Fess up! - How many take in account insulin duration, peak action, etc?

[StillMamamia]

I didn't (out of pure ignorance), until recently....and it's helping.

For now, I have to write down the times when it starts working, when it peaks, and when it 'ends'...and I even set a timer (at home only) to help me out.

I never did it before...I would just correct with the scale I was given at the hospital...but now I think when did I gave the last bolus, etc etc and adjust correction or meal bolus accordingly.

Have you always done this or not? Am I the only idiot on board??:(

[Charmed7]

I don't do it.

[twodoor2]

Do I have to tell you that I do - ;) That's all I write about on this board!

[Kaylee's Mommy]

I do... because Kaylee is so insulin sensitive, if I don't take those things into consideration, then she will definitely be low..

[Nancy in VA]

I do it more on the pump, obviously, than I did on shots, but we did take it into account.

We spent a lot of time trying to find the DIA while on shots. We thought we had it pinned down and then when we went on the pump, that changed. Turns out a lot of it was affected by her varying needs of insulin at different times of day.

We had already been using variable ISFs when correcting on shots, but our big challenge was that if she was high between meals, we couldn't correct until she was over 300 because the dose was so small that we couldn't draw it effectively into a syringe.

We are a lot more accurate all around now.

[Lee]

Now that we are pumping - I think about it all the time - but it helps to see the number! On MDI, we did, but not near as much!

[frizzyrazzy]

I always did on mdi - but then I always log everything, so I could just look back at the log and say "ok he got a shot at 2pm, and now it's 4 and so I know he still has about x units left" But now with the pump I don't have to do that anymore! woot! I love the pump for this more than anything.

[miss_behave]

I don't think anymore. My pump does :o But seriously, I look at the IOB and the other calculations on the pump and thats it.

[StillMamamia]

I always did on mdi - but then I always log everything, so I could just look back at the log and say "ok he got a shot at 2pm, and now it's 4 and so I know he still has about x units left" But now with the pump I don't have to do that anymore! woot! I love the pump for this more than anything.


We're also on the pump, but are so far behind on using all the handy features, it's silly....we're still trying to get a good grip on combo bolus...it's embarrassing.
At our endo appt next week, I'm asking for a pump rep to come over to Lux and do a one-on-one presentation on all these features. I hope it works out.
(no, there was never a pump rep with us before...it's always the nurses who show us things)

[miss_behave]

We're also on the pump, but are so far behind on using all the handy features, it's silly....we're still trying to get a good grip on combo bolus...it's embarrassing.
At our endo appt next week, I'm asking for a pump rep to come over to Lux and do a one-on-one presentation on all these features. I hope it works out.
(no, there was never a pump rep with us before...it's always the nurses who show us things)

Do you use the bolus wizard on the pump? You have all your settings programmed and it does the calculations for you. Its one of my favourite things about the pump.

[Emma'sDad]

I don't use charts or graphs or stuff, but we give the injection, test exactly.. (well, give or take 5 to 10 minutes), after the injection to judge if there is a need for a snack and then 2 hours later it's assumed gone and ready for the next meal.

I'm all for the pump, but that's one of my concerns about it. "People" say that it liberates their kids, if they want a candy in the middle of the afternoon, they bolus for it. That's great and all, but that bolus is the same insulin that we give MDI. What happens at supper and they're a bit high? Do you compensate for being high even though you bolused for something an hour before?

[miss_behave]

I'm all for the pump, but that's one of my concerns about it. "People" say that it liberates their kids, if they want a candy in the middle of the afternoon, they bolus for it. That's great and all, but that bolus is the same insulin that we give MDI. What happens at supper and they're a bit high? Do you compensate for being high even though you bolused for something an hour before?

Thats whats great about the pump. It takes into account insulin on board (IOB) and subtracts it from your next bolus.

[Lee]

I don't use charts or graphs or stuff, but we give the injection, test exactly.. (well, give or take 5 to 10 minutes), after the injection to judge if there is a need for a snack and then 2 hours later it's assumed gone and ready for the next meal.

