Training on pump Thursday

[MReinhardt]

We have pump training on Thursday morning. I got the Drs orders from on of the MM reps that does training, and I dont agree with what/how the dr wrote the order.

Sensor stuff I changed. Dr knew about this the last time. I dont think he would care if this was changed again.

However, what I dont agree with is the range that we wants her blood sugars in. Its a much tighter control. I see many more hypos coming on. :(

This what he wrote: Blood glucose range.
12:00 am -6:00am 100-120
6:oo am-9:00 pm 100-100
9:00pm-12:00 am 100-120

Even the Carb exchanged is way off.

Am I off bases, or is this something that is written normally?

[Lee]

We didn't see anything written before pump training...her range hasn't changed, although I expect it to soon, she is still 80 -150...but yes, her carb ratios were very different, and the DEd was right on with those.

[Boo]

We have our ranges on the pump set at 80-120 during the day, and 100-120 at night. I like the fact that it offers tighter control, but YDMV, and you need to go with what works for you. Discuss it with the endo, maybe they can give you a logical explanation of why they made the changes that they did.

[Abby-Dabby-Doo]

Our ratios were much different on the pump verses MDI.
Our range is 150 to 180.
But Abby's 7 (younger than Chell)- and I'm comfortable with her running in the 90's. Chell has some underlying problems with digestion causing lows, correct? If that's the case I'd suggest discussing it with the Endo.

[Judy&Alli]

Michelle,
You are a fighter and you know what is best for Chell. Challenge them tell them what works for her. I'm really glad you are starting training. That is a huge positive and closer to getting Chell feeling better!! Congrats!!:D
Judy

[MReinhardt]

Thank you Lanae, Now you know why I dont like those numbers.:(

[tandjjt]

I'm right there with you. I think the numbers are WAY to tight for pump start. Our endo backed off of everything for the first week and the ideal BG # was set at 150 in the beginning -- after she saw the first week of numbers, then we started making adjustments increasing insulin and really working on getting the BG where we wanted it...... now 5 months later we have the ideal # set at 120...

They gave the reason for backing off a little for pump start as there is a high likelyhood that the insulin will be absorbed differently/better through the infusion site. Even staying at the same exact same levels for insulin ratios is a little "iffy" because it may be utilized much differently.

I would hate for a child to associate their pump start with bad lows... that said, even backing off, during the first week of pumping we had our first and only meter reading of "LO" :eek:

Also, remember you are changing over from Lantus (or whatever long acting you've been used to) to the short acting full time for both bolus and basal. This can make a big difference too as sensitivity to short acting can be much greater than the long acting...

What kind of infusion sets are they starting you on?

[twodoor2]

Elizabeth is only 4 (about to turn 5) and the endo wants her range to be 80 to 120. Sorry, I totally disagree with her. I think those are nutty ranges for a 5 year old. I think an adult who can sense a low may be okay with those ranges, but not me. I prefer 110 to 180, and my endo disagrees. I don't care, I set them to the ranges I think are safe for Elizabeth, and she's doing fine. No hypos.

Maybe because your daughter is older, that's why she gave such tight ranges?? Still, I understand your concern. I also agree that in the beginning, you should not start out on such tight ranges since you're still testing and learning the pump.

[MReinhardt]

No one even told me what infusions sets to start her with, so I personally chose the Silhouette 23 inch length with the 13 mm canula. I thought that was for the best.

Even in the drs notes is states to start the temp basel at 0, until 24 hours after the last dosage of levemeir. That I understand why.

[Abby-Dabby-Doo]

Here's some photos for you...
3 infusion sets by MM
http://quick.holdthatpic.com/images/203573.jpg (http://www.holdthatpic.com/)

Quick set w/ inserter
http://quick.holdthatpic.com/images/203574.jpg (http://www.holdthatpic.com/)

Silhouette w/ inserter
http://quick.holdthatpic.com/images/203575.jpg (http://www.holdthatpic.com/)

[Abby-Dabby-Doo]

Sure T's (alone)
http://quick.holdthatpic.com/images/203576.jpg (http://www.holdthatpic.com/)

All needles up close
http://quick.holdthatpic.com/images/203577.jpg (http://www.holdthatpic.com/)

[MReinhardt]

Lanae to the rescue. You ask questions or make statments. Lanae Provides pictures. THANK YOU.

So, I think we might be able to rename you Lanae911. :D

Those pictures will help in the future.

Well, I know the drs office got my email. I am sure they will reply this afternoon or tomorrow morning. Lanae I am still, breathing.

[MReinhardt]

Well told you I knew they would respond fast. Ok here is their scoop on things.


Hi Michelle! Everything will work out FINE :0) I'd be worried if you weren't anxious and concerned. To answer your questions...

1. Most people require less insulin on the pump than on MDI. I'd rather go easy than bottom her out. (which I totally agree) I also thought you'd cut back on her insulin due to all the lows she was having. (which we did) Anyway, if you think she needs more then you can change it. Just let me know.

2. All the target means is that if she is high when she boluses (using the bolus wizard) the pump will use that target range as how much insulin to give her to get her to that number. Those are pretty standard as far as pumps go. I'd try it and see what happens. Remember...she'll still be wearing the sensor too!

3. You'll be fine (see above)! ( told them the Dr is freaking me out)

4. Call me on Friday to review blood sugars (number is below) and then call the MD on call over the weekend...it'sDr. Eddy (he is an ok, dr dont have too much trust in him as he doent know the values of blood ketones). The exchange number is 800-000-000. We'll talk about calling over the weekend on Friday. Maybe you won't have too.

Talk to you soon and let me know if you have any other questions!

[twodoor2]

2. All the target means is that if she is high when she boluses (using the bolus wizard) the pump will use that target range as how much insulin to give her to get her to that number. Those are pretty standard as far as pumps go. I'd try it and see what happens. Remember...she'll still be wearing the sensor too!
3. You'll be fine (see above)! ( told them the Dr is freaking me out)


She forgot to tell you about the low part of the target, and how pumps use that. If she is below the min target, the pump will subtract insulin as a negative correction to avoid a potential low later on. That is why there is a min and max target. My problem is that if she's 90 at one meal, and it doesn't subtract any insulin, she may inadvertantly go lower at the next.

[MReinhardt]

So Marsha oh wise one, how do I correct that?

[Ali]

Remember the pump is just a tool you can always over ride the suggested action based on what you know is/was/will be going on and then adjust the bolus. I always read through the suggested action, noting IOB etc. and adjust based on what I know. i.e. meal type, activity level, ability to check BS levels over the next few hours, etc. etc. Good Luck. Ali

[twodoor2]

I personally don't care for such a low min target, especially when you're new to the pump. I know many parents here have their children on higher minimum targets, and they wanted me to go on a low target (80). We started our min target at 90 since I didn't know how the pump did it's calcs when we first started. When I realized that was dangerous, within a week, we were at 100, and 110 a few days later. Now I'm much happier, but that's only after I knew she had the correct ISF, I:C ratios, DIA, and other variables.

If she has a tendency to go hypo, I would raise the minimum to at least 110, and then when you get all the variables correct on the pump, maybe lower it back to 100. I don't think the nurse properly understood the fact that the pump does a negative correction when the BG is below the min target, otherwise why didn't she mention it? Or maybe I'm just too anal retentive and I just look too closely at every little detail???:rolleyes: