Fasting + initial pump settings -- does anyone do this when first using a pump?

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1

I think I may finally be close to using / receiving an insulin pump. And in preparation I just early this morning (2am ish) decided to start using only Humalog to see if I could see basel rate patterns. (Long story, but the nutritionist / CDE I have been seeing all summer won't give me settings in spite of my almost killing myself documenting absolutely everything I have been doing, so I can get just that -- their settings).

So, I ended up thinking hey, I can do this myself, and potentially more accurately for first settings by fasting and watching my cgm and testing, to see how many units per hour or whatever increment did what to my bg tests.

I'm having a great time so far, granted, I am just 11 hours into it. Next would be trying out my historic carb ratios against this. (I might have a different story once I am into this evening's / early tomorrow's wee hours, thinking this is so much fun, granted!)

Has anyone else done this on their own, or is it just me? It seems like a logical way to test things out, sans food so as not to influence the basel settings, first, no?

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All your questions have already been answered by Walsh and Roberts in Pumping Insulin

I’d recommend you get it and read it cover to cover before getting too far along in your own testing program. This book is our pumpers’ bible.

Cheers and good luck, Mike

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Thanks Mike, I have heard of that book. I will purchase en route home today maybe. I am wondering if others here have come up with their own basel rates when first starting pump use?

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I dunno ,but this doesn’t sound like the best idea to me,only because you don’t even know if you’re getting a pump.What if you don’t get approved for one from your current doc/CDE? Plus it sounds like you’d have to do a ton of needle sticks. I’m on a pump and if I had to stick my self every hour that my pump delivers basal insulin and then for correction boluses,and food I would run out of places to stick.I hope you do get approved though, I love my pump and it definitely makes life easier.

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I hope that you will get the pump!

This does not sound like a good way to test your basal rates – nor does it seem like a good way to control your blood sugar. If you ever go more than 4 hours without an injection, you could be facing serious DKA. Are you doing injections every 2 hours or how often? If you ever oversleep and don’t get up to give an injection, you could be in serious trouble. I do not think that this is a good idea and would advise taking your basal insulin until you actually start on the pump.

The best way to test your basal rates is after you have a pump and you can do fasting tests that are described in the book that Mike recommended, Pumping Insulin (it’s really the best!). Given that a pump gives you a very, very small dose of insulin every 5-10 minutes, it is impossible to replicate this with injections.

Keep us posted if you get a pump! Please, please take care of yourself (i.e. take your basal insulin until then)!!

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Thank you!

I am getting a pump, the prescription finally went through; now for the insurance hurdle. Logs sent too; phew.

And interestingly and excitingly (to me) I have stayed totally even. Watching it all unfold via Dex, so I’m keeping a close eye on it. I just want to see the patterns, while fasting (or more accurately, while eating things <3 grams/carb anytime I do eat). A lettuce salad may be my biggest count between today and yesterday, so far. I might skip it. I just want to really watch the basel things. I actually passed this by my endo and he’s cool, even if to other docs I know they’d all look down on me. But I think that learning on my own is really the only / best way to go.

And yes, I was interested and excited to see that while I slept it stayed all even all the time, though I did not sleep for more than 2 hours at a time.

I still can’t believe that no one has done this, here… maybe someone will chime in soon who has and has any tips.

I have a meeting with the pump educator on Saturday, and I know they are all willing to get me the thing asap. I have heard that insurance is easy to get through re pumps, and I have submitted everything. Re the Dexcom, I actually got one from the rep as soon as he had the Rx – I am hoping the same for the [Omnipod] pump, though their rep hasn’t called me still, though they received the Rx/letter of med nec this morning.

Kristin, I am very curious to hear that this does not sound like a good way to test basal rates to you – telll me more? I am tracking when I take how many units of insulin, and jotting down tests or Dex #s at least every half hour. It’s actually a relief after all of my [pointless] carb/insulin/bg logs I’ve done for the nutritionist (who never gave me starting rates). Way easier doing this than all of that was to me.

Yes what I am doing re injections is not perfect, a whole unit coming every… whatever re tests + what I see the data points on Dex doing, rising or falling, tell me to do. But, it’s giving me a clear indication of the hours of day I need / use more to stay even. My range so far has been great (to me) 71-133, just using whole units.

And I’m lucky, needles have never bothered me, so i’m good there. I would likely give it up anyway after a few days if this takes a while to get the thing, but, I wanted to see whatever the pattern indication would show me, sans food events affecting that.

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I guess it’s not dangerous if you are taking an injection every two hours or more often. I just think that you will not get the same picture as you will when a pump is delivering 0.05 units every five minutes. We were able to nail down my basal rates pretty quickly with a some fasting basal tests once I started on the pump. There are formulas to calculate starting rates based on the amount of basal insulin that you took previously.

Plus your body reacts differently when you are fasting for days, I think. The “fasting” basal tests means skipping ONE meal and testing your basal rate. I don’t normally fast all day.

If you are really sure that you will never go more than 3 hours without an injection, then you should be OK, but I think that you would figure things out quickly once you read pumping insulin and start on your pump.

I guess I’m just afraid that you will become exhausted and fall asleep for 6 hours and wake up in DKA. That’s why I would not do this.

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P.S. Good news about the pump!

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I know! Finally, hopefully the insurance hurdle will be easily overcome, versus those docs/nutritionists.

I have a pump adjustment brochure from the top-rated endo department so that’s helpful, yes, talking about fasting only for shorter periods of time. Though I am staying so even, of course it’s attractive.

Even last night, and really as long as I am not active, I stayed all even, all night, sans injections. Night before, getting up at 2am to start this, getting active required insulin, so… also good to know of course.

Then my next needs are of course 9-10a, then oddly late afternoon. Taking Lantus, it peaks in me around 8 hours, so that’s frequent hypo time of day for me, historically.

And yes, I guess I eat very, very few carbs overall anyway, ever, so it’s not all that different for me than usual, this so-called fasting / no-carbing.

Fingers… crossed! Thank you for your information + notes, Kristin. :slight_smile: