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The 'New on Pump' thread!
- Thread starter Patricia
- Start date
- Status
Hi Patricia,
Just to let you know that i am reading all your posts - i just dont have much to add - other than i like the way you describe things - it makes it sound a lot simpler than any of the articles i have read! I look forward every day to reading the latest- so dont stop. You all sound so relaxed and happier with a pump! Well done and keep up the good work.
Bev
Just to let you know that i am reading all your posts - i just dont have much to add - other than i like the way you describe things - it makes it sound a lot simpler than any of the articles i have read! I look forward every day to reading the latest- so dont stop. You all sound so relaxed and happier with a pump! Well done and keep up the good work.
BevThanks for this support Bev and Mand. Just so appreciate it. Have come back from long overdue errands, ran into friend who's brother is type1, diagnosed at the same age as E (and actually, I think pretty much all three of our boys?!). His control has been up and down. He's now 35 ish, and losing sight in one eye. He also has not attained all of his height. I tried not to show it, but it jolted me a bit, and made me so frustrated. Therapy has changed so much in this short time -- I pray that our boys will get the best they can out of their lives. A bit of a shock though. And upsetting. This chap is so young....
Anyway, so. Big breath. Pumping Insulin book Mand (!) at last: we have the fourth edition. Author is John Walsh. Cover is in gradients of blues, with bright yellow writing. Get it!
Bev, did you get the Hanas (sp?) book in the end? We have used it loads, I confess...
Anyway, so. Big breath. Pumping Insulin book Mand (!) at last: we have the fourth edition. Author is John Walsh. Cover is in gradients of blues, with bright yellow writing. Get it!
Bev, did you get the Hanas (sp?) book in the end? We have used it loads, I confess...
Oh gosh Patricia. That is a worrying story. As you say, lets hope our boys will do better. Hopefuly they will because they are the next generation to him and improvements have been made. But it certainly makes you stop and think. Very sobering thoughts.
Thanks for the details re the book. I will definately order it. In fact will do it right after this post!
Please keep up your escelllent posts. I do not know if we will have the same success as you but you have certainly given me hope and strength and i thank you for that.
Yesterday we had a courier delivery of all the bits and pieces that go with the pump and also i went to the chemist to pick up the new insulin. I have had the pump put on our home insurance, as requested by our dsn and I have nearly finished the on-line pump training course - so roll on 7th July!
Have a good weekend and i hope you get some sleep! 🙂🙂
Thanks for the details re the book. I will definately order it. In fact will do it right after this post!
Please keep up your escelllent posts. I do not know if we will have the same success as you but you have certainly given me hope and strength and i thank you for that.
Yesterday we had a courier delivery of all the bits and pieces that go with the pump and also i went to the chemist to pick up the new insulin. I have had the pump put on our home insurance, as requested by our dsn and I have nearly finished the on-line pump training course - so roll on 7th July!
Have a good weekend and i hope you get some sleep! 🙂🙂
Thanks Mand. Less successful day today -- 3 hypos! Not sure where from, esp after adjustments. But PE may have played a part...Adjustments wrong? Argh. Feeling confused...Will sit down tonight with hubster and crawl through numbers and try to see what's happening....Out to dinner first though: end of exams and examining for everyone!
Sigh. I just want to *solve* everything -- now! But that's not what diabetes does, is it?
Have a great night folks.
Sigh. I just want to *solve* everything -- now! But that's not what diabetes does, is it?
Have a great night folks.
Adrienne
Well-Known Member
- Relationship to Diabetes
- Parent
Hi Patricia
What is the care plan for PE? There are so many different ways to deal with it. With my daughter's PE it is about 45 minutes of something. We have a sliding scale of what do to beforehand ie if 6.0 to 8.0 one digestive biscuit, if over 8.0 ok etc etc. If over 14.0 you can exercise but you HAVE to give insulin even if the pump says no !! If you don't know this let me know and I'll take you through why and how.
If PE is particularly energetic, she is tested halfway through. Then she is tested at the end of PE and regardless of what she is we have to have a temp basal of 0% for an hour.
One friend does a temp basal afterwards of about 70% for 8 hours and another friend puts the temp basal on beforehand for say 50% for an hour. It is whatever works. So your basals maybe ok, you just have to compare it with non PE days and you may need to look at the PE care plans.
If you know all this sorry but just in case you didn't its worth me mentioning it.
Hope it helps.
By the way you are doing just great.
I can understand how you feel about wanting to solve everything, Patricia. But the problem with diabetes is that the goal posts keep moving! So from my experience so far i am thinking that it is impossible to get it right all the time. I think that is you can get it right most of the time then you are doing a pretty fab job!