I'm all for the pump, but that's one of my concerns about it. "People" say that it liberates their kids, if they want a candy in the middle of the afternoon, they bolus for it. That's great and all, but that bolus is the same insulin that we give MDI. What happens at supper and they're a bit high? Do you compensate for being high even though you bolused for something an hour before?

Actually, it takes IOB into account in that case. So, she had a snack, and is 180 one hour later and it is supper time. We plug in her 180, and then her carbs. It doesn't correct down to under 150 - because it knows that there is still .76 (random #) of active insulin in her and that her sensitivity rate is 48...so that would put her in range.

[twodoor2]

I'm all for the pump, but that's one of my concerns about it. "People" say that it liberates their kids, if they want a candy in the middle of the afternoon, they bolus for it. That's great and all, but that bolus is the same insulin that we give MDI. What happens at supper and they're a bit high? Do you compensate for being high even though you bolused for something an hour before?

You also have to remember that the pump is only as good as your settings are. If you bolus every other minute (like the pump companies would have you believe is so easy to do:rolleyes:), you're either going to end up with inadvertant insulin stacking because larger boluses in the system last longer (it's part surface area effect as well), or highs because you're constantly feeding. It's problematic because the insulin needs a specific time to do it's job, and that time period is usually at least 4 hours, and hopefully you're in range by 2 hours. It would be nice to have ultra fast-acting insulins, which drug companies are currently working on since they realize the need for this. If her DIA was truly 3 hours, I could more comfortably give snacks. The DIA on the pump is not necessarily the DIA reflecting what the body truly has. Elizabeth has an average DIA of 4.5 hours. I could set her DIA on the pump lower, but that would cause insulin stacking, and if I set it too high, that would result in highs. She actually has 4 different DIA's based on the size of the bolus, but the average is 4.5 hours.

Yesterday for example, I gave Elizabeth a mid afternoon snack of 21 carbs (it was a correct carb amount and a low GI food). She already was 2 hours into her DIA from her last bolus, and was 190. I knew by dinnertime, that she would definitely be in range, but she wanted a snack. I give her a snack and 1 hour later, she's 297, so this corrupted what would have been a good BG at that time. She was well into range by dinner time, but snacks on top of snacks do affect blood sugar. Spacing doses is still important on the pump as well as MDI. Yes, the pump knows to subtract IOB, but that doesn't mean you're going not going to go too low or high as a result of constantly dosing. Therefore, I usually wait after every DIA period to give meals, except at bedtime snacktime (which I have a special dinnertime bolus for to avoid high spikes). This results in BG's that are in the 100's at least 75% of the day. If I gave snacks, this would definitely result in higher BG's and/or inadvertant stacking for her.

[momtojess]

When we were on MDI & th 1st pump that didnt calculate iob, dia, etc, I would think about the IOB, etc but didnt really have a formula for it. Now we have the pump that does it for us, we just look at the suggested bolus to make sure it makes sense. I do go back and look at stuff about once a month to make sure none of our settings seem off.

[hawkeyegirl]

One of the first books I read after diagnosis was "Think Like a Pancreas." In there, he gives a chart that tells you approximately what percentage of insulin is used up after 1 hour, 2 hours, 3 hours, etc. I've always kept that in the back of my head when deciding whether to give a snack, correct, etc. Now that we're on the pump, it does the calculation for us, but I also still think about whether I want to give a snack based on a 2 hour number.

Don't feel bad. There's so much to learn with this disease.

[valerie k]

before pump, almost never... now, that pump is so much smarter then me...an it thinks about the things I cant remember to. thank God.

[Christopher]

Interesting thread, nice job Paula. :cwds:

I mentally think about IOB but do not use a formula. She is on MDI, but if I understand the pump method, it takes the amount of insulin last given and the time and "calculates" how much insulin should be on board. But since the rate the insulin is working is something that I assume changes often, and there is no way for the pump to determine how much is actually active in the body, I would think that you could over or under bolus just as easily as you could on MDI. Maybe I am just sleep deprived and not thinking clearly....:rolleyes:

[Jacob'sDad]

Do I have to tell you that I do - ;) That's all I write about on this board!


