new to pumping - need specific advice!

[Mumlé]

My little one is 18 months old and just went on a pump on monday, she really has changed overnight - like you said adrienne if you read this! It wasn't just me imagining things then. Anyway - here's what I am unsure about at the minute.

Today she had a nap late, so had tea time snack at 4pm instead of 3. Of course there are probably loads of pumps and I can't remember what it's called, don't want to go in her room because she only just went to bed! It's medtronic anyway.

I always bolus after she eats because you are never quite sure what she will eat. So - I gave her tea time snack then bolused using bolus wizard to work out the amount and take into account active insulin and correction amount.

Then she had her supper at 5. I bolused for this with the wizard but left the BG blank - so it worked out the amount but no correction or taking account of active insulin. I thought this was the right thing to do because it was too soon after her snack to take another BG. But I don't really know. Any comments? Basically I think that if it's 2 hours since eating then you can take a new BG and bolus for food again with the wizard. If it's less than 2 hours, certainly less than 1 hour, I would only use the wizard to calculate the insulin only for the food. Is this right or not? It would be the same if you had a second helping wouldn't it, if you hadn't planned on having it.

Easy to get a little tied up in knots...

 

[Northerner]

I'd better leave the technicalities to the pumpers I think, but just wanted to wish you and your little one well with the pump - great that she is taking to it so well! 🙂

 

[shiv]

I think in that circumstance, the bolus wizard would have told you to give the full amount for the food she had eaten. I can't think of the last time I had this circumstance but it sounds about right.

 

[bev]

Hi Charlotteking,

Yes I would do the same as it is just the same as having a desert after a meal - so no need to enter another BG.

I completely understand about not wanting to bolus until seeing how much food has been eaten - but the problem is that for the whole of this time the levels are rising and this all adds up throughout the day. What some people do with little children is to give about half or one third of the full amount of insulin as a 'downpayment' to give the insulin and food time to start working. So if the full amount is 30 carbs for example, just put in 10 carbs before eating and then the rest once you know whether all the meal will be eaten or not.🙂It sounds like you have got the hang of things and little one is doing really well - well done.🙂Bev

 

[Adrienne]

Ooops sorry I disagree at the moment. Gosh never thought I would be controversial.

My thoughts are that you are very very new to pumping and I think you need to learn to trust the pump. This is going to take you some time. This was the best bit of advice our fantastic DSN gave us (she is type 1 and pumps herself). She said learn to trust the pump.

I didn't understand that until I did trust it and that took some months. I think you need to follow all the rules and not deviate at the moment and when you are au fait with the pump and are confident then you can start doing things like that.

I am presuming it is all set up ok so that you can correct and bolus etc etc.

If your daughter ate a snack at 4 pm and then tea at 5 pm a lot can potentially happen in an hour up or down.

I would never do a bolus without testing unless it really was dinner and pudding but then as young as your daughter is, there would never realistically be an hours gap.

When you did the 5pm tea and bolus you should have done a BG, then using the wizard put in the BG, enter the carbs and look at the info screen.

From memory, it would tell you the BG, the carbs, the insulin to cover the carbs, the insulin to correct a high BG, the active insulin, then the insulin it will be giving. It will take into account the insulin from the previous hour (the active insulin) and minus it from any correction it thinks it wants to give. So I'm pulling numbers out the air here ok just as an example :

Insulin to give : 2 u
BG : 15.0
Carbs : 20
Food insulin : 2 u
Correction : 1 u
Active : 1 u


Therefore that is telling me that it wants to give 2 units of insulin. The BG is 15.0, the carbs being eaten are 20 carbs. The insulin just to cover the carbs is 2 units (that tells me the bolus ratio is 1 : 10) and the correction is 1 unit (ie 1 unit will bring the 15 bg down to whatever target your pump is set at) but it tells me there is 1 unit active already.

Therefore the Active insulin cancels out the correction insulin and it gives the food insulin of 2 units only.

Now I know that what you did and what the others say is what they would do is the same outcome but in my view and my experience you need to go through the motions of a proper bolus with BG etc to get to know and trust your pump. Read the info screen every time and get a feel for it. It will work.

Plus Bev is right. You have got to give insulin first. This is so much easier on the pump than on injections with small ones.

The reason is what Bev says but also this : if you eat first the food will start working and levels will start rising. If you wait till after eating to give insulin, the insulin won't start working until after the food has. The insulin will never catch up with the food. You will be putting in a BG from before food whereas by the time you give insulin that BG level will be much more. You need the insulin to start working way before the food to combat and spikes and/or high levels.

The down payment method is great. As Bev says count the carbs for the whole meal, it is is 30 then bolus for 10 carbs. The best time is 20 minutes before eating but that is hard to do, so even if a couple of minutes or 5 minutes do give it. Then the insulin will start working first. When the food starts, the insulin will be there present and correct and doing its thing. Once you know what has been eaten you can give the rest. You can give some in the middle but always give a downpayment first.

Hope that helps and sorry if it has complicated things somewhat. 🙂