Tiny basals on pump & ISF of 400

[kel4han]

Got our Minimed 522 yesterday, pump training next week. I have setup bolus wizard, ISF, ratios, and basals just as examples to learn this pumping stuff. So, how will the pump trainer figure out basals? Maddison is on .5 levemir right now. So, that would be .02 per hour over 24hours. Minimed doses smallest increment at .05. She typically goes up up right when she falls asleep progressively until about 3am or so, then down until 7am when she rises again. No basal needs all day, only at night....so basals pumping would be programmed something like this?.........10pm until 2am .05 then off for a few hours....??? Make sense? I know pump trainers and the CDE is responsible for this initially but I am just wondering if this makes sense? Any other pumpers that have an ISF of a huge number like 400?

[wendyc]

Ours is 200.

Our endo wrote orders as to what the starting basals should be. The trainer had all this stuff when she came to the house. Then we checked in daily and adjusted as needed. We did this over a 2 week period.

[Abby-Dabby-Doo]

They're still messing with our sensitivity. We started at 100, and are currently trying 150. I think it should be 200 or higher.

AS I UNDERSTAND IT, yes you take your total Levemir total and divide it by 24 hours and get your .02. BUT like you said at times your daughter doesn't need insulin, so that increment might raise or lower at different parts of the day instead of being totally equal for every hour of the day. Is that clear as mud?

Yes -to what your saying about basal patterns. They will set different basal patterns for different parts of the day. My daughter gets no insulin from 2pm to 5pm.

[MaggieM]

My ds's ISF 100 during the day and from 9 p.m. - 6 a.m. he is 200. The pump trainer will work it out. Joey started based on 4.5 units of Lantus a day and I believe I have him on a 24 hr. basal dosage of 3.2. I'm still making adjustments. It will change throughout the year with activity and such. Good luck - I'm sure you will figure it out in time. It is a long process though - be prepared.

[selketine]

We have an animas pump which can give .025 basal increments so I haven't had to do this but....

It seems to me you'd have an hour of .05 then an hour off, then an hour on, then an hour off, etc.

The other option might be to use diluted humalog in your pump - diluted half strength (they use a special dilutent - you have to buy it or a compounding pharmacy would mix it for you). Then you could give .025 increments every hour. The pump would be programmed for .05 (the smallest setting) but the insulin is diluted so it is really giving .025. For boluses you would also have to consider that you are giving half strength insulin too.

[sammysmom]

The one thing that amazes me is when you switch to the pump, you actually see how strong that lantus/levemir really was. You might be suprised at how her body reacts to novolog only...her requirments may be more than you think.......having a starting point is a good idea but it never ceases to amaze me how strong one little insulin can be....

shannon

[D-Dad]

I think you will need to dilute the insulin. Even if you go .05 on for an hour and .05 off for an hour - you end up with .6 for the total daily basal and I do not believe it's ideal to go 2 hours off. It will also allow more flex to give more at night to counter her highs. Often when you go on the pump your TDD goes down.

I'd also be a bit weary if the doctor says - "well since she's still producing some of her own insulin, you'll be fine with a few hours off."

[kel4han]

Oh man. I am stressing that even the .05 lowest setting is going to be too much! I am telling you! Her tiny tiny amounts make you believe that she really isnt diabetic! I knew Animas did much smaller dosing, but I really liked Minimed overall the most. Our TDD now is only typically 6.5 units of which 6units is entirely to cover food! Some days with little eating she only takes in about 4 units total :eek: Now I am worrying myself that we should have waited until her needs increased to start pumping. !@$$#
Guess I am just fearing the change, and worsening things.

[D-Dad]

huh. .5 basal with a 6.5 TDD sounds off. Typically basal makes up 30-60% of the TDD. Have you thought about upping the basal and changing your insulin to carb ratio? Our TDD generally ranged from 8 to 10. It's not a big deal to dilute insulin - some pharmacies even do it for you but it easy enough to do it yourself - all you really need is a bottle of saline. you'll be fine. pumping is the way to go.

[Rachel]

We started with only about 10 units for the TDD and often were down to 7 for awhile. I am curious why it would be an issue to have the basal off for more than 2 hours ... we will often turn on a temp basal of a few hours or more when our son's numbers are running low.

I tried to figure things out before the pump start too ... it is nice to have some numbers in your head when they help you get started. But I found our endo had a slightly different take on how to calculate (can't remember the details). So, my advice is to know that you are well informed going in - and it sounds like you are - and just wait to see how your endo team will help solve the problem of the low basal need.

And know whatever you start with, it will change. Part of the fun of pumping. ;)

[selketine]

some pharmacies even do it for you but it easy enough to do it yourself - all you really need is a bottle of saline. you'll be fine. pumping is the way to go.

I would NOT use saline to dilute the insulin - use the dilutent that is sold by the company that makes humalog and if you cannot find a pharmacy to do it then you could be trained by the dr. on how to do it yourself.

Of course they say not to use diluted in a pump - I don't know why exactly. Sometimes they say those things cause it hasn't been tested - perhaps someone here has used diluted in a pump.

Worst case you could continue the levemir shot if the basal thing cannot be worked out. If you dilute the insulin though then problem solved.

The MM pump is great - I know many with little kids are torn cause of the CGMS with it now - yet the basal rate is too high. I know someone here (Amy maybe?) had advice on how to deal with the basal issue.