So do not get too frustrated. You are doing a great job. I just hope i can do half as well as you! 🙂
How often and when do you test your sons blood?
Adrienne, your advice is going to be sooooooooooooooo helpful when we start pumping! Even though we not started yet, i read the advice you give to Patricia so i can build my knowledge. 🙂
So do not get too frustrated. You are doing a great job. I just hope i can do half as well as you! 🙂
How often and when do you test your sons blood?
Adrienne, your advice is going to be sooooooooooooooo helpful when we start pumping! Even though we not started yet, i read the advice you give to Patricia so i can build my knowledge. 🙂
Patricia, if you think back to when you were on MDI and how hard it was to try to resolve anything - you must surely realise that having the pump means there is always a way and it only takes a short period of time to resolve! So give yourselves a big pat on the back and dont worry if your getting little blips - i am sure it wont be for long! 😉
Mand, your right, Adrienne is an expert on the use of pumps! What she doesnt know you could put on a postage stamp! And if she doesnt know - she has loads of contacts on the other forum who can help! Thats another reason that i am on the other forum - there is so much advice that is tailored towards diabetes in children. So i get the best of both worlds as i also get tons of advice from adults living with diabetes and all their years of experience etc..from this site!Bev
Mand, your right, Adrienne is an expert on the use of pumps! What she doesnt know you could put on a postage stamp! And if she doesnt know - she has loads of contacts on the other forum who can help! Thats another reason that i am on the other forum - there is so much advice that is tailored towards diabetes in children. So i get the best of both worlds as i also get tons of advice from adults living with diabetes and all their years of experience etc..from this site!
BevBev, that is very re-assuring news re Adrienne and her pump knowledge. I am so thrilled to have found this forum as i cannot imagine life without it now! I have learnt so much re pump already from Adrienne and Patricia. It is just invaluable.
Can't decide re the other forum. Adrienne very kindly did a post giving lots of details about it but just concerned as i struggle, timewise, to keep up with this one. But at the same time, i do not want to miss out on valuable info. Maybe will consider it when we return from our hol.
🙂🙂
Can't decide re the other forum. Adrienne very kindly did a post giving lots of details about it but just concerned as i struggle, timewise, to keep up with this one. But at the same time, i do not want to miss out on valuable info. Maybe will consider it when we return from our hol.
🙂🙂
Hello all
An interesting few days...
On Friday, the three hypo day turned into a four hypo one -- cripes! None of them really washed him out, but we were all a bit 'what the heck was *that*' by the end of the day... Adrienne, we are pretty sure it was a fairly active PE session...your sliding scale is a great idea. We were given a temporary basal pattern to start off with by our team, which we are trying today (another PE session!) -- so I'll let you know. Like you say, it's all trial and error. But we were worn out by the end...
Then Saturday was another strange one: high-ish (11 and 12) all morning (we think from 'carrying over' the waking level of 12, we think in turn from over-correction of last hypo!), and then strangely unable to correct using bolus wizard, because of 'active insulin' still on board...so by mid-afternoon, we decided to override it and force a little correction, which brought him down. We are investigating what to do in this scenario -- while the mechanics make sense (the wizard doesn't want to give a correction if insulin is still active, because it believes that the insulin given will eventually settle things out, so doesn't want to overdose things), the reality is that after 2.5 hours and he's still high, we all know he needs a touch more to come within range. On this particular day, it was probably due to a lingering insulin resistance, having been 13 in the night ...Anyway, will let you know what the team say about that as well...Once he was down, he then had a hypo late in the day again. Sigh. I suspect we will mess with that rate, esp given events of last night!
Then yesterday (Sunday) all went along swimmingly really, until --. But first, the slightly reduced nighttime basal meant that he woke on 6, which feels better than 4, and had not dropped at all in the night. Dosing went well all day -- even the pizza, which we dual waved over 3 hours as suggested, and at four hours post meal he was 7mmol, which was great. In the evening, he had a roast dinner (wizard-ed), a small ice cream (wizard-ed) and then was mighty thirsty so had some apple juice (wizard-ed). We tested him two hours 15 mins after the ice cream bolus, and he was 4.5. We knew we weren't comfortable him going to bed on that number, so he had a packet of biscuits (14g carb). We said we'd check him in another hour, which was 2 hours after the apple juice bolus, 1.5 units). We did so, and he was 1.6!!! He was difficult to move, very sweaty, and not making much sense, sound asleep...Got him up, combination of glucose and apple juice. Once he woke up a bit he could click that he was low, but oh my... 15 minutes later he was 6.6, and at 3 in the morning he had shot up to 11mmol. This morning he was on 10mmol.
