I’m sort of new to tudiabetes and haven’t figured out how to navigate all the forums hence I’m adding a discussion.
Just started my Animas Ping last Monday…
Questions:
I’m under the care of an endo nurse practitioner who really seems to know her stuff; yet it’s been one week and I feel like we’re moving too slow; I"m getting pretty crappy numbers and I feel she’s being too cautious in saying I have a 1/33 insulin ratio…I always thought it was more like 1/25 or even less. How long should it take until I"m seeing the 100 plus or minus 10 that is my goal? My basal rate is .250 an hour; is this typical?
I just changed my site and thought I was going to have a cartridge of around 80 units; the pump says I have 43! I know I wasted at least 1 unit in priming (wasn’t paying attention…where did the rest go)?
So, if I run low, can I just change the cartridge and not my site or do I have to change the whole infusion site too?
Any helpful suggestions would be nice; I’m doing okay but tend to stress out a tad. (Doesn’t help that I’ve been forgoing my wine since I got the pump (a week ago)! I am so excited about getting a pump and am not all that patient, and have getting really kind of bummed about still seeing BS in 200s.
I have used the Ping for a little over a year. Which infusion set do you use? I use the inset 30’s and I don’t need to change my set at the same time as my cartridge. I am not sure about the other sets, but if the tubing is separate from the package of the actual inserter (like the 30’s) are, you can change either at any time. Since it’s only been 1 week I wouldn’t get too upset about the slow moving progress! It takes a while to get in the rhythm and really figure out your ratios. Are you new to diabetes? ( I am guessing you are if your ratio is that high). If so, the pump will be awesome because your rates will change. You might go through a few phases where you’re almost starting from scratch with your settings. If your ratios are giving you after eating numbers of over 200 I would say maybe try lowering your ratio a TAD (like by 1 or 2 carbs). Tell your endo you are doing this and talk to him or her about how you don’t think your current ratio is correct. They should support you.
Actually, I’m NOT new to diabetes…just new to the pump. My tubing IS separate so I’m assuming that I can change the cartridge any time. Still can’t figure out how I ended up with half the insulin in the cartridge than I’d planned…unless I was looking at the wrong rubber ring in the cartridge. Oh well, mistakes make for learning!
I’ve been injecting for years…that’s why I’m wondering why the nurse is being so careful. I see her next week and will speak honestly.
I change the cartridges and infusion sets together but I keep them for up to 3.5 days until I use all of the insulin in my cartridge. I haven’t seen any adverse affects.
If you change just the cartridge or the infusion set, always make sure you are connected or disconnected when you are supposed to be!!!
I lose about 10 units priming but it’s still in the tubing so it’s not completely lost. You probably actually lose about 1-2 units. If you go too fast (I prime 1-3 units at a time until it comes out of the needle) you can lose quit a bit of insulin. I don’t know how you went from 80 to 43 except priming too much and not guessing correctly?
If you’re correcting to 100 but are still rising later then maybe your basal need to go up. If it’s rising too much after food, then maybe your ratio needs to be adjusted.
Have you contacted Animas about their new-to-ping support person? It’s free. For a month they can help you figure out your basal and bolus, etc. They might be the solution to your highs.
If you are a veteran diabetic, trust yourself a bit more.
Have you performed any basal testing to determine if .25/hour is truly adequate? Is that the basal rate for all 24 hours, or do you have some variation for dawn phenomenon and the initial hours of sleep?
Getting the basal rates set is the key to successful pumping, IMO.
I would also recommend keeping track of your TDD (total daily dosage), because if you think you should have had 80 units and you only have 43, it has indeed gone somewhere and you should know where. Did you take into account the insulin used to fill the tubing?
Yes, you can change any bit independently of another; cartridge, tubing, and infusion set have “life spans” that are independent of each other.
If you think you should be @ 1:25 ratio, go for it! Test appropriately and make sure you have glucose tabs at hand. One of the great things about the pump is the ability to change what it is doing on the fly, so if you do go low, you can take some glucose tablets and lower or suspend your basal insulin if necessary.
The endo nurse practitioner is there to help you learn to use the pump to manage this chronic condition, but in the end, you get to make the decisions. Use her as a sounding board, not as the one who is in charge.