People, if you don't get the DIA (duration of insulin action) right, you'll be fighting to get your I:C's and ISF's to work for you. It will be a constant battle you WILL NOT WIN! You have to know how much insulin is still working in order to make the right corrections and the right meal boluses. Please read through past topics on the subject if you want more info. Search for posts by twodoor2 and you'll find more info than you'll know what to do with.:eek:

[clb1968]

I almost never thought of these things. I did not learn them from any of the doctors .
I did a study about 2 years ago, that brought it to my attention and I thought about it some when on MDI and now with the pump , it helps me to remember to think out more when dosing for snacks and stuff.

[twodoor2]

Interesting thread, nice job Paula. :cwds:

I mentally think about IOB but do not use a formula. She is on MDI, but if I understand the pump method, it takes the amount of insulin last given and the time and "calculates" how much insulin should be on board. But since the rate the insulin is working is something that I assume changes often, and there is no way for the pump to determine how much is actually active in the body, I would think that you could over or under bolus just as easily as you could on MDI. Maybe I am just sleep deprived and not thinking clearly....:rolleyes:

That is true, there is no way for the pump to tell you exactly HOW much bolus is on board; however, the pump charts for the Animas and Paradigm are a very good estimation, and are based on studies and scientific information researched by PhD's and people that work closely with the manufacturers of insulin. These DIA charts really give the best "estimation" you can find. . . otherwise, you're sort of flying blind when taking IOB into consideration. Even IOB charts in books are not as accurate.

Now one of the things I've been hoping that the next generations of smart pumps do is variable DIA's based on size of the bolus. The DIA is not always a fixed set time - if you're giving .3 IU of insulin and 2 IU of insulin, which one do you think is going to linger around longer?

My pump trainer totally agreed with me on the variable DIA issue and she hopes that smart pumps will eventually take that into consideration.

[StillMamamia]

People, if you don't get the DIA (duration of insulin action) right, you'll be fighting to get your I:C's and ISF's to work for you. It will be a constant battle you WILL NOT WIN! You have to know how much insulin is still working in order to make the right corrections and the right meal boluses. Please read through past topics on the subject if you want more info. Search for posts by twodoor2 and you'll find more info than you'll know what to do with.:eek:


Guess it's a 'YES' for you too...:D

[Ella's mom]

While Ella was on MDI I would take insulin duration into account but not insulin on board. I would hold Ella off from any carbs until her duration of her last shot was "done" with. The freeing of pumping was the IOB and letting her eat carbs sooner than I would let her when she was on MDI.

Lots of things to think about and when one thing is off the rest is off as well:rolleyes:

[wilf]

Interesting thread, nice job Paula. :cwds:

I mentally think about IOB but do not use a formula. She is on MDI, but if I understand the pump method, it takes the amount of insulin last given and the time and "calculates" how much insulin should be on board. But since the rate the insulin is working is something that I assume changes often, and there is no way for the pump to determine how much is actually active in the body, I would think that you could over or under bolus just as easily as you could on MDI. Maybe I am just sleep deprived and not thinking clearly....:rolleyes:

I'm so experiment-oriented that I actually tested DD to see how long the Novolog, Regular and NPH last in her system, and calculated how much of the insulin was used every hour after injection.

For DD for Novolog it's typically:
- after 1 hour 25%
- after 2 hours 60%
- after 3 hours 85%
- after 4 hours 95%
- after 5 hours 100%

Obviously this will vary for others. It even varies for DD - insulin is used faster when she's warm or exercising.

I think the pump may give you an illusion of knowing how much insulin is still working, but unless you've dug deep and tested to see if the pump's settings are applicable to your child then that's all it is - an illusion.

I prefer the honest toil of doing the mental gymnastics myself, rather than relying on a piece of silicon.. ;)

With our 4 insulins we almost always have overlapping effects - which may be one reason why we've never seen ketones.

[Gwyn]

Yep, we use these things.

We do a lot of testing too, to get things worked out. I use peak action especially to judge how well a correction is working or when I have to do a wild guesstimate. Knowing how the insulin usually works is really helpful in those situations.

However, we often avoid iob calculations by spacing out mealtimes. It's not always possible, but works pretty well for us. (Except for tonight of course when I overcorrected)

[twodoor2]

For DD for Novolog it's typically:
- after 1 hour 25%
- after 2 hours 60%
- after 3 hours 85%
- after 4 hours 95%
- after 5 hours 100%


Well, at least your experiment shows this is a curvelinear decay of insulin, rather than a linear decay.;)

The thing I really like about the pump charts is that it also shows curvelinear decay, but it cuts the time intervals into smaller pieces, whereas you have your percentages changing by the hour. Elizabeth will not have 25% of her original bolus in her for that whole last hour, it decreases that whole last hour, and when you're particularly insulin sensitive, the smaller time increments make a difference.

[StillMamamia]

Well, at least your experiment shows this is a curvelinear decay of insulin, rather than a linear decay.;)

The thing I really like about the pump charts is that it also shows curvelinear decay, but it cuts the time intervals into smaller pieces, whereas you have your percentages changing by the hour. Elizabeth will not have 25% of her original bolus in her for that whole last hour, it decreases that whole last hour, and when you're particularly insulin sensitive, the smaller time increments make a difference.


Ahem.....am I the only one feeling really stupid here ?:( ***bowing down in awe to Marsha and Wilf***
One day......I think I can, I think I can...

[ScottB]

We don't simply because Justin is such a spur of the moment teen, it's almost impossible to predict insulin duration and peak action. He can be flopped on the couch one minute and playing hard with his brother the next and then sitting at his computer with his stereo cranked a while later and not always in that order which is why he always has juice and or glucose tabs handy. Yeah teens are fun.:)

[lil'Man'sMom]

Ahem.....am I the only one feeling really stupid here ?:( ***bowing down in awe to Marsha and Wilf***
One day......I think I can, I think I can...

Ditto :eek:!

[mjtjmcouch]

Yes and no. He is on such low doses and only two shots a day, it's easy to remember when and how much he got and then if he's low or high I figure the insulin's peaking or waning as the case may be. Wow, that's as clear as mud. ok, I'll stop now.:confused:

[mjtjmcouch]

Ok, after actually reading all the posts I realize I obviously have so much to learn. I really feel that I know less than 1/8 of 1% of what I need to know about this disease. Does this get easier? does it just click one day and you say, "Oh, I get it now"? Can you all please come to my house for a week and be Super Nanny for Parents of Children with type 1?

[liasmommy2000]

Ok, after actually reading all the posts I realize I obviously have so much to learn. I really feel that I know less than 1/8 of 1% of what I need to know about this disease. Does this get easier? does it just click one day and you say, "Oh, I get it now"? Can you all please come to my house for a week and be Super Nanny for Parents of Children with type 1?

We've been at this 2 1/2 years and I have NO clue about most of what is being talked about here. I understand IOB and why it's important but trying to figure it out for Lia is way beyond me. But I still get totally confused every time I try to figure out carb factors. But then I had to take dummy math in H.S. and failed my second year of intro to algebra. Never did manage to to finish any math course in college, had to drop them as I was so lost. Poor Lia had to get D and have me for a mom!

ETA-at one point in my life I think I may have been able to muddle through it at least a little better. But I'm going on almost nine years of less than six hours of sleep a night and I'm a person that needs at least eight to truly function. I have seen my ability to concentrate decline greatly in the last five years. Just when I was getting my act together after being thrown for a loop by mixing motherhood and work, D came into our life. Hopefully one day I manage to get things back under control!

[twodoor2]

Ladies!! This is NOT complicated math at all, and I apologize if I'm making this sound like rocket science, this doesn't even have any algebra, it's basic arithmetic!!