We are feeling wrung out. How could he have dropped from 4.5 to 1.6 in an hour, with biscuits on board?! Options: the apple juice we bolused for went in and out so fast that the insulin basically missed it, and also went in before the biscuits could take hold? Or stacking boluses? (But I thought this was okay on the wizard...).
In any case we figure the 11mmol in the middle of the night was a result of the biscuits and glucose settling in....
Ugh. All questions now set out to team, so let's see what emerges. Our main concern is how to treat these sorts of scenarios -- this swinging around is difficult, of course. We need to understand managing bedtime more clearly, perhaps...And today, more PE! Argh. He's trying a temp basal. We've also made clear that he needs to ride high if anything, free carb if necessary, to try to avoid another dreadful low in the next day...
Still: I know in my heart it's manageable. These are all just situations for which we have no precedents, and are learning on our feet really...
The one unexpected thing that has come through from this is that because there is such micro-management possible, I'm finding my urge *is* to micro-manage. I feel that a completely even and worked out life *must* be possible on this system....so am rather living it too much. I think this will go away in time, but I'm more anxious than I'd like to be...I want it all to be *right*. Sigh. We've been here before, haven't we, hasn't everyone?!
Okay. For now. Will stay in touch.
How was everyone else's weekend?!
An interesting few days...
On Friday, the three hypo day turned into a four hypo one -- cripes! None of them really washed him out, but we were all a bit 'what the heck was *that*' by the end of the day... Adrienne, we are pretty sure it was a fairly active PE session...your sliding scale is a great idea. We were given a temporary basal pattern to start off with by our team, which we are trying today (another PE session!) -- so I'll let you know. Like you say, it's all trial and error. But we were worn out by the end...
Then Saturday was another strange one: high-ish (11 and 12) all morning (we think from 'carrying over' the waking level of 12, we think in turn from over-correction of last hypo!), and then strangely unable to correct using bolus wizard, because of 'active insulin' still on board...so by mid-afternoon, we decided to override it and force a little correction, which brought him down. We are investigating what to do in this scenario -- while the mechanics make sense (the wizard doesn't want to give a correction if insulin is still active, because it believes that the insulin given will eventually settle things out, so doesn't want to overdose things), the reality is that after 2.5 hours and he's still high, we all know he needs a touch more to come within range. On this particular day, it was probably due to a lingering insulin resistance, having been 13 in the night ...Anyway, will let you know what the team say about that as well...Once he was down, he then had a hypo late in the day again. Sigh. I suspect we will mess with that rate, esp given events of last night!
Then yesterday (Sunday) all went along swimmingly really, until --. But first, the slightly reduced nighttime basal meant that he woke on 6, which feels better than 4, and had not dropped at all in the night. Dosing went well all day -- even the pizza, which we dual waved over 3 hours as suggested, and at four hours post meal he was 7mmol, which was great. In the evening, he had a roast dinner (wizard-ed), a small ice cream (wizard-ed) and then was mighty thirsty so had some apple juice (wizard-ed). We tested him two hours 15 mins after the ice cream bolus, and he was 4.5. We knew we weren't comfortable him going to bed on that number, so he had a packet of biscuits (14g carb). We said we'd check him in another hour, which was 2 hours after the apple juice bolus, 1.5 units). We did so, and he was 1.6!!! He was difficult to move, very sweaty, and not making much sense, sound asleep...Got him up, combination of glucose and apple juice. Once he woke up a bit he could click that he was low, but oh my... 15 minutes later he was 6.6, and at 3 in the morning he had shot up to 11mmol. This morning he was on 10mmol.
We are feeling wrung out. How could he have dropped from 4.5 to 1.6 in an hour, with biscuits on board?! Options: the apple juice we bolused for went in and out so fast that the insulin basically missed it, and also went in before the biscuits could take hold? Or stacking boluses? (But I thought this was okay on the wizard...).
In any case we figure the 11mmol in the middle of the night was a result of the biscuits and glucose settling in....
Ugh. All questions now set out to team, so let's see what emerges. Our main concern is how to treat these sorts of scenarios -- this swinging around is difficult, of course. We need to understand managing bedtime more clearly, perhaps...And today, more PE! Argh. He's trying a temp basal. We've also made clear that he needs to ride high if anything, free carb if necessary, to try to avoid another dreadful low in the next day...
Still: I know in my heart it's manageable. These are all just situations for which we have no precedents, and are learning on our feet really...
The one unexpected thing that has come through from this is that because there is such micro-management possible, I'm finding my urge *is* to micro-manage. I feel that a completely even and worked out life *must* be possible on this system....so am rather living it too much. I think this will go away in time, but I'm more anxious than I'd like to be...I want it all to be *right*. Sigh. We've been here before, haven't we, hasn't everyone?!