Let us know how you are progressing. There is also an Animas group on TuDiabetes.
I never thought about the Animas folks as helping to set rates. I feel I should give the endo a bit more time but after that I’m going to start being on my own…
Currently I’m at .250 for all hours…I believe that the next step will be to consider the other rates for different times.
How does one come up with the basal rate? I couldn’t really understand how she came up with it…it appeared that she divided my total daily insulin total and divided it by 24? My issue is that I never used a lot of insulin because, first of all, I’m extremely sensitive to it and can easily hypo, and also, I ate hardly any carbs at all. (Previous to the pump I was using 10 units of lantus at night and an average of 10-15 a day of novolog, if even that.
Having a pump, I would like to increase my carbs (not by tons) but enough to be able to eat a piece of bread once in a while. The other day I risked eating two pieces of bread (never done in years) and I was in the 200s and feeling horrible with blurry eyes…lack of focus.
So, I do wonder if she’s underestimating what I need. Frankly, I’ll be glad to be on my own but at this time I’ve signed a contract that I will not make any basal rate changes for the first week…which it is…
You get to your basal rate by fasting and testing hourly to see what your BG is. Your endo nurse should be able to step you through it. Typically, you want to figure out the overnight rate(s) first. It is easiest since you normally do not eat while sleeping ;), you just have to wake up every hour to test.
After you get through this initial period, you will soon have it all down and working with your pump will become second nature (still a lot of work though!)
I’ve found this article by Gary Scheiner, MS, CDE, published in DiaTribe very helpful in setting basal rates. I’ve been a T1 for 27 years and have yet to encounter a doctor willing to support a diabetic 24/7 during difficult BG control times. I don’t necessarily blame the MDs or their staff; our whole health care system is not set up well for the minute-to-minute care that insulin-dependent diabetics sometimes need.
When I assumed the primary responsibility for my care, it was the best thing for me. I view doctors, nurses, and diabetes educators as necessary experts for consultation. In the end, I make the decision and also accept the consequences. I attend all my diabetic medical appointments, listen to the experts’ recommendations and then keep them apprised of my actions.
As someone else in this thread noted, basal rates are key to good control.
I too use the Ping. I find it takes 20 to 25 units altogether to load the cartridge and prime the tubing. I like the 43 inch tubing. I put in 3 days worth of insulin plus the 25 extra. It’s actually not lost just in the tubing or not counted. My pump can say zero but I actually have about 10 units left.
I agree with the others that getting your basal rates set correctly is the first priority. I haven’t read the Gary Scheiner article but the Ping workbook has excellent info in there on testing basal rates and bolus settings. If you were to do some basal testing this weekend you’d be ahead when you next talk to your endo. On the other hand if you’re partaking in Super Bowl goodies it may not be the best circumstances for a basal test.
Another good reference is Pumping Insulin by John Walsh. I believe the 4th edition is the still the latest.
Thanks! My tubing is 23 inch…I actually had already ordered that book and it should be here tomorrow. Geez, I had no idea that the workbook is so helpful! I will go through that…need a week off just to go through all this stuff.
Actually I won’t be partaking in Superbowl goodies…not that exciting here in Mass.
A lot of times when they start you on the pump, they look at your TDD to calculate your starting basal rate. They will divide the TDD in half & then take another 20-25% off of that. Your current rate works out to 6 units per day so I am not sure how she came up with that.
I started adjusting on my own right away because I knew what my trainer had me on was not going to work. I had done basal testing pre-pump and also took 3 very different doses of Levemir per day so knew one flat rate was not going to work – I was going very low the first day so cut back right away. Just remember, you only want to make small changes and wait 48 hours in between the changes.
As far as the “disappearing” insulin, Animas subtracts about 16 units from what you think you put in. If you fill up the cartridge, it won’t show 200 units but will show 184 units even though you know you filled the cartridge up. I log my insulin when I fill my cartridge so I can remember what I put if I find myself either throwing away too much insulin or running short. I write that number down before I prime the tubing so I know it has nothing to do with priming. If you let your pump run down to zero units, when you pull the cartridge out, you will see that those missing 16 units are still in the cartridge. My guess is that it is a safety feature for the pump.