If you cannot figure out IOB like the pumps do, I've given you (and with the help of Jacob'sDad) some great tools to do so. You can use the IOB charts that I've been publishing over and over on this board. I don't want to hijack this thread, but I recently started this post (see link), and it shows and explains some IOB charts that you can use.

http://forums.childrenwithdiabetes.com/showthread.php?t=15364&highlight=extrapolating

If you have questions about it, please reply to the above thread, and I will try to answer them. This is really easy to do. I think many people don't do well in math in school, and anything to do with math may give them a bad taste in their mouth. However, if you can eyeball a chart, use a calculator, and figure out the hours and minutes from the last dose, that's all there is to figuring out IOB. It's very easy. Please don't be intimidated by it.

. . . and for the anonymous person who gave me negative feedback about this post, I'm not trying to be rude by these comments. People are complaining they don't understand and they don't like math. These charts took a lot of work to come by, and I'm trying to impart helpful information so that people on MDI can do calculations like a $6,000 pump. I could choose to keep this information to myself, but it is my great desire to help people from what I've learned, and I would hope everyone would want to do the same in return. This is the great thing about this forum.

[Heather(CA)]

I didn't (out of pure ignorance), until recently....and it's helping.

For now, I have to write down the times when it starts working, when it peaks, and when it 'ends'...and I even set a timer (at home only) to help me out.

I never did it before...I would just correct with the scale I was given at the hospital...but now I think when did I gave the last bolus, etc etc and adjust correction or meal bolus accordingly.

Have you always done this or not? Am I the only idiot on board??:(

I'm not as technical about it as you seem to be being (Knowing the exact peak)...But, if Seth eats again within 3 hours of his last shot..I don't give any correction, I just give insullin for what he ate. Nor would I give any correction unless it had been more than 3 hours since his last shot snack or not. I rarely give corrections other than at meals:D

[caspi]

I'm not as technical about it as you seem to be being (Knowing the exact peak)...But, if Seth eats again within 3 hours of his last shot..I don't give any correction, I just give insullin for what he ate. Nor would I give any correction unless it had been more than 3 hours since his last shot snack or not. I rarely give corrections other than at meals:D

Heather, we do the same exact thing. :D

[Gaia]

One of the first books I read after diagnosis was "Think Like a Pancreas." In there, he gives a chart that tells you approximately what percentage of insulin is used up after 1 hour, 2 hours, 3 hours, etc. I've always kept that in the back of my head when deciding whether to give a snack, correct, etc. Now that we're on the pump, it does the calculation for us, but I also still think about whether I want to give a snack based on a 2 hour number.

Don't feel bad. There's so much to learn with this disease.

People, if you don't get the DIA (duration of insulin action) right, you'll be fighting to get your I:C's and ISF's to work for you. It will be a constant battle you WILL NOT WIN! You have to know how much insulin is still working in order to make the right corrections and the right meal boluses. Please read through past topics on the subject if you want more info. Search for posts by twodoor2 and you'll find more info than you'll know what to do with.:eek:

Ok I am feeling way off here now. I never thought to calculate his IOB. Was never taught to and wouldnt have a clue where to start. We simply do what the doctor tell us. Take bg before meals, he eats & then gives insulin based on carbs eaten. They said he can do this while hes honeymooning but will eventually have to bolus before meals.......I REALLY need to get that book!!!!!! :(

[Gaia]

Ok, after actually reading all the posts I realize I obviously have so much to learn. I really feel that I know less than 1/8 of 1% of what I need to know about this disease. Does this get easier? does it just click one day and you say, "Oh, I get it now"? Can you all please come to my house for a week and be Super Nanny for Parents of Children with type 1?

Sign me up for this too!!!!

twodoor, I am going to that thread right now. I know I have more to learn and Im open to all teaching! I love learning things. As for someone giving you negative rep........pllllfffffftttttt on them lol.......just ignore it. I would.