Advanced Features

Diabetes Technology Insulin Pumps
#1

I was hoping I can get some input. Today I used the advanced features to the Ping of EZ Carb and EZ bolus on two meals. Had a couple of numbers that I didn't understand so hoped someone could help.

My son has a Target of 120 and I:C ratio of 10 and ISF of 50.

So he had tested before he ate earlier and was at 76 for a BG. He had 40 carbs for the meal.

So the screen showed the following:

EZ Carb

Carbs 40 g

I:C = 10g

Add BG

Actual 76 mg

Target -120

= -44

IS Factor 50 mg

Show results

Carb 4.00 u

BG -0.88u

IOB --,--

Total 3.10 u

I can't figure out what the BG -0.88 u means and how it was calculated.

I did give my son the bolus for 3.10 u and at his next meal his BG was 119 before eating.

HE had 36 carbs.

The screen showed EZ Carb

Carbs 36

i:C 10

BG Actual 119

Target 120

= 0

IS Factor 50 mg

Results

Carbs 3.60 u

BG - 0.00

IOB: 0.15

Total 3.60.

I would think that the pump would subtract the 0.15 IOB from the 3.60 for a number of 3.45u of bolus yet it showed a bolus of 3.60 and seemed to ignoe the IOB.

What am I missing

Thanks guys

#2

In your first scenario, your sons BG was low and out of range and the pump rightly suggested subtracting some of that bolus insulin to bring him back to target. It was calculated based on the target being 120 and him currently being at 76. 120-76 = 44 mg/dl below target.

44/50 = 0.88 units of insulin below target based on his 50 mg/dl ISF.

To answer the second part, is his target set at 120 + or - anything?

For instance, my target is currently set at 110 ± 10. My I:C ratio is 1:11 and my ISF is 40. Lets say my BG is 109 and I have 0.15 units of insulin on board. No matter what I bolus for carbs, the IOB will not be subtracted because it’s still in range of my 110 ± 10.

0.15units x 40mg/dl = 6 mg/dl, which the pump would estimate to bring my BG down to 103, which is still in my 110 ± 10 range.

#3

Hi Jason
Thank you so much for the help. On your target being 110 - I know typically the range is 70-150. Is the 110 a number you chose based on the halfway point of those parameters or is it something you measured and worked with your doctor on and how did you come up with 110. What is the -10 number?
THe ISF at 50 that my son has and the 120 target were just kind of the standard that the hospital my son was diagnosed sets at the start but I know there are things to refine. Did you average the day’s insulin (bolus and basal) and use the 1800 or 1500 method to determine the ISF of 40??
Thanks again
Keith

#4

Even though Jason’s answer was great I’m going to try to answer your question in my words.
1st the target is 120 but the range most CDEs set is 120 +/- 10 meaning 110-130 should be considered with in range when the pump calculates it’s ISF. Now since your son’s BG was 76 it was 44 points below the target of 120 so once the total units for his carbs was calculated the pump chose to subtract 0.88 of a Unit to prevent over coverage that may cause a low in his BG.
2nd. Your son had 0.15 Units still on board but his BG was higher than his 110 ( the - part of the +/-) so it was safe to keep that amount to cover the 9 points over 110 and still cover the carbs being taken in.

I that was alittle easier to understand. I work in an ER so this is how I usually break this down for my PTs

#5

Actually, I just double checked my pump and my target is set at 110 +/- 20.

I think I started at 120 +/- 10 and personally decided to slowly lower that to 110 +/- 20 after getting much of my settings (basal rates, IC ratios, ISF, IOB) dialed in correctly. This lets my pump know that if my BG is 90 through 130, it is “in range” and OK.

I chose my ISF of 40 and my I:C ratio of 11 after a lot of testing. My doctor started me at an I:C of 13 and ISF of 45, but I have been tweaking over the past 2 months and I’m still adjusting them little by little. These are very personal numbers and will vary for everyone. If you haven’t already, get the book “Pumping Insulin” by John Walsh. It’ll walk you through correctly testing to get all of your settings right. Also, Animas has a workbook that should have come with your pump that has similar testing and fine-tuning directions.

#6

You’re right Jason about numbers changing per individual. My I:C is 1:9 but after 7PM it changes to 1:8 and my Basal increases till Midnight. My Basal varies depending on the day of the week and my work schedule and time of day. And my ISF is 40. I do some adjusting on my own but you should always check with your CDE before making adjustments until you become more experienced. I’m still waiting to get the John Walsh book. But hope to get it soon. i’ve heard a lot of great things about it.

#7

Agreed, when making changes, you should always check with your CDE, especially if this is new to someone. I’ve been Type 1 for 11 years now, so my doctor and I are comfortable with me making my own minor adjustments.

#8

Wow 11 years. That’s great you’ve got that much experience behind you. How old were you when you were diagnosed? I was 25 but diagnosed Type II but now I’m 31, 32 in April and not making much insulin on my own at all. Started insulin alittle over a year ago and have never been better since starting the Pump this Jan. Is the Ping your 1st pump?

