First week of pumping not going well

Dick- I know for you this bolus calculation can get you in to trouble. We have discussed it before. I agree in your case this instance is bad. For me if I am going to eat carbs then I need insulin for those carbs! If there is still IOB then I more than likely am still above my target or I still have food digesting- thus the IOB. I can see if your glucose is already low (in which case the pump will consider this) you would not want to give insulin for these carbs as you want them to raise your blood sugar. For me this situation ends up happening very infrequently. If the pump ALWAYS subtracted carb insulin based on IOB 95% of the time it would end up with a blood sugar above my target. So I guess my point is that 5% of the time I would rather have to self adjust than to have to adjust for the 95%

Yes the big boy swung his leverage and used a stupid patent to drive the best pump out of business. Whats next excel cant populate a field - it is ridiculous that anyone can patent the population of a mathmetical expression with the answer. This is where our government in trying to protect us goes overboard. Thjis never should of been patented 2 + 2 = wait next line

4

ok next line bolus =

0.0



Crazy just to ■■■■ people off patents are for new or novel ideas the formulas are from othes and MDI techniques that predate the pump. I wish that cozmo would of fought this further thru the paent courts - seems like a good patent lawyer should of gotten it overruled. When a patent is used to eliminate competition, it is just plain wrong

I really suspect insulin stacking - perhaps too short a duration of insulin

Firstly, dropping on corrections. If he is dropping below target when you correct him, the correction factor is too low (meaning you should be giving LESS insulin for corrections)… sounds like a lot less. Children get less insulin usually overnight for corrections. Some endos give half the correction overnight. Whatever you are giving, reduce it by half (blood sugars of 30 are way too low, too dangerous). You can go up and down from there. If child is dropping after meals, you should be giving less insulin for his meals. Adjust the insulin to carb ratio UP by two increments. If ICR is 1 to 10, go up to 1 to 12. Children have a higher insulin to carb ratio than adults. He could be 1 to 20, or higher, easily. Basals on the pump: Our endo started her on the pump with a flat, lower basal, lower than she had used on Lantus. We then were instructed to do fasting basals for all time periods to get the correct basals for each period. With a pump, you can easily see the body’s basals, which differ at certain time periods of the day. I think we started with 4 time periods (they are different now). We started with 4 basal time periods: basal period 6am thru noon, noon thru 6pm, 6pm thru midnight and midnight through 6am. These generic “time patterns” do not match her individual rhythms. When you basal test you will notice the time his sugar rises, falls, etc. Log it. You will then be able to verify and set his individual pattern. Secondly, endos set the basals lower than normal as a safety feature. You can increase the basals. Basal patterns for children. Children often rise in the early evening 6pm to 11pm (highest basal of day; can be a lot higher); drop 11pm through 2:30 or 3am (watch for lows this time period, often lowest basal of the day), then either flat or they may have Dawn Phenom anywhere from 3:30 to 5am; basals a little higher or normal for the morning/breakfast period until noon. A lot of kids need lower ICR (more insulin) for food eaten at breakfast. Breakfast is a very difficult meal to control. You may have to nix cereal, be careful what food is eating at breakfast and lower the amount of carbs a bit. Keep logging and observing. You will figure it out. But it is a challenge! Then, when you have it all figured out, it changes. Children have growth spurts and their blood sugars are variable. It is a definite roller-coaster. Hang on tight!

kelly - how were air bubbles a pump problem - The only time i have seen air bubbles is when the cartridge wass not filled properly - The animas cartridge is the easiest to fill of any cartridge and almost never gets bubbles. I doubt if it is bubbles with a correction bolus following the initial bolus causing an over correction - really sounds like stacking insulin probably compounded by incorrect factors programmed into pump

Dick, when you have a defective pump, it can cause air bubbles. I had 2 pumps that did it. I know everyone, including Animas, wants to blame the user but that is not always the case. I went thru all the procedures with Animas to make sure I was doing it right. They had me trying all kinds of different things & I even worked with an Animas bubble expert. Animas even watched me fill my cartridge and putting my pump on and agreed I was doing it right. I met someone from Animas in Pittsburgh and sat in the car for several hours after that to get home. About an hour after I got home, the tubing had air in again. It was the pump, not me.