Okay. For now. Will stay in touch.
How was everyone else's weekend?!
Hi Patricia,
Obviously i cant comment on anything pumpwise, but Alex had an applejuice last week for the first time since diagnosis, he went to bed on 7 - but we checked at 11pm and he was 2mmols! I suspect its timing of the insulin with apple juice as its like lightening through the body and probably misses insulin completely! Anyway, your doing brilliantly - dont be disheartened - i think there must be a time when there are teething problems and lots of 'unknowns' - but i am sure you will iron them out eventually! People who have been pumping for years still have the odd blip so dont give yourself a hard time.Bev
Obviously i cant comment on anything pumpwise, but Alex had an applejuice last week for the first time since diagnosis, he went to bed on 7 - but we checked at 11pm and he was 2mmols! I suspect its timing of the insulin with apple juice as its like lightening through the body and probably misses insulin completely! Anyway, your doing brilliantly - dont be disheartened - i think there must be a time when there are teething problems and lots of 'unknowns' - but i am sure you will iron them out eventually! People who have been pumping for years still have the odd blip so dont give yourself a hard time.
BevReply from our team is quite interesting and comprehensive:
We are lowering a couple of basal rates by 0.05u/hr in the evening, to try to get all those levels a little higher (and presumably then not so susceptible to bolus activity). We are also changing the evening carb ratio from 1:10 to 1:12 (had wondered about this just this morning, okay the middle of the night!).
As for the difficulties giving corrections, we are changing the 'active insulin' rate to 3 hours, having started at 4 (most start on 5, apparently, but with E growing etc and eating lots through the day, we started on 4 hours). This will allow us to correct sooner with leftover insulin in the system.
Phew. Wonderfully good humoured note though saying 'good grief yes you have had an interesting time of it!' -- rather good to hear that we're not just totally messed up...Acknowledged too that diabetes just sometimes *does* these things, as we all know...
Re bedtime levels: the whole idea is to get evenings stabilised through the night such that you can go to bed on 5 ish or 6 ish, no top up needed. But this is dependent on being able to regularly reach 6mmols by bedtime. We have maybe too often been lower than that, so things are starting feeling unstable, with middle of the night readings then becoming a little changeable because of carb on board...So hopefully with these changes over next couple of days, bedtime readings will feel more comfortable. What I don't know yet is then what to do with snack bolus last thing at night? Hmmm...
I'm sure everyone knows this by now, but the whole idea of hypo treatment too is glucose only (which we've been doing). In this case the idea is that the basal rate is so stable and finely tuned that carb is not needed. The bgl comes up a bit, and the body can stay there. Apparently larger amounts of lantus/levermir are needed on MDI -- more than the body really *needs*, because of absorption rates and metabolism -- so that's why carb is still needed with hypos on MDI, to balance what is assumed to be too much background insulin that strictly necessary. It is kind of strange, though, just to give glucose. At first our feeling was 'oh no, he's going to crash'...but actually, he doesn't! He just stays at 6 or whatever...
Although someone -- Adrienne? can't remember -- mentioned that long-lasting carb is going out of MDI as well. Interesting...
Okay, bye for now. Text from school says doin' good!
We are lowering a couple of basal rates by 0.05u/hr in the evening, to try to get all those levels a little higher (and presumably then not so susceptible to bolus activity). We are also changing the evening carb ratio from 1:10 to 1:12 (had wondered about this just this morning, okay the middle of the night!).
As for the difficulties giving corrections, we are changing the 'active insulin' rate to 3 hours, having started at 4 (most start on 5, apparently, but with E growing etc and eating lots through the day, we started on 4 hours). This will allow us to correct sooner with leftover insulin in the system.
Phew. Wonderfully good humoured note though saying 'good grief yes you have had an interesting time of it!' -- rather good to hear that we're not just totally messed up...Acknowledged too that diabetes just sometimes *does* these things, as we all know...
Re bedtime levels: the whole idea is to get evenings stabilised through the night such that you can go to bed on 5 ish or 6 ish, no top up needed. But this is dependent on being able to regularly reach 6mmols by bedtime. We have maybe too often been lower than that, so things are starting feeling unstable, with middle of the night readings then becoming a little changeable because of carb on board...So hopefully with these changes over next couple of days, bedtime readings will feel more comfortable. What I don't know yet is then what to do with snack bolus last thing at night? Hmmm...
I'm sure everyone knows this by now, but the whole idea of hypo treatment too is glucose only (which we've been doing). In this case the idea is that the basal rate is so stable and finely tuned that carb is not needed. The bgl comes up a bit, and the body can stay there. Apparently larger amounts of lantus/levermir are needed on MDI -- more than the body really *needs*, because of absorption rates and metabolism -- so that's why carb is still needed with hypos on MDI, to balance what is assumed to be too much background insulin that strictly necessary. It is kind of strange, though, just to give glucose. At first our feeling was 'oh no, he's going to crash'...but actually, he doesn't! He just stays at 6 or whatever...
Although someone -- Adrienne? can't remember -- mentioned that long-lasting carb is going out of MDI as well. Interesting...
Okay, bye for now. Text from school says doin' good!
Hi Patricia
Very interesting posts! I am exhausted just reading them but you had to live them! But i guess i better brace myself as i will be living it soon!
I second what Bev says, you are doing a fab job and early on hiccups are all part and parcel of starting on a pump. You are clearly very committed and contientious (oh can't spell that!) and so is your son. You will get there eventually, although i do not think you can ever completely 'get there' with diabetes because the goal posts keep moving and so many factors come into blood sugar levels.
I am glad about not having to have a carb after a hypo because it means that they don't have to eat extra calories which cant be a good thing in the long run for maintaining a healthly weight.
I have completed my on-line pump training course so i have at least some idea of how to operate it. But the bit that i cannot get my head around it something that you mentioned in your post. If you try to give a bolus when there is active insulin still about then the pump will not allow you to give what is needed. Oh i not explaining this too well. What i mean is, for example, if you have eaten a meal and need 6 units of insulin then you give the insulin. Then one hour later you are offered a piece of cake. You need 4 units for this but the pump will only allow you to do 2 because of active insulin but surely that means that you will be high later because you needed the 4 units for the cake but ony gave two.
Anyway, please keep up your posts! They are so interesting. 🙂🙂
Very interesting posts! I am exhausted just reading them but you had to live them! But i guess i better brace myself as i will be living it soon!
I second what Bev says, you are doing a fab job and early on hiccups are all part and parcel of starting on a pump. You are clearly very committed and contientious (oh can't spell that!) and so is your son. You will get there eventually, although i do not think you can ever completely 'get there' with diabetes because the goal posts keep moving and so many factors come into blood sugar levels.
I am glad about not having to have a carb after a hypo because it means that they don't have to eat extra calories which cant be a good thing in the long run for maintaining a healthly weight.
I have completed my on-line pump training course so i have at least some idea of how to operate it. But the bit that i cannot get my head around it something that you mentioned in your post. If you try to give a bolus when there is active insulin still about then the pump will not allow you to give what is needed. Oh i not explaining this too well. What i mean is, for example, if you have eaten a meal and need 6 units of insulin then you give the insulin. Then one hour later you are offered a piece of cake. You need 4 units for this but the pump will only allow you to do 2 because of active insulin but surely that means that you will be high later because you needed the 4 units for the cake but ony gave two.
Anyway, please keep up your posts! They are so interesting. 🙂🙂
Hi Mand -- appreciate the support! Though I suspect sometimes I'm boring everyone to tears with all this...It's just been a particularly complicated couple of days, maybe!
Re the bolus and active insulin: this is all worked out with your team. E has a max bolus of 14 units, at the moment set on 'active insulin 4 hours'. This means that he can't have more than 14 units of active insulin in him in the space of 4 hours... The level of his max bolus is taken from how much he has had at once (or split, as we did, with pasta etc). The duration of active insulin is something worked out according to guidelines -- apparently, many teenagers end up on 3 hours like E, because he eats frequently. This means he can have a lot of food in a short time!
We have never yet had a problem bolusing for carb, at all different times of day and all different amounts -- so his max bolus is right, I reckon. What we *have* had problems with is *correcting*, eg giving a bolus with no carb. This is down to the 'duration of active insulin' setting on the pump -- which was set for 4 hours and will now be set for 3 for us. What has happened is that the pump has not wanted to give more insulin with no carb to balance it *while there is still active insulin* (eg within 4 hours bolus) -- because it wants you to wait and see if you actually *are* high once the bolus has run its course.
We are changing our duration of active insulin to 3 hours in order to be able to correct a little sooner, that's the only real difference. On MDI anyway, we would never correct until 2.5 hours after a bolus, and I guess for us the same principle is what we want. Saying that, we've only wanted to correct with no carb once (this last weekend!) in two weeks...so I guess in theory, you won't need to do it much at all.
Does this make any sense?! I'll speak to the slightly more logical other half and see if this is the true picture...but it's what I think it's about, anyway!
Re the bolus and active insulin: this is all worked out with your team. E has a max bolus of 14 units, at the moment set on 'active insulin 4 hours'. This means that he can't have more than 14 units of active insulin in him in the space of 4 hours... The level of his max bolus is taken from how much he has had at once (or split, as we did, with pasta etc). The duration of active insulin is something worked out according to guidelines -- apparently, many teenagers end up on 3 hours like E, because he eats frequently. This means he can have a lot of food in a short time!
