Transition to Pump

Hi all

As you know I got my pump and did 5 days on saline to get used to the settings, changing sets, etc. (Good way to work yourself in slowly without pressure).

This morning I started on insulin. No more shots! Yay!

My question is about the transition process. I know I have a basal deficit right now I need to catch up on. I previously took 8 units of Levemir in the AM and 8 in the PM. This morning, as directed, I did not take my 8 units. I started on my pump dose of .525 units per hour at 11AM (6 hours ago). That comes to 12.60 a day (a planned decrease of 20% from my MDI dose). My blood sugars are currently running in the mid 200s and so far corrections aren’t doing much to bring it down. I know this is to be expected as I don’t yet have enough basal in my system, but I was wondering how long it takes to stabilize? I was thinking maybe 12 hours? Or is it more like a full 24?

I’m not particularly worried as I understand it’s a process. I was just wondering when I will be at the point that the results I’m seeing are more indicative of how accurate the new pump doses are. I’m also wondering how aggressively I should continue correcting (with my pump or course keeping track of IOB - what a treat that I don’t have to do that myself!). I’ve never had to continue correcting, because in the past one good correction gets me back down.

When I started this summer, I was actually running low. I know when I started, they had me at a higher correction factor than what I am really am – that is probably typical also. You know another possibility could be a bad site. Are you able to call your trainer and ask her?

Thanks, Kelly. I actually gave them all the numbers myself, and the only thing they changed was reduced the basal by 20%. I’m not really too concerned about it yet as it makes sense that it takes time for the basal to catch up which is what the trainer said when she saw my high today. The Clinical Manager is going to call to check in on me so I’ll ask her too. I was just wondering what other people experienced. If you have a bad site does it still show the boluses and basals as “delivered”?

Yes, it will show everything as being delivered. Some sites are really, really bad and your BS will shoot way up - high enough to make you sick. Others are just not good and you might hang in the 200s where you are now. I was told when in doubt, yank it. I guess you were pretty high when you started then? That probably is a big part of then. I took fast acting the morning I started mine to make sure I did not get too high.

I have also been having some insulin problems - with my Apidra. Right before Christmas, I was running in the 200s and could not get it down. I changed several sites and did all kinds of stuff. I did not think it ws the insulin because I was half way thru a vial. As soon as I changed that out, my BS came down fast. Last night, I changed a site & my cartridge. I started going high again so decided to change the insulin out to a new vial and my BS came down. A month or so ago, someone was searching for Apidra problems and landed on my blog for some reason - I never wrote about Apidra problems. I Googled that and found a blog that she was having a problem with Apidra going bad at about 10 days. That is when mine seems to be dying. The 2 vials it happened with had the same lot number so I am anxious to see what happens with this lot.

Oh dear, sorry you are having problems with Apidra. I’ve done fine with the pens, but this is my first time with the vials.

No, I didn’t start out high at all. I woke up at 74, then was 91 before breakfast at 8:30. I did my regular injection for breakfast. I normally do 8 units of LEvemir around 8, but I didn’t do it this morning. The trainer got me started on insulin around 10:30AM and by the time I did a test at 11:30 I was 246. I’d eaten a bit more potatoes than usual with my weekend breakfast but she said she thought it was more from not having my morning basal and it would take awhile to catch up with it in my system which makes sense.

I think I will maybe do my bolus/correction by injection for dinner and if I come down then, I’ll suspect the site.

It’s common for your sugars to be all over the place the first few weeks when you’re starting on your pump. Most pump trainers and clinicians are conservative, and tend to start out with lower I:C ratios, duration of insulin action settings, etc. (It’s better to be “high” than “low”.)

Once you’ve amassed enough data to show trends over a period of time, then you’re levels will be adjusted. Just don’t get discouraged if you see some wide swings in BG levels.

Another thing to check if you are getting high readings, is to disconnect the tubing from your site, and hold the tubing up at eye level and look for air in the line. An air bubble will definately make you go high! If you see a bubble in the line, it’s a matter of either pushing it out (by doing a “prine” while disconnected) or changing the vial and line out completely.

I’ve never heard of Apidra going bad in 10 days, and I’ve been using it in my pump for over 5 years. I’m assuming you’re keeping the Apidra refrigerated after you’ve started using it.

Pumping since 2004…started on a Deltec Cozmo, and went to the Ping when Deltec folded… LOVE the Ping!

Thanks a lot for your response, Joe. I’ve sort of expected it to take awhile to get my doses and blood sugars stable, but I was just concerned because I jumped up to the 200s and couldn’t correct it back down. The trainer said it could be from my skipping my usual Levemir dose this morning, but I figured the hourly basal should have built up by evening.

Actually the Animas staff didn’t set my I:C ratios or duration of insulin, they just accepted the numbers I gave them. The only thing they asked me to adjust was my basal doses which they reduced by 20%. I’m just going to adjust doses myself as needed, like you said, after I start to see patterns.

I decided to take a correction by injection and that finally started to bring my numbers down. I ate and bolused a bit more by injection (counting out my IOB of course). The Clinical Manager called to check up on me (since I declined the daily number monitoring service) and she agreed the corrections I did with the pump should be bringing me down no matter what was causing the highs and recommended I change the site. I’m going to take her and your recommendation and change the site. Can’t hurt. Even though I still have to read the instructions and take a 1/2 hour to do it…lol.

Thanks again.

The problem became very obvious when I removed the set. The canula was bent!

zoe, when i was first diagnosed a few years ago, i used this

and although i’ve discovered over time that my sensitivity factor changes at different times of day

but the numbers from that calculator [actually one like it from a website i can’t find now] helped me get the pump numbers mostly right within a few days. sickness, my period and other medications [antibiotic] mess the numbers up though
although, per my doctors orders, my constant is 1800, not 1500. not a clue why

Hopefully you had a better BS day today! Here is a link with a visual guide. I thought that was better than the instructions (I think you said you were using the Insets!). It only took 29 minutes that way!

Thanks, guys. Yes, I am much better today. My numbers are either in target or a little low and I am going to wait a day or two and then look to reduce my basal a tad if I continue being on the low side.

When the injections started to bring my numbers down which the pump boluses had not, I definitely suspected there was a problem with the site. And it definitely explained it all when I pulled out the set and saw the canula was bent! I have no idea how I did that; maybe pulling the inserter thingie out at an angle instead of straight?

Sounds like you started on the pump right when you were diagnosed, marti? I can’t even imagine learning both things at the same time! I’m used to figuring and adjusting my numbers myself (I just tell the doctor what to write prescriptions for…lol) So now I can focus on learning about the pump. I’m still slogging my way through the 214 page workbook!