The second pump started making a strange noise when I went to change the cartridge about dinnertime. That night, it got a ton of bubbles in. Animas also replaced that pump, but I had enough by that point and decided to go back to MDI. Pumps can malfunction and cause air problems and that is exactly why I bringing it up here.

It was actually your post in the Animas group that made me realize that the first pump was giving me too much insulin. You posted that the same weekend Animas replaced the first one. One of the things that you mentioned was there was 16 units of insulin left in the cartridge – I almost told you that you were wrong because mine was always bone dry. After I got the new pump, I let it run out deliberately to test it and guess what, you were right!

If he is having sporadic bubbles, that can cause him go to high and then drop low with the corrections. If his pump has a problem like my first one did, he might be getting different amounts of insulin – like .9 units instead of 1 or 1.1 instead of 1 type thing, each time he gets insulin.

One needs to know the situation but making a signigificant difference in Bolus depending upon whether one has a Blood Glucose of 99 (below target) or 101 (above target ) - makes no sense. If I eat at 12:00 noon and take a corection bolus at 3:30, then eat dinner at 5, all of the correction bolus is correcting not taking active calories from current meal and if I dont subtract the IOB in my next bolus for dinner, then I will go low. It seems that it would be nice to factor correction bolus different than carb boluses?

Thanks for the presentation. There are so many things that can be happening but having this info definitely helps. We will work through it with his Endo but it has definitely been a blessing having this group. I really appreciate everyone and their feedback.

I appreciate the help Alan. We are using humolog. Also, trying a different infusion set is definitely something we are willing to try.

Thanks,

Chance

Thank you so much for your reply. I know that we will get through this tuff period. In a bit of good news, I called Animas and we will have a new pump on Tuesday morning. They said that scratches are not covered under warranty but they would make a one time exception for us. I am very pleased that they dis that for us. I will definitely be looking into some of the cases that you recommended.

Thanks for your help,

Chance

I was trained by my CDE, who is a registered Animas trainer. You may want to call Animas and see if you can meet with a trained rep…some even do house-calls.

I was going to take my screen lens off too…and then read somewhere that screen scratches were common and so I decided I’d rather be safe than sorry! But if I hadn’t read that right before…I’m sure I would have taken mine off too! I don’t know how many people take them off/leave them on, but like I said…better safe than sorry!

This is a great observation dickengel.

Chance, do you know what the insulin duration is set to on the pump? You can go in Setup, Advanced, then scroll through the screens until you see one that says Insulin On Board at the top and Duration at the bottom. The number under Duration is telling the pump how long insulin is active in your little guy’s body.

“Free” market capitalism is definitely dog-eat-dog. And they do whatever they can to survive. And some of them make it and some of them don’t. The consumer is NOT the most important part of the equation!

Chance - I recently had real bad experiences with Humalog - Its duration of action is very long and its potency degrades after about 40 to 48 hours, leading to erratic results sometimes too weak sometimes too strong. I have switched to Novolog which is the only insulin rated for 6 days in a pump by the FDA - Humalog is only rated for 48 hours and my studies with the cgm indicate closer to 40 hours. The other interesting thing is that the peak action is later with the humalog than with Novolog - So in my humble opinion, I really thing that insulin stacking is the issue - you probably have three or 4 hrs programmed in your pump for duration and 5 or 5 1/2 would be more apropriate. So the pump thinks that most of the insulin is gone when you give a correction and then you have both the initial bolus and the correcttion bolus working simultaneously - thus the unexplained lows…

Good Luck sorting this out and keep us posted as to how you make out with it

After scraping my wife off the sidewalk or other places after unexpected lows, i would rather adjust for a high than have an unexplained low - maybe the artificial pancreas will be smart enough to know the difference and this all goes away meanwhile e all need to be aware that the insulin on board needs to be considered when doing a bolus and should neither alwayus nor never be subtracted - each situation needs to be considered - in particular is this iob from a meal bolus or from a correction bolus.