We have never yet had a problem bolusing for carb, at all different times of day and all different amounts -- so his max bolus is right, I reckon. What we *have* had problems with is *correcting*, eg giving a bolus with no carb. This is down to the 'duration of active insulin' setting on the pump -- which was set for 4 hours and will now be set for 3 for us. What has happened is that the pump has not wanted to give more insulin with no carb to balance it *while there is still active insulin* (eg within 4 hours bolus) -- because it wants you to wait and see if you actually *are* high once the bolus has run its course.
We are changing our duration of active insulin to 3 hours in order to be able to correct a little sooner, that's the only real difference. On MDI anyway, we would never correct until 2.5 hours after a bolus, and I guess for us the same principle is what we want. Saying that, we've only wanted to correct with no carb once (this last weekend!) in two weeks...so I guess in theory, you won't need to do it much at all.
Does this make any sense?! I'll speak to the slightly more logical other half and see if this is the true picture...but it's what I think it's about, anyway!
Adrienne
Well-Known Member
- Relationship to Diabetes
- Parent
Hi
Sorry been away for the weekend. Patricia you have had a weekend of it. Just caught up with the messages.
My first thought was the active insulin on board (IOB). Loads of childrens are set to 3 hours. They tend to start at about 4 or 5 but soon move to 3. I was going to ask what E's was set at but now they have changed it to 3. I only know one person who has 2.5 hours so that is fairly unusual.
What pump do you have, if my memory serves me correctly it is the Medtronic Paradigm. They do work differently. At least the Animas works differently to the Medtronic. The Animas' IOB takes into account food bolus which I don't like and some people ignore that actually. The medtronic doesn't. The scenario that Mand has suggested ie lunch was x cho (carbs) and the wizard gave 6 units. Two hours later you have cake or something and that is 40 cho so you put it in the wizard and the pump will give you insulin to cover that. Because it was two hours after having the lunch insulin you can give a correction if too high. The rules for pumping are that if you have had insulin within the previous 90 minutes you cannot give yourself a correction bolus. If you forced the pump to give yourself a correction ie overrode the wizard you will more than likely hypo. However if you eat within that 90 minutes you CAN have a bolus of insulin because it is a food bolus to cover the food eaten. With the medtronic the pump will give the correct amount of insulin to cover the food eaten. The Animas won't. It will work out the IOB (regardless of whether you put in the BG reading or not) and it will minus some units from the food bolus. This makes no sense. It is suggesting that you have enough IOB still to cover the new food eaten. Again no sense as the IOB is to cover the food eaten at lunch and you have just eaten more.
Does that make sense or have I confused everyone further ?
What people say is that if you need to have more than about 7 units to cover a meal or food, do it in a couple of doses ie one before you eat and the rest after. You can get overload and hypo.
Patricia - the 1.6 hypo. I personally think it was the roast dinner. Myself and lots of friends find roast dinners very hard to manage on a pump. They hardly have any carbs ie just roast pots, perhaps parsnips but that is generally it unless E eats stack loads of veg that you need to count. Jessica always used to hypo after a roast. However saying all of that the hypo was a lot later. I think you are right re the apple juice, maybe the insulin missed it. If Jessica wants fruit juice she only has it at a meal time so I can include the bolus with the rest of the food. Sometimes we don't even bolus for the juice if she is slightly low ie 3.9 or 4.1 before eating.
I'm sure I can answer loads more but am knackered and need to go to bed.
You are doing brilliantly.
One piece of advice that has stuck with me from day one of pumping. Our wonderful DSN said 'trust the pump', when you trust the pump you'll ok. She's right. I didn't understand to begin with. I couldn't think that I would ever trust the pump, thought it a bizarre thing to say. Well I say it now to all the people I know who start and to you to, trust the pump. Its hard but trust it. The amount of times I haven't and I have overridden the wizard and we have hypos galore. If she ever goes over 22.0 that is the only time I override the pump and add on 0.5 units but anything lower than 22.0 and I never override.
Take care
Sorry been away for the weekend. Patricia you have had a weekend of it. Just caught up with the messages.
My first thought was the active insulin on board (IOB). Loads of childrens are set to 3 hours. They tend to start at about 4 or 5 but soon move to 3. I was going to ask what E's was set at but now they have changed it to 3. I only know one person who has 2.5 hours so that is fairly unusual.