[D-Dad]

In regards to having no basal for a few hours........ your body always needs some insulin. I remember reading that you should never go more than then two hours with no basal – which makes sense since short acting insulin peaks at 90 minutes and generally done in 3 or so hours. Without the insulin you are apt to go high or if you are honey mooning – you’ll produce your own insulin and sacrifice the beta cells (which may come in handy later). Zero basal for 3 hours would be a no go for me and I’d have to think hard about 3 hours. If it’s a regular thing – it just seems easy enough to dilute a vial of insulin once a month.

[D-Dad]

Got our Minimed 522 yesterday, pump training next week. I have setup bolus wizard, ISF, ratios, and basals just as examples to learn this pumping stuff. So, how will the pump trainer figure out basals? Maddison is on .5 levemir right now. So, that would be .02 per hour over 24hours. Minimed doses smallest increment at .05. She typically goes up up right when she falls asleep progressively until about 3am or so, then down until 7am when she rises again. No basal needs all day, only at night....so basals pumping would be programmed something like this?.........10pm until 2am .05 then off for a few hours....??? Make sense? I know pump trainers and the CDE is responsible for this initially but I am just wondering if this makes sense? Any other pumpers that have an ISF of a huge number like 400?

I would NOT use saline to dilute the insulin - use the dilutent that is sold by the company that makes humalog and if you cannot find a pharmacy to do it then you could be trained by the dr. on how to do it yourself.

Of course they say not to use diluted in a pump - I don't know why exactly. Sometimes they say those things cause it hasn't been tested - perhaps someone here has used diluted in a pump.

Worst case you could continue the levemir shot if the basal thing cannot be worked out. If you dilute the insulin though then problem solved.

The MM pump is great - I know many with little kids are torn cause of the CGMS with it now - yet the basal rate is too high. I know someone here (Amy maybe?) had advice on how to deal with the basal issue.



Ahh - very good to know. You also reminded me of another option - which I would not be a fan of - but still an option. When we where looking at pumps and had to deal with this issue a rep suggested that we put in a basal pattern and then always used the temp basal - so if the she was on an hour of an hour with .05 (or a total of .6) and had the basal reduced by 20% it would give .48 (I'm not sure if the the Minimed would do this but just a thought). After pumping for a bit, I hate the idea of having to set the temp basal every day - and god forbid if you forgot - oh man.

[Rachel]

Ahh - very good to know. You also reminded me of another option - which I would not be a fan of - but still an option. When we where looking at pumps and had to deal with this issue a rep suggested that we put in a basal pattern and then always used the temp basal - so if the she was on an hour of an hour with .05 (or a total of .6) and had the basal reduced by 20% it would give .48 (I'm not sure if the the Minimed would do this but just a thought). After pumping for a bit, I hate the idea of having to set the temp basal every day - and god forbid if you forgot - oh man.

My understanding is that the MM only delivers in .05 increments or greater increments, on the half hour, even when in the temp basal mode. This info was from a previous post awhile ago. I never did confirm this with MM and need to call the help line anyway on something else ... so I'll double check with them.

This is why we have our temp basal setting to be the value, not the %. With such little basal to begin with, I want to know exactly what is going in, without having to do a lot of calculating and rounding.

[Rachel]

My understanding is that the MM only delivers in .05 increments or greater increments, on the half hour, even when in the temp basal mode. This info was from a previous post awhile ago. I never did confirm this with MM and need to call the help line anyway on something else ... so I'll double check with them.


Finally checked with the MM support line on this.

The total basal dose for the hour is divided by 0.05 to determine how many little doses to do, which are then spread out evenly throughout the hour.

So, following this logic, here is what it would look like for some of the small basal settings:

.05 1 dose -- on the hour
.10 2 doses -- on the hour, :30
.15 3 doses -- on the hour, :20, :40
.20 4 doses -- on the hour, :15, :30, :45
.25 5 doses -- on the hour, :12, :24, :36, :48

Why does this matter? Mostly for deciding when/how much/how long to set temp basals. For example, if I turn off (temp 0) the basal at 12:01 for a .05 basal, the whole basal for the hour has already been given so there is really no point. But if I turn it off at 12:01 when there is a .25 for the hour, it can catch all but the first .05, so a full .2 has been turned off, which can make a HUGE difference for us when our son is running low.

[Boo]

Rachel...thanks for posting this. It is good to know. We are only a couple of months into pumping, and my son has much higher basals (he is almost 12 and tall for his age). This will help me to figure out how long to cut his basals, and by what percentage, on those nights following baseball games.

[nebby3]

How old is your child? When my dd started pumping at age 2, they started her off with a correction factor of 500. It quickly went down to 350 but then stayed there for quite some time. Now at age 5 it is 200 most of the day. Your basals calculations seem liek a good starting place to me. I imagine they will change a lot. Pretty much you just have to guess in the beginning and then tweak a lot. Many people find less insulin is needed overall with the pump. It is best to start of conservatively and increase basals.
Good luck

[Momof4gr8kids]

Julia had a dose of 4 units when we started pumping. We have the animas, and that even seemed huge to have a .025. Julia started on 3 units for her total daily basal because we were seeing a lot of lows during the day. It was quite the trick to figure out, but they will be able to help you weather it is alternating, or whatever is needed, and like the others said there is always a way to dilute humalog. I just wanted you to know from one mom that has been there that it will be ok, and the trainers, and your endo will help you figure it out. It will work, and it will be good. Take care, Jamie