Normal Pump Start Strategies?

[jenet]

One more question: Based on the Pumping Insulin book and the Animas training materials, I expected the first week to start working on fine-tuning my basal rates, and over the following weeks to move on to boluses and ISFs once the basal was set properly.

Day 1 and Day 2, I spent at the Dr's office, so they could closely monitor my start and make sure the initial settings were OK. Day 3 I called my overnight and morning numbers in, and was instructed to change my basal rate and my ISF. I have a "follow-up appointment" scheduled Monday afternoon (Day 6), and then the next appointment will be in two weeks.

I have read that it can take 3-4 days for Lantus to be fully out of your system when transitioning to the pump, so I can understand waiting until Monday since the weekend fell in the middle of this. Should I expect to start basal testing after Monday's appointment? Or, do you have to do something else before basal testing?

Maybe I was naive, but I thought that testing was strongly recommended before changing basal and bolus settings (as long as you're somewhere in the ballpark to start with and not way too high or way too low). Is it common for an endo or CDE to change basal and bolus settings without testing? How long did you wait between pump start and basal testing? What things had to happen before you started testing your basals?

If you made it through that tangle of questions, you've probably figured out I feeling anxious and confused about this whole startup. I am putting together a list of questions for my Monday appointment, and any comments on real-world pump start experiences would be very useful.

Thanks much,
j

[spike]

One more question: Based on the Pumping Insulin book and the Animas training materials, I expected the first week to start working on fine-tuning my basal rates, and over the following weeks to move on to boluses and ISFs once the basal was set properly.

Day 1 and Day 2, I spent at the Dr's office, so they could closely monitor my start and make sure the initial settings were OK. Day 3 I called my overnight and morning numbers in, and was instructed to change my basal rate and my ISF. I have a "follow-up appointment" scheduled Monday afternoon (Day 6), and then the next appointment will be in two weeks.

I have read that it can take 3-4 days for Lantus to be fully out of your system when transitioning to the pump, so I can understand waiting until Monday since the weekend fell in the middle of this. Should I expect to start basal testing after Monday's appointment? Or, do you have to do something else before basal testing?

Maybe I was naive, but I thought that testing was strongly recommended before changing basal and bolus settings (as long as you're somewhere in the ballpark to start with and not way too high or way too low). Is it common for an endo or CDE to change basal and bolus settings without testing? How long did you wait between pump start and basal testing? What things had to happen before you started testing your basals?

If you made it through that tangle of questions, you've probably figured out I feeling anxious and confused about this whole startup. I am putting together a list of questions for my Monday appointment, and any comments on real-world pump start experiences would be very useful.

Thanks much,
j


To test basals you'll need to skip at least one meal. Your bg's need to stable, skip a meal, and keep checking your bg's at least once an hour and record them. The object is to get your bg's as close to their target value as possible and then move on to another time of day as soon as practical. that might be the next day, or several days later.

Don't bother with basal testing around meal times unless you are stable! The reason to skip a meal is because you don't want any bolus insulin in your system during the period you are recording bg's. You'll also need to check in the middle of the night to see how your nighttime basal is doing to keep you within your target range.

You'll need to get the basals pinned down before figuring out your carb/insulin (or as others have noted, your insulin/carb) ratio, but you should be in the ballpark from your MDI knowledge. fine tune your ratios as you go along. Keep good records.

Your drop ratio (insulin sensitivity) also needs to be checked ONLY under stable conditions. You need to be ABOVE your target range, as the idea is to take ONE unit and keep checking your bg's every hour or more. At the 4 hour point, your bg's should bottom out from the unit. That's your "insulin sensitivity". It might bottom out between 3.5 to 5 hours. I feel that's the toughest number to pin down, because it all depends on how stable you would have been had you not taken the unit.