What pump do you have, if my memory serves me correctly it is the Medtronic Paradigm. They do work differently. At least the Animas works differently to the Medtronic. The Animas' IOB takes into account food bolus which I don't like and some people ignore that actually. The medtronic doesn't. The scenario that Mand has suggested ie lunch was x cho (carbs) and the wizard gave 6 units. Two hours later you have cake or something and that is 40 cho so you put it in the wizard and the pump will give you insulin to cover that. Because it was two hours after having the lunch insulin you can give a correction if too high. The rules for pumping are that if you have had insulin within the previous 90 minutes you cannot give yourself a correction bolus. If you forced the pump to give yourself a correction ie overrode the wizard you will more than likely hypo. However if you eat within that 90 minutes you CAN have a bolus of insulin because it is a food bolus to cover the food eaten. With the medtronic the pump will give the correct amount of insulin to cover the food eaten. The Animas won't. It will work out the IOB (regardless of whether you put in the BG reading or not) and it will minus some units from the food bolus. This makes no sense. It is suggesting that you have enough IOB still to cover the new food eaten. Again no sense as the IOB is to cover the food eaten at lunch and you have just eaten more.
Does that make sense or have I confused everyone further ?
What people say is that if you need to have more than about 7 units to cover a meal or food, do it in a couple of doses ie one before you eat and the rest after. You can get overload and hypo.
Patricia - the 1.6 hypo. I personally think it was the roast dinner. Myself and lots of friends find roast dinners very hard to manage on a pump. They hardly have any carbs ie just roast pots, perhaps parsnips but that is generally it unless E eats stack loads of veg that you need to count. Jessica always used to hypo after a roast. However saying all of that the hypo was a lot later. I think you are right re the apple juice, maybe the insulin missed it. If Jessica wants fruit juice she only has it at a meal time so I can include the bolus with the rest of the food. Sometimes we don't even bolus for the juice if she is slightly low ie 3.9 or 4.1 before eating.
I'm sure I can answer loads more but am knackered and need to go to bed.
You are doing brilliantly.
One piece of advice that has stuck with me from day one of pumping. Our wonderful DSN said 'trust the pump', when you trust the pump you'll ok. She's right. I didn't understand to begin with. I couldn't think that I would ever trust the pump, thought it a bizarre thing to say. Well I say it now to all the people I know who start and to you to, trust the pump. Its hard but trust it. The amount of times I haven't and I have overridden the wizard and we have hypos galore. If she ever goes over 22.0 that is the only time I override the pump and add on 0.5 units but anything lower than 22.0 and I never override.
Take care
Hi Adrienne. Hope you had a nice weekend away.
I read your post with much interest. If i have understood you correctly then you are saying that with the Medtronic Paradigm (we are getting the 772) then we can give the correct amount of insulin to cover a meal and then enough insulin to cover a peice of cake an hour later and the pump will allow us to do this so that basically my son will have had enough insulin to cover all the food. So if we calculated the food correctly, in theory his blood should be fine. Is this correct?
The reason i am querying is that i seem to remember his nurse telling us that the wizard might not allow all the insulin for the cake to ge given if there is still too much active insluin around from the meal bolus. My concern is that is if you need 6 for the meal and 4 for the cake then you need 10 units of insulin in total or you will surely definately be too high later as you have eaten 10 units worth of food and so need 10 units of insulin.
A similar scenario would be if my son ate lunch and had his bolus then went out to play with his friends. Then they see an ice cream van and he wants one like his friends so he has one and boluses for it. He will need all the lunch bolus and ice cream bolus or he will end up too high.
Sorry Adreinne, if i am a bit slow picking this all up. But the more i can get my head around things before he starts pumping then the more help i can be to him.
Hope you slept well and feel more refreshed now. 🙂🙂
I read your post with much interest. If i have understood you correctly then you are saying that with the Medtronic Paradigm (we are getting the 772) then we can give the correct amount of insulin to cover a meal and then enough insulin to cover a peice of cake an hour later and the pump will allow us to do this so that basically my son will have had enough insulin to cover all the food. So if we calculated the food correctly, in theory his blood should be fine. Is this correct?
The reason i am querying is that i seem to remember his nurse telling us that the wizard might not allow all the insulin for the cake to ge given if there is still too much active insluin around from the meal bolus. My concern is that is if you need 6 for the meal and 4 for the cake then you need 10 units of insulin in total or you will surely definately be too high later as you have eaten 10 units worth of food and so need 10 units of insulin.
A similar scenario would be if my son ate lunch and had his bolus then went out to play with his friends. Then they see an ice cream van and he wants one like his friends so he has one and boluses for it. He will need all the lunch bolus and ice cream bolus or he will end up too high.
Sorry Adreinne, if i am a bit slow picking this all up. But the more i can get my head around things before he starts pumping then the more help i can be to him.