Chance,
Let me jump in with my two cents worth:

  1. Read about combo boluses - spread the insulin out over time. For example, a sausage biscuit is 50% now on slow and 50% over 1.5 hours.
  2. Read about changing the “Check BG” from the default 2 hours to 3 hours.
  3. Check www.galls.com for a “lens polish” for emergency warning lights use by volunteer EMS and Fire staff. It gets scratches out of Lexan, etc. Then follow the screen protector ideas from others.
  4. As others have said, call Animas Tech support and get the contact info for the Animas Clinical Manager in your neighborhood.
  5. Do you think his endo will go for a CGM? If so, Dexcom is the way to go. Read about it. It has a much better sensor (wire vs canula) compared to Medtronic. I had 5 of 5 Medtronic sensors fail on start-up because they filled with blood. None of my Dexcom Sensors have failed on start-up and those that failed later were replaced when I called Dexcom support.
    Jay

Combo boluses are great, but it’s important to remember we are all different and you need to find the formula that works for you. For me I use 60 now and 50% spread over 4.5 hours. I came to this formula for higher carb and high fat meals such as pizza after trial and error to see what worked to keep my blooc sugar in target. But I think the OP has more basic problems to stabilize before trying combo boluses which are more of a fine-tuning.

Jan - Correction facror being too low may only be one of several possibilities. All the factors being right are important including:

  1. is the Basal rate close?
  2. Is the Insulin to carb ratio right?
  3. is the duration of insulin right (frequently set too low for most people by trainers
  4. ensure that the infusion set is OK (does not sound like this is the issue)
  5. How long has insulin been in cartridge (Humalog is ionly approved for 48 hrs - I find it is only good for 40 hours)

If the correction is taken too soon after the initial dose and there i s more insulin on board than expected, it is a guaranteed low shortly thereafter and the low is likely to perservere for a while, creat aver treating followed by a high and guess what another correction and the roller coaster never ends. It is hard to be patient in these matters but better to stay a little high for another hour or two than risk the lows

The other thing I’m seeing here is that it’s very possible w/ 032810 dx that “the honeymoon is over” which perhaps may have prompted some of the instability in the numbers that made them think the pump might help? I suspect with a child one wouldn’t necessarily change things radically perhaps as often as someone who was older and duller like me so the pump settings may have been extrapolated form the old insulin dose which, in turn was calculated out of the gate for someone who was smaller, since a 3 year old would have grown a bunch since dx and also dealing with losing whatever “home grown” insulin they’d been cooking up. The BG isn’t totally uncontrolled since it responds but I am thinking the basal might benefit from a close look, like maybe increase basal for one period, a good time of day when you can observe him closely for a few hours and try a small, incremental adjustment up in the basal to get things more stable? Going into meals closer to your goal might, in turn, prevent so much of the doses being for correcting the off numbers so you can get the carb/insulin ratio evaluated too? I have a MM pump that keeps track of IOB w/ the Wizard and sort of take it for granted but I’m not sure how to work around that to cut CB if you are repeatedly having crashes after correcting but there must be some way to trim the boluses down a bit?

If the CB are bringing it down, even too much, I would think that would remove the sets not working from the suspects/

I can only imagine how challenging this situation would be in terms of diabetes management and how tortuous it would be as a parent. I hope that Chance can get it figured out!!

Chance, from reading message boards for years, I have seen some pretty tough pump start ups with children. Sounds like you are willing to stick it out until you get it all figured out though. They do sell screen covers that may be better than what it on the pump screen when they ship it. You can buy them or order online, there are different brands. We use them on our phones, and also use them on the Dexcom screen. We used them on the Cozmo pump, but now using the Omnipod, and the screen is flexible so it won’t work. That screen is replaceable so it is not a worry anyway. I knew that Animas replaces pumps because of bad scratches early on for little ones, because I have seen it posted before.
You should be logging everything and faxing to the endo, who should be able to help get things changed and working well for you. It sounds to me like there is a lot of tweaking to do. Keep us posted and good luck. Try not to worry too much about the highs, but I agree with half corrections at night and checking every few hours. That is pretty standard with pump starts anyway.