[jenet]

Thanks for the recap Spike. That sounds like what I was expecting from Walsh's book, but I haven't been asked or told to do any of that yet. I'm just so tired of the ups and downs. I got up this morning at 7:46 AM with BG of 147 (after a 3:00 AM of 88), and an hour later was over 200 before breakfast. :(

j

[spike]

Thanks for the recap Spike. That sounds like what I was expecting from Walsh's book, but I haven't been asked or told to do any of that yet. I'm just so tired of the ups and downs. I got up this morning at 7:46 AM with BG of 147 (after a 3:00 AM of 88), and an hour later was over 200 before breakfast. :(

j

You should be working with the endo to get your basals adjusted starting right away (according to ME, and my endo). I'm not an authority; I'm just telling you my OPINION, and recounting my endo's method. With all the studying and calculating I did before getting my pump ( I made spreadsheets up the wazoo), I STILL was nervous about sleeping with my pump that first night. After that, I relaxed, sent my endo my readings and made adjustments each day to get closer to my target values. He gave me input and I either did exactly as he said, or I'd modify it slightly. It wasn't long before I was confident in the pump and it's effect that I began making the changes on my own and reporting them to him during my visits. The first 3 days he called me at home.

Before I got my pump the common thing was for new pumpers to spend a couple days in the hospital. I BEGGED them not to do that to me. I said my actiivity level is so different than laying around in the hospital, that it would be useless in setting up the pump. He agreed and so I started my pump at 3 PM in the privacy of my home.

Gawd, I love pumping! :) It gave me back my life.

I forgot to mention: I started on Velosulin which is much slower than Humalog. Setting the basal rates was more difficult due to the lag time. the word was that you adjusted your basal rates 2 hours before the time period you were trying to affect.

[jenet]

My CDE is part of my endo's practice, and they were both involved with my pump start this week, so yes I am trying to be good :angel: and work with my team, instead of just testing and tweaking on my own (as tempting as that is :-).

I didn't have any problems sleeping, because I knew my pump's basal total was 25% lower than my daily Lantus total. And, I'd already read a lot of posts here saying it worked fine to tuck it under your pillow or let it roam free on the bed. I'm thankful I have you and the rest of the folks here to provide anecdotes and perspective based on real-life experience.

Another example, my CDE thought I should bolus extra for the caffeine in my latte, because someone else does. My 3 hour BG was fine without any adjustment. People here have taught me that it's OK to say YMMV - for many things, there is no one easy automatic answer that will fit everybody. I just need to feel more comfortable about saying that to her. I like her, but she has a very strong personality. ;)

Just being able to share my concerns, and have someone respond who's "been there, done that" is so helpful.
Thanks again!
j

[spike]

My CDE is part of my endo's practice, and they were both involved with my pump start this week, so yes I am trying to be good :angel: and work with my team, instead of just testing and tweaking on my own (as tempting as that is :-).

I didn't have any problems sleeping, because I knew my pump's basal total was 25% lower than my daily Lantus total. And, I'd already read a lot of posts here saying it worked fine to tuck it under your pillow or let it roam free on the bed. I'm thankful I have you and the rest of the folks here to provide anecdotes and perspective based on real-life experience.

Another example, my CDE thought I should bolus extra for the caffeine in my latte, because someone else does. My 3 hour BG was fine without any adjustment. People here have taught me that it's OK to say YMMV - for many things, there is no one easy automatic answer that will fit everybody. I just need to feel more comfortable about saying that to her. I like her, but she has a very strong personality. ;)

Just being able to share my concerns, and have someone respond who's "been there, done that" is so helpful.
Thanks again!
j

I never heard of bolusing for caffeine, but I see some mention of it on the internet. someone else needs to weigh in here on that one!

Yes, DM is definitely a "YMMV" disease. Even hypo symptoms vary. I remember to this day, back in 1989 a fellow telling me he is vision turned blue when he was hypo. By that time I had already been on insulin and had my share of severe hypos for 10 years. In the past 8-10 years I've experienced what he was describing, only it's blue sparkles.