Hope you slept well and feel more refreshed now. 🙂🙂
Adrienne
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Hi Mand
You have it spot on. Your nurse is wrong where the Medtronic is concerned. She would be correct if she is talking about the Animas.
We don't always do a whole meal bolus at the same time. We know what Jessica is having for main part of the meal and we generally bolus before as she always eats everything on her plate. However she doesn't always know what she wants for pudding so will choose, fruit, yoghurt etc and then we will bolus for that as well. We don't put the BG in the second time, no need to as we have done it for the first time.
Don't think you are being slow, it takes a long time to get your head about what a pump does. When you have your pump it will be so much easier to understand what us pumpers or pumper mums are talking about. Ask anything at all.
You have it spot on. Your nurse is wrong where the Medtronic is concerned. She would be correct if she is talking about the Animas.
We don't always do a whole meal bolus at the same time. We know what Jessica is having for main part of the meal and we generally bolus before as she always eats everything on her plate. However she doesn't always know what she wants for pudding so will choose, fruit, yoghurt etc and then we will bolus for that as well. We don't put the BG in the second time, no need to as we have done it for the first time.
Don't think you are being slow, it takes a long time to get your head about what a pump does. When you have your pump it will be so much easier to understand what us pumpers or pumper mums are talking about. Ask anything at all.
Morning all
Adrienne, thank you so much for all your input -- invaluable. Hope you are feeling more rested today?!
Roast dinner is interesting -- yes, low carb. We've never really had probs with it, but I do suspect that the combination of ice cream at the end, then juice on its own, will have woven together to send him down....
Good to hear about the 3 hour active insulin setting being normal. That's what we are now on.
Various changes in settings meant that he was rather high last night, although we did bolus him late for a snack (bowl of cereal -- teenagers!) with a small correction, and at midnight all was well (8). He woke on the same number, but at least we can chip at it downwards rather than picking him up off the floor! We think that the change in basal setting and dinner ratio was probably an overreaction -- clearly our team didn't like the mega-low hypo! Personally though, as I've said before, I'd rather get it right from the top down, rather than always scraping him up...
Oh, and the temp basal did the job with PE! He ran a little high all in all yesterday, but at least he had a break from hypos! Suspect that when the levels finally settle more securely, we will need to play with the temp basal setting as you suggest Adrienne, but even with this first venture it clearly helped.
Phew. Feel we are getting there again, which is a relief.
You're so right that it's hard to trust the pump completely. We are so used to calculating and making judgments, that it's hard to let things ride out. But every time we have trusted the pump, it's been okay. Things have settled.
Re number of units at once -- well, he can do 11 or 12 without a real problem! He's never done more than that at once, but this is a guy who can eat for England really at the moment. Last night the amount of food he put away was staggering: chicken filets and chips, beans, roasted tomatoes, yoghurt, small packet of biscuits, an actimel, and a bowl of cereal 2 and half hours later! There's a lot of carb there, but he has this sort of thing about once a week -- and LOVES it.
Okay. For now!
All best everyone.
Adrienne, thank you so much for all your input -- invaluable. Hope you are feeling more rested today?!
Roast dinner is interesting -- yes, low carb. We've never really had probs with it, but I do suspect that the combination of ice cream at the end, then juice on its own, will have woven together to send him down....
Good to hear about the 3 hour active insulin setting being normal. That's what we are now on.
Various changes in settings meant that he was rather high last night, although we did bolus him late for a snack (bowl of cereal -- teenagers!) with a small correction, and at midnight all was well (8). He woke on the same number, but at least we can chip at it downwards rather than picking him up off the floor! We think that the change in basal setting and dinner ratio was probably an overreaction -- clearly our team didn't like the mega-low hypo! Personally though, as I've said before, I'd rather get it right from the top down, rather than always scraping him up...
Oh, and the temp basal did the job with PE! He ran a little high all in all yesterday, but at least he had a break from hypos! Suspect that when the levels finally settle more securely, we will need to play with the temp basal setting as you suggest Adrienne, but even with this first venture it clearly helped.
Phew. Feel we are getting there again, which is a relief.
You're so right that it's hard to trust the pump completely. We are so used to calculating and making judgments, that it's hard to let things ride out. But every time we have trusted the pump, it's been okay. Things have settled.
Re number of units at once -- well, he can do 11 or 12 without a real problem! He's never done more than that at once, but this is a guy who can eat for England really at the moment. Last night the amount of food he put away was staggering: chicken filets and chips, beans, roasted tomatoes, yoghurt, small packet of biscuits, an actimel, and a bowl of cereal 2 and half hours later! There's a lot of carb there, but he has this sort of thing about once a week -- and LOVES it.
Okay. For now!
All best everyone.
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