[YouthIncJr]

Hey guys,
First let me say I totally enjoy reading these forums. You are all a big help. I have started back on a pump (Amimas 1250) about 3-4 weeks ago. Several years prior, I was on a disatronics pump. Anyway, alot has changed. It seems like there is still some fine tunning that I am going through to get the pump "settled". Is this length of time normal or is this maybe more of a case of a cautious diabetic educator? I saw one of Duck's posts about the pumping book by Welsch, I think I need to dig mine out, and refresh a little. Just wondering what you all thought.

T-1 Diabetic for 31 years, currently using Apidera in my pump.

[David]

Hi YouthIncJr. How long ago were you using a Disetronic? Which one? The HTron? The DTron? Yeah, things have changed. The new pumps, including the 1250 have their insulin wizards and IOB can now be factored in. Apidra is a new rapid-acting insulin, so your CDE may be a little over-cautious using it until he gets an idea of its action profile. Humalog may not work exactly like Novolog in you and the same goes for Apidra. How old is your Walsh's Pumping Insulin book? Make sure you have the latest edition. I see you're in Ohio. Me too, near Toledo
David

[ricardo]

Originally Posted by YouthIncJr

Hey guys,
First let me say I totally enjoy reading these forums. You are all a big help. I have started back on a pump (Amimas 1250) about 3-4 weeks ago. Several years prior, I was on a disatronics pump. Anyway, alot has changed. It seems like there is still some fine tunning that I am going through to get the pump "settled". Is this length of time normal or is this maybe more of a case of a cautious diabetic educator? I saw one of Duck's posts about the pumping book by Welsch, I think I need to dig mine out, and refresh a little. Just wondering what you all thought.

T-1 Diabetic for 31 years, currently using Apidera in my pump.

What exactly is the problem?

Walsh's book is the best out there. Learn it backwards and forwards.

Ricardo

[Amanda_Jo22]

Welcome to the forums, Youth! And congrats on your 1250! How do you like it? I love mine. I had a Minimed 511 before this pump (started on the 508). I think the fine-tuning time is normal. It varies from person to person. It took me about that amount of time to fine-tune when I switched to the 1250 as well.

Glad to have you on board!

[YouthIncJr]

[quote=ricardo]What exactly is the problem?

Seems to be taking a loooooong time. Seems like when I think I am getting close, it gets farther away. I change basal rates, let them settle for 2 days or so, seems to be fine. Then couple days later, seems like they need to be changed again.

I guess I am expecting quicker results. You know, like start on the pump this morning, and by noon I want my blood sugars ato be normal and stay normal.

[YouthIncJr]

[quote=David] I see you're in Ohio. Me too, near Toledo


Hey what do you know, I am in Toledo.

[ricardo]

[quote=YouthIncJr]

Originally Posted by ricardo

What exactly is the problem?

Seems to be taking a loooooong time. Seems like when I think I am getting close, it gets farther away. I change basal rates, let them settle for 2 days or so, seems to be fine. Then couple days later, seems like they need to be changed again.

I guess I am expecting quicker results. You know, like start on the pump this morning, and by noon I want my blood sugars ato be normal and stay normal.

figure around a month to get everything "dialed in". If your activity level and/or carb or fat intake varies much from day to day, you'll find that one day is fine and another is a "disaster". Try to keep both at the same level until you get a handle on pumping. Then you'll have an easier time with changes. MAKE SURE YOU SKIP A MEAL TO DIAL IN YOUR BASALS, as indicated in the pumping literature. I can't stress that enough. It's imperative to get the basals set correctly before moving on to bolus adjustments. and test, test, test.

Priorities:

1. Set accurate basal rates to keep you at your target bg level (that means if you don't eat and bolus your bg's should be hovering around 100).

2. Learn what your carb to insulin ratio is for each time of the day. That ratio MIGHT be the same all day long, but many use a lower ratio in the morning.

3. Learn what your sensitivity (or "drop") ratio is. That is set when you've hit a period of time when your bg is stable for at least 4 hours. You take ONE unit of insulin and check to see how far it brings you down at the end of 4-5 hours. THERE'S NO WAY TO DO THIS TESTING IF YOUR BG'S ARE FLUCTUATING!

4. Learn how to manage exercise. Rule of thumb: if you exercise moderately to heavily after a bolus and meal, cut the bolus in 1/2. Set the basal (a "temporary basal") to about 60% or less (depending on how strenuous you expect the exercise to be) from 1/2 BEFORE the exercise begins. Resume a regular rate when you are do, assuming you are doing ok. ALWAYS KEEP GLUCOTABS ON HAND FOR AN EMERGENCY. You should also have one or two Glucagon kits. I'd never, ever go out in the wilderness on my bike without a Glucagon kit. And I always carry at least 20 Glucotabs.

5. If your activity level diminishes for the day, consider cutting back on carbs or set a temporary basal rate a little bit higher than normal.

There you have it--the basics to pumping! Good luck!

Ricardo

[jeggeman31]

Originally Posted by David

I see you're in Ohio. Me too, near Toledo

Hey what do you know, I am in Toledo.

Columbus Ohio here

[David]

[quote=YouthIncJr]

Originally Posted by David

I see you're in Ohio. Me too, near Toledo


Hey what do you know, I am in Toledo.

Hey cool. Who's your endo? I go to Beham at Central at Secor.
David

[YouthIncJr]

David ,

That is who I see.

[YouthIncJr]

[quote=ricardo]

Originally Posted by YouthIncJr

figure around a month to get everything "dialed in". If your activity level and/or carb or fat intake varies much from day to day, you'll find that one day is fine and another is a "disaster". Try to keep both at the same level until you get a handle on pumping. Then you'll have an easier time with changes. MAKE SURE YOU SKIP A MEAL TO DIAL IN YOUR BASALS, as indicated in the pumping literature. I can't stress that enough. It's imperative to get the basals set correctly before moving on to bolus adjustments. and test, test, test.

Priorities:

1. Set accurate basal rates to keep you at your target bg level (that means if you don't eat and bolus your bg's should be hovering around 100).

2. Learn what your carb to insulin ratio is for each time of the day. That ratio MIGHT be the same all day long, but many use a lower ratio in the morning.

3. Learn what your sensitivity (or "drop") ratio is. That is set when you've hit a period of time when your bg is stable for at least 4 hours. You take ONE unit of insulin and check to see how far it brings you down at the end of 4-5 hours. THERE'S NO WAY TO DO THIS TESTING IF YOUR BG'S ARE FLUCTUATING!

4. Learn how to manage exercise. Rule of thumb: if you exercise moderately to heavily after a bolus and meal, cut the bolus in 1/2. Set the basal (a "temporary basal") to about 60% or less (depending on how strenuous you expect the exercise to be) from 1/2 BEFORE the exercise begins. Resume a regular rate when you are do, assuming you are doing ok. ALWAYS KEEP GLUCOTABS ON HAND FOR AN EMERGENCY. You should also have one or two Glucagon kits. I'd never, ever go out in the wilderness on my bike without a Glucagon kit. And I always carry at least 20 Glucotabs.

5. If your activity level diminishes for the day, consider cutting back on carbs or set a temporary basal rate a little bit higher than normal.

There you have it--the basics to pumping! Good luck!

Ricardo

RICARDO -
I finally got my Pumping insuling book out over the weekend. I am glad someone mentioned the new edition thing. as I have the sencond edition, and ordered the 3rd over the weekend as well.

Here is what I have gathered to this point. IN 2000 on the disetronics i remember my rates being around 1.2 units per hour the educator was starting me around .5 units per hour based on the low end of my weight (165 - 170) that range closely matched my lantus intake of 30 units. HOWEVER, It did NOT match my TDD of around 48 units. I have been increasing my basal rates slowly. but steadily. It seemed as though i was getting close on Saturday, then sunday with fathers day and all, BG ran high. understandable with the cookouts and all. but this morning, prebreakfast was 124 by 11 with nothing to eat it was 245. I know I need to skip meals to check, but it just seems like i get close, then the rates need to be increased.

I have graetly appreaciated my CDE, but there also seems to be a disconnect. I think I will be calling this afternoon.

