Good grief what a busy thread!!!
Going kind of backward through then: Sugarbum, my awful night is on the 'weird high' thread from yesterday, didn't put it on my own thread cos thought it would spread beyond pumping...And I *did* put a couple of (long) posts (!) on my thread re the hol and what we learned, so you may find it useful...
Tracey, hope you enjoyed your wine -- even in the land of any excuse, there isn't a much better excuse than getting a pump date! Also, somewhere in my thread is the thinking behind only using fast-acting on the pump: this is because on MDI the background insulin is always more than it needs to be, because you have overshoot in order to provide cover, and because it doesn't have a completely flat profile. So in a hypo situation you need the long acting carb to cover the background insulin. On a pump, in theory the background is completely flat, so you only need the short acting in order to pull your bg back to that level. Once it's there, it stays. Actually, this more or less does work -- and if it doesn't, then your basal's set too high!
Saying that, Bev, in the early days esp, we used free carb quite a bit on the pump, while we tried to establish the basal rates. So it's not like it's never used. We've also used free carb when we forget to set a temp basal for exercise etc...
Okay now, Bev and Alex: agree with Mand that you *must* get the basal right if you can at all first, unless you are certain that the ratios are the mess up (eg he's hypo-ing around two hours after eating). I'm confused though about what your ratios actually are: The ratio system for the pump is as far as I know along the same number lines; for example on MDI E's breakfast ratio was 1:5 -- on the pump it's gone between 1:7 and 1:8.
I feel like a fool but I don't know the 500 rule! If we used it as you say, then our ratios would be completely different...but what I think is actually happening here is maybe a confusion over what percentage of the overall (TDD) is used for the basal, and what percentage is used for the ratio? If you look at how much levermir A was on, take away 25%, then divide that by 24 (hours), then you will have a guesstimate for his per hour basal rate. Have they given you one rate, or several for different times of day? It's this rate which may need looking at if he's hypo-ing a lot?
If A's ratios were as you say on MDI, then I'm not surprised they went for 1:20 to start -- we started all of ours on 1:10, which was the highest ratio for E across the board on MDI. So they've started high. It looks to me like it's more possible it's his basal rates which are wrong -- what are they? At what times of day did he hypo?
If it's any help E hypo-ed on and off all through the first two days -- his basal rates were generally too high, and we quickly reduced them ALL across the board by .05unit/hr, so that we could work down to good numbers rather than propping him up!
Presumably you set ratios, basal rates, with the hospital? And it's all written down?
This brings me to your appalling support. I simply can't believe you don't have a mobile. We phoned every day at 7pm and in the first few days, at 7am as well. This is appalling. The ward, as you know, will know nothing.
I'm really feeling for you, Bev. To be straight on insulin AND with little support is a unsettling start I think. Do you have your consultant's email? Can you impress upon him that you need more support? I think you do. Changing basals, which is what it looks like you need to do, is hard to do on your own. We didn't do anything without clearing it for at least two weeks. I'm wondering if you could do with speaking to another pumping parent? Let me know.
I'm thinking of you. We too are back in the 3am club, once again tracking pasta through with gritted teeth. We *will* get this! We are going to try 30% bolus up front, followed by the 70% on an 8 hour dual wave...Something like the equivalent of 150% basal rate...What do you think, Sugarbum?! From last night's debacle (why we did what we did, I don't know. We weren't thinking straight, and did a bunch of things we *know* don't work! Argh. But it is now super-clear that a 3 hour dual wave actually doesn't work very well for us with pasta, and that chances are, if he starts around 5mmols, doesn't have a pudding -- he will crash at 5 hours. Duh. We also now are very clear that the rise from pasta *is* over about 8 hours. At 3am he was 14mmols (having been 1.9mmol at 11pm!!). We corrected fully, and he was 4.7mmol at 7am, which suggests he didn't rise at all during the intervening 4 hours) -- it's 8 hours. Do we do an 8 hour dual wave, or a 6 hour one because of the lasting effects? Who knows.
Bev: let us know how the night was. We're here. I'll keep checking today.
xxoo
