Pump help needed. Active Insulin, what to do?

[SamsMom]

Okay, you pump pros out there can you help a novice?

Sam was 263 at 4:30 this afternoon (pump site came out at school, long story.)

He had an 84gram chocolate milk. The pump said take a total of 2.6 units for the correction and carbs.

Rechecked at 6:15 and he was 220. Pump said .9 Active insulin still on board.

Then at 6:30, pump said .7 Active insulin still on board.

Did I miss something? I thought the bolus would do the trick even with the carb drink and put him back in range after about an hour. I know Novolog can take a while to peak so was it just too soon to check?

Should he have not had the chocolate milk until his numbers got back within range?

Should I expect him to fall back into range at the 2 hour mark? 3 hour mark?

We are going to be eating dinner soon and now I am nervous about giving him even more insulin on top of what is still on board.

Advice appreciated. Thanks!!!

[TripleThreat]

dont worry about supper on minimed pump takes into consideration active insulin and his number is dropping

[Abby-Dabby-Doo]

First off if he took the insulin for the chocolate milk, there is no reason why he shouldn't have had it. If it was a wonderful understanding world, you should be able to dose and stay in range. But we all know that won't happen. It sounds like he was a little high from the site coming out, and not receiving his basal. He came home and corrected and had a little milk. No harm done, in my personal opinion.
Everyone differs on how quickly they will come down, it has a lot to do with how long the insulin was in before the milk also. Remember that insulin can take up to 30 minutes just to start working. My daughter takes about 2 1/2 hours to be in range.
If you are high or above range the pump takes active insulin into consideration. That way stacking cannot occur. If you are in range or low the pump expects you to take active insulin on board into consideration.
I'd say eat dinner, you should be fine.

[SamsMom]

Thanks, so I had him test too soon it sounds like? I don't know why I thought ALL of the insulin would go in immediately. It surprised me that there was