2u . . . . . . . 01:24
15/02/2013 14:58 . . . . . . . . 5g . . . . . . 0.2u . . . . . . . 01:24
15/02/2013 15:46 . . . . . . . . 25g . . . . . . 1u . . . . . . . 01:24
15/02/2013 17:20 . . 3.4
15/02/2013 17:31 . . 3.7
15/02/2013 17:36 . . 6
15/02/2013 As another hypo within 90 minutes of bolus, carb ratio upped to 1:30
15/02/2013 18:15 . . . . . . . . 41g . . . . . 1.4u . . . . . . . . 01:30
15/02/2013 18:27 . . . . . . . . 4g . . . . . . 0.1u . . . . . . . . 01:30
15/02/2013 20:11 . . 4.4
15/02/2013 20:35 . . . . . . . . 15g. . . . . . 0.5u . . . . . . . 01:30
15/02/2013 22:04 . . 5.3
16/02/2013 00:02 . . 5.3
16/02/2013 02:01 . . 5.5
16/02/2013 04:01 . . 4.1
16/02/2013 05:01 . . 3.1
16/02/2013 05:17 . . 3.7
16/02/2013 05:32 . . 6.5
16/02/2013 08:46 . . 5.9
16/02/2013 09:30 . . . . . . . . 23g . . . . . . 0.8u . . . . . . 01:30
16/02/2013 09:47 . . . . . . . . 13g . . . . . . 0.4u . . . . . . 01:30
16/02/2013 11:05 . . 3.6
16/02/2013 11:22 . . 5.5
16/02/2013 12:35 . . 3.6
16/02/2013 After another 2 hypos, upped carb ratio to 1:40
16/02/2013 12:50 . . . . . . . . 45g . . . . . . 1.1u . . . . . . 01:40
16/02/2013 14:53 . . 4.4
16/02/2013 15:44 . . 5.3
16/02/2013 16:58 . . 4.2
16/02/2013 17:40 . . 4.5
16/02/2013 18:23. . . . . . . . . . 37g . . . . . 0.9u . . . . . 01:40
16/02/2013 20:23 . . 8.4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1u
16/02/2013 20:48 . . . . . . . . . 11g. . . . . 0.3u . . . . . . 01:40
16/02/2013 22:38 . . 5.5
17/02/2013 00:31 . . 4.7
17/02/2013 01:56 . . 2.6
17/02/2013 Went in to find Fin at 2.6 confused and dis-orientated. Was not responsive for a while and so put a temp 0% basal on and decided to do 2 hourly tests
17/02/2013 02:11 . . 6.4
17/02/2013 03:57 . . 8.8
17/02/2013 06:01 . . 5.5
17/02/2013 08:14 . . 5.2
17/02/2013 Levels stayed stable all night from 2am with no insulin, put pump back into normal run mode upon waking
17/02/2013 08:56 . . . . . . . . 30g . . . . . 0.8u . . . . . . . 01:40
17/02/2013 Cannula changed at 9:03am, bolus of 1u given to fill head of cannula
17/02/2013 09:03 . . . . . . . . 15g . . . . . 0.4u . . . . . . . 01:40
17/02/2013 11:00 . . 7.4
17/02/2013 11:48 . . . . . . . . 7g . . . . . . 0.2u . . . . . . . 01:40
17/02/2013 12:02 . . 3.3
17/02/2013 12:26 . . 5.3
17/02/2013 12:32 . . . . . . . . 10g . . . . . . 0.3u . . . . . . . 01:40
17/02/2013 13:44 . . 3.1
17/02/2013 13:55 . . 3.8
17/02/2013 13:58 . . 4.6
17/02/2013 Due to hypos still occuring despite carb ratio being put up, put a temp 80% basal on.
17/02/2013 14:21 . . . . . . . . 35g . . . . . . 0.9u . . . . . . . 01:40
17/02/2013 14:38 . . . . . . . . 23g . . . . . . 0.6u . . . . . . . 01:40
17/02/2013 15:12 . . . . . . . . 12g . . . . . . 0.3u . . . . . . . 01:40
17/02/2013 16:22 . . 7.2
17/02/2013 17:13 . . 7.2
17/02/2013 17:21 . . . . . . . . 12g . . . . . . 0.3u . . . . . . . 01:40
17/02/2013 18:19 . . 7.7
17/02/2013 18:19 . . . . . . . . . 10g . . . . . 0.3u . . . . . . 01:40
17/02/2013 18:52 . . . . . . . . . 20g . . . . . 0.5u . . . . . . 01:40
17/02/2013 19:39 . . 4.3
17/02/2013 20:01 . . . . . . . . . 21g . . . . . 0.5u . . . . . . . 01:40
17/02/2013 22:00 . . 16.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5u
Checked for ketones, none present. Put basal back to 100% after giving correction
17/02/2013 22:32 . . 14.5
17/02/2013 22:59 . . 14.7
17/02/2013 23:23 . . 11.3
18/02/2013 00:36 . . 9.9
18/02/2013 02:01 . . 3.9
18/02/2013 02:12 . . 3.1
18/02/2013 02:17 . . 3.8
18/02/2013 02:23 . . 5.7
18/02/2013 Turned pump off for an hour due to lows
18/02/2013 04:01 . . 12.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0.3u
18/02/2013 Put pump back on 100%
18/02/2013 06:02 . . 4.9
18/02/2013 07:29 . . 4.9
18/02/2013 08:16 . . 3.6
18/02/2013 08:33 . . 6.8
18/02/2013 09:00 . . . . . . . . 30g . . . . . . 0.8u . . . . . . 01:40
18/02/2013 09:28 . . . . . . . . 12g . . . . . . 0.3u . . . . . . 01:40
18/02/2013 11:00 . . 4.3
18/02/2013 11:33 . . 4.4
18/02/2013 12:07 . . 3.8
 
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No criticism will come from anyone. It's really hard to manage this and you are doing really well with some very stable numbers but they are still a bit too low. This is why your team have reduced the basal again. It might also help if you don't give any insulin if your son eats less than say 20g to see if his levels rise after eating. Similarly don't make any corrections until you have a better idea what the ratios are.
How are you treating the hypos?
With the meal insulin you need to be prepared for the ratios being different at different times of the day.
Keep posting the numbers and keep up the good work.
 
Hmmmm - ?? honeymoon period perhaps?
 
I definitely think he still produces overnight especially.Plus he has always had injections in his legs whereas cannulas are now in his tummy so absorption is better? x
 
Hats off to you for being so vigilant, you are doing an amazing job 🙂 Hope you're not too exhausted and that it all settles soon.
 
trophywench said:
Hmmmm - ?? honeymoon period perhaps?
Click to expand...

Was wondering about honeymoon too as Millie was on nothing overnight for about 6 ish weeks, we were pre pump so stopped her suppertime levemir and she would just have her teatime novorapid and a mix on the morning. I do feel for you having all those hypo's to sort out. We went other way with the pump as she was probably coming out of this honeymoon, and so we were increasing and increasing for all these high readings - no fun:(

Keep at it it'll come right 🙂
 
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