Today Brennen is officially a pumper!!! We are all so excited! However, we are not out of the woods yet. This whole pumping thing may not work out. We are going to be crossing our fingers and try to stay optimistic about it. I think if everything works out, this is going to be an amazing new tool in helping us manage Brennenâs diabetes.
It was really strange to go to pump training and hear the pump training nurse tell us that she just wasnât sure what was going to happen on the pump for us. This is the situation: Brennen was just diagnosed 2 months ago with Type 1 Diabetes. We are still in the âhoneymoonâ phase. He is insulin sensitive. He is only getting 1/2 unit of short term insulin at each meal and 1 unit of long acting insulin daily at this point. We had not been given an insulin to carb ratio before. We were just told to have him eat normal meals and if doing exercise to let him have a 15 carb snack. We have never given him a correction bolus when his sugar is high, because at his age the endo wanted to be cautious and avoid lows if possible and he has always come down after a couple of mealtime shots of insulin.
So, to make a long story short he was on a total of 2 1/2 units of insulin daily. The smallest basal rate the pump delivers is 0.05u and his calculated to 0.04u which would really need to be set much lower. So, we are trying to give him his meal time boluses and correction boluses through the pump while keeping the basal rate suspended. (We have to re-susspend every 12 hours.) Also, they arenât sure if the cannula is going to occlude or stay patent due to the fact that insulin will not be flowing continuously. No one knows. We were told that this is the first time our situation has come up. It is like Brennen is a little guinea pig. Our first reading on the pump was high, but after a correction bolus, it came back down close to range, so at this point it is still working. We are just going to have to keep praying and keep our fingers crossed that this is going to work!
I hope all goes well for you and your family. You seem to be diligent and intelligent and loving parents, I am sure one day he will thank you for all the hard work and sleepless nights you have all had. My hats off to youâŚyou are amazing! Keep up the good work!
Why not trying the 0.05u setting with close monitoring for 24 hours (testing every hour or getting a rental CGMS from the endo)?
The way I have understood your strategy you will cover 12 hours with the bolus insulin only. I think this will stimulate the beta cells in an on and off mode. Likely this will lead to strange effects because the beta cells are used to contantly release some insulin to compensate the output from the liver. Now there will be times where their output is benefitial and times where in combination with the basal it is not so benefitial. There is a risk that the influences on the glucose control will be hard to comprehend for you. What is the cause what the effect? Have the beta cells overshooted in their reaction causing a low? Did the a site occlusion occur causing a high? Is the high from the missing basal? How to skip a meal when he is sick? Do not get me wrong: if your strategy works everything is fine. It just seems odd to not try the easier way first.
Holger,
I am new to this and this is all really confusing, but our strategey is basically to not cover him with a basal rate through the pump at all. Instead we are continuing to give him his 1 unit of Levamir each day. The every 12 hours comes into play because that is the longest amount of time the omnipod will allow you to suspend the basal rate. Therefore, we are being forced to suspend it every 12 hours so that it is suspended continually. I asked about trying the .05u setting and was told that with his pre pump readings and dosages that it would be scary and dangerous to even try him at a .025u rate which is what the Ping offers and happens to be the smallest increment offered by any pump. It has only been 24 hours since we started pumping, but so far our strategy seems to be working. I think we may need to adjust his insulin to carb ratio a little, but other than that, so far so good. Still keeping our fingers crossed!
Can you set the rate to .05U and then use a âtemporary partial basalâ setting on the pump to cut it further? The MM 722 pumps allow you to set a temporary basal for a period of time up to 24 hours, so you could set it all day? Iâm not quite sure how reliable the dosing is at such small levels but I have had really good luck both turning it down (from 0% to 85% to exercise) and up (200% when rxâed steroids!). Two of my high school friends have a 3 year old w/ a MM523 that seems to work pretty well for them?
We are going to be crossing our fingers and try to stay optimistic about it. I think if everything works out, this is going to be an amazing new tool in helping us manage Brennenâs diabetes.