#9

I just borrowed the John Walsh from the library. It is a must read - I will return it with a lot of dog-eared paged. He says things in a plain and simple way that makes the information so much easier to understand. I finished it last night at 2 am and will get a copy. I saw so much to highlight. A lot of what I like is that he explains things we were told but never told why. I remember when they showed us how to use fill a cartridge in pump training and the nurse said to move the plunger up and down a few times and then fill the bottle with air. He mentions how the cartridge has a lubricant inside and that the o rings are lubricated by moving the plunger up and down a few times. He also showed an example of bubbles that can accumulate between the o rings that could cause leaking that you would be unaware of. That is just an example but something I had no idea of.

#10

I didn’t think about the library. The easy way always slips my mind…lol. Good thinking. How old is your son?

#11

I was diagnosed when I was 17. I started having the typical symptoms, sudden weight loss, insatiable thirst, frequent urination. I could barely move by the time we decided to go to the ER.

It wasn’t easy for a while and things have gotten much better. Looking back, my old doctors/endos were pretty horrible. I think the main reasons that I’ve been doing much better is because I found a really great Doctor that knows what she’s doing and that I’ve researched and educated myself as much as possible so that I could make sense of everything on my own. I think self education is key because it allows you to be an active, rather than passive, participant while discussing treatment options with your doctor.

The Ping is indeed my first pump. I love it so far. I don’t miss 6-8 shots a day in the LEAST.

#12

Hi
My son just turned 15. He was diagnosed on April 11, 2009 so we are coming up on the one year anniversary.
The book has been great - he mentions that alcohol wipes are not strong enough to cleanse the skin prior to inserting and that it is best to use IV prep wipes. That is one of those things that seem to pass by in the whole process. I went on the ANimas site - where they have an e-store and you see different dressings, adhesives, adhesive removers etc and being new no one takes the time to explain what they or even how they work. I saw one product called IV3000 dressing by Smith and Nephew with frame delivery and the same product without frame delivery and you get so confused you want to throw your hands up. It feels like everyone knows about these things and how they work but you.
The books suggests that we should place a bio-occlusive adhesive like Opsite IV 3000 over the steralized skin after it dries. This is to prevent bacteria from gaining access to the skin around the infusion site which sounds like a good idea. He then mentions that most adhesive materials are not bio- occlusive. He then goes on to say the infusion set is goes over this bio-occulive material. So it looks like I have been using alchol pads to kill bacteria on the skin instead of IV prep. I don’t even know what bio-occulsive means and they say you can order the IV 3000 with our without a frame.
I don’t even know what the difference is and when you ask at Animas they don’t seem to really know themselves.
So I also see a product called Tagaderm listed on the same page as the smith and nephew dressing and I wonder if they all do the same thing.
IT does get frustrating - I don’t know if the Smith and Nephew IV3000 does the same thing as the product he names in the book (Opsite IV 3000) but it sounds like it could.
I got the IV3000 Smith and Nephew product and the instructions were very unclear. I thought it went over the infusion site and when my wife did that my son couldn’t detach the insertion clip.
Sorry that was always a bit of venting lol.
Just when you think you have a handle on it it seems like you don’t. Anyway, I very much appreciate the help you given me. IT has been invaluable.
By the way the library should also have the book Think like a Pancras which has some really nice tips in it also.

#13

I agree with the self education and the right doctors. Without the right education I wouldn’t have known I needed a better Doc and would be in worse shape than I am.
I really hate to hear you were so sick before you found it. I work in an ER so I see lots of kids come in like that. I’m not an educater but usually end up being sent to answer questions they have. I don’t mind. If I have to have it I’m happy to help. Makes it seems alittle worth it.

I love my ping. It’s my 1st. One of the girls I work with has a daughter on the paradigm and she got me interrested. Working in the ER doesn’t give you much time to leave the floor, test and take a shot. It really is alot easier. I don’t have to test as often and so far (knock on wood) I haven’t had to take a single shot other than the infusion set since I started it. My arms, legs, and belly are alot happier. 7-10 shots a day you start running out of unbruised tissue.

Glad it’s working out for you.

#14

Bless his heart. I seem them at all ages. We got a 3 month old a few weeks back. Poor parents were in hysterics. Can’t say that I blame them. It’s hard getting started but even whe you learn all you think you need there’s always something new. I try to think of it this way…I look to learn something new each day. If I don’t find something new to learn then it was a waisted day. It doesn’t have to be diabetes related but it’s a bonus when it is. there’s a quote by somebody to that effect. I don’t know who it was but it worked for me.

I was 14 when I started having trouble but wasn’t taking care of properly. When I was 18 and pregnant I was on insulin but after I had my son they just said I didn’t need it anymore without testing. Then when I was 25 I was diagnosed with type II that gradually got worse with diet and exercise and oral meds. Finally with little control and an outragous amount of complications for a 30 year old I asked for insulin. I feel better now then I have since I was 14. I make still make small amounts of insulin but decreases each year. I’ve been pushing my doc to find out if it’s LADA. But he just says we found a treatment that’s working lets stick with that. I’m thinking I was looking for a better doc when I found him might as well keep looking.

I wish you and your family the best of luck and peace with your new encounter. Don’t forget to breath. Oh another thing that helps me is to think of how lucky I am that my condition is diabetes. It could have very easily have been something worse.