Another Problem that I seem to run into is this. I run 2 to 3 miles every day, Except for the weekend. I think this amount of exercise, carries well into Sayurday, but sunday and monday are affected by the lack of the 2 to 3 mile run. Generally, If my bg is "normal" I will set a temp basal for -50% for about and hour, which should probably move to 1.5 hours. this is more that needs to be figured out.

Needless to say, I think my carb ratios and insulin sensitivity numbers are skewed by the lower settings from my CDE.

Another Question I have for you all is this. If The Insulin takes 4 hours to fully affect the BG why do we check 2 hours post meal.???? seems like if you are good 2 hours post, you will be even lower 4 hours post based on the 4 hour duration. I am waiting for the pumping insulin 3rd edition to arrive later this week to help with some of these general questions.

I feel like i am a little more in control since posting my original question and make adjustments over the weekend.

Any other advise is welcomed.

~Jr

[duck]

I was confused by the four hour window as well until I "rejoined" this site about November of last year...Basically, the "rapid acting" analogs peak at about 2 hours, and QUIT working at 4 hours. We're measuring our post meal glucose levels based on that activity.

[ricardo]

I finally got my Pumping insuling book out over the weekend. I am glad someone mentioned the new edition thing. as I have the sencond edition, and ordered the 3rd over the weekend as well.

Here is what I have gathered to this point. IN 2000 on the disetronics i remember my rates being around 1.2 units per hour the educator was starting me around .5 units per hour based on the low end of my weight (165 - 170) that range closely matched my lantus intake of 30 units. HOWEVER, It did NOT match my TDD of around 48 units. I have been increasing my basal rates slowly. but steadily. It seemed as though i was getting close on Saturday, then sunday with fathers day and all, BG ran high. understandable with the cookouts and all. but this morning, prebreakfast was 124 by 11 with nothing to eat it was 245. I know I need to skip meals to check, but it just seems like i get close, then the rates need to be increased.

Pumping experts usually cut back MDI basals to 80% as a starting point, because pumped insulin seems more effective than an equal amount of long acting insulin. I agree that your basal sounds like is too low if you are going up to 245 midmorning without eating.


Another Problem that I seem to run into is this. I run 2 to 3 miles every day, Except for the weekend. I think this amount of exercise, carries well into Sayurday, but sunday and monday are affected by the lack of the 2 to 3 mile run. Generally, If my bg is "normal" I will set a temp basal for -50% for about and hour, which should probably move to 1.5 hours. this is more that needs to be figured out.

I agree with your assumption that exercise carries over to the next day. Then it’s effect dissipates late that day.

Needless to say, I think my carb ratios and insulin sensitivity numbers are skewed by the lower settings from my CDE.

Yup, you gotta get the basals accurately set before you set the ratios.

Another Question I have for you all is this. If The Insulin takes 4 hours to fully affect the BG why do we check 2 hours post meal.???? seems like if you are good 2 hours post, you will be even lower 4 hours post based on the 4 hour duration. I am waiting for the pumping insulin 3rd edition to arrive later this week to help with some of these general questions.

The 2 hour check is just an average time that a well balanced meal will peak your bg’s. Eat pizza or Mexican and forget about that! Even though Humalog lasts 4-5 hours, it’s peak effect is around the same time frame as a balanced meal. It isn’t going to perfectly coincide with the blood glucose raising action of all food, but it’s one of the best currently available. If you have ever used regular, you know how lousy that was at matching the onset of rising bg’s induced from eating.

I feel like i am a little more in control since posting my original question and make adjustments over the weekend.

Glad to hear you are getting a handle on the basics.

Any other advise is welcomed.

[am1977]

Just wanted to welcome you to the forums (sorry for being a little late ) , but I hope to see you visiting and posting often

Andrea , Type 1, MM 511

[YouthIncJr]

I am going to attempt to reply to all of you in one short message. Here Goes:

Thanks for all the help and the warm welcome.

The basics I think I have a handle on, it is just a matter of getting settled in. But, I think that I am on my way to gettng there more quickly now.

~Jr