Okay another question, got into pump settings it has carb ratio set at 8.5 is this to mean the ratio is 1:8.5 seems kind of extreme I have been using 1:30 doing MDI with good results. Haven’t used pump in over a year but had great control when I was on it. Getting insulin for it today. New transmitter will be here monday (next)
Who set it to 8.5? (sounds like you are quite sensitive to insulin if you do 1:30)
My last endo. Like i said worked great for me as does the 1:30 ratio I use doing MDI. Am not looking to change anything at this time just wondering if I was interpreting that # (8.5) correctly. But it really sounds extreme compared to what I am currently using.
At 1/30 you would take 1 unit of insulin for every 30 carbs you ate. 1/8.5 would be about 3.5 units for 30 carbs. I would call your endo’s office before giving yourself 3.5 tines your usual dose. Your correct to be concerned about such a change.
And just for giggles it has my sensivity at 32 where I use 50. Am going to text endo and tell him my current #'s and what I am going to change to. Am sure he will say call my trainer who I haven’t talked to since I got pump and who isn’t even a diabetic. I think to be a CDE you should have to be diabetic.
No big deal on the sensitivity. That means if you are correcting a high and gave yourself 1 unit of insulin, it would take your BG down 32 or 50 points so you wouldn’t be in any danger. However, your carb ratio dilemma could cause a problem.
We change our settings.
We have no need to call any trainer as we know which screen the setting is on.
I am also not going to use any configuration which the Endo says if I don’t agree. Our Endo does not live here. We live here.
However that is us.
I certainly understand that different people approach this from different directions.
I think your concerns are entirely justified. Going from 1:30 for an I:C ratio right down to 8.5:1 would be IMHO absolutely insane. If anybody ever convinced me that there was a good reason to do this, I would do the adjustment in many small steps. Then monitor the results after each change.
For example, start with 1:30 for the I:C ratio if that is what you are used to right now.
Run a couple days to get a baseline.
Then make a change by about 15% or so. Modify it to 1:25. Run like that for a few days.
And so on and so on.
But when changing, I change by percent - not by absolute number.
Point being a change from 1:30 over to 1:25 is far different from a change of 1:10 over to 1:5.
And if things are basically looking good then what is the rush. Take your time. Do the changes slowly and see how they go.
Some background on the insulin to carb ratio. John Walsh, author of Pumping Insulin and Using Insulin, suggests using the 500 rule to give a good starting point for an insulin to carb ratio (I:C). That rule says to divide 500 by your total daily dose of insulin and that will give you approximately how many grams of carbs one unit of insulin will cover.
Walsh says that this rule is specific to Humalog and Novolog and that if using Regular insulin then use 450 instead of 500.
This rule does not hold true for me, however. I think that’s due to my low carb way of eating. I use about 27 units of insulin per day. 500/27 = 18.5, so my I:C, according to Walsh should be 1:18.5. My actual I:C is 1:4 in the morning and 1:8 the rest of the day.
I changed to 1:30 and told doc also changed sensivity to 1:50. These are values I use doing MDI. Would rather start here and slowly fine tune. I think it’s better to be conservative at this point. Better to add a little verses going low and trying to get back up. Although perfect is optimal, but hugh is perfect, not me.
That is exactly how my endo told me to approach pumping. That was back in '96 and with his input and John Walsh’s book, I started out safely/conservatively and ramped up the settings to get my bg’s under more ideal control. You’ve got the right idea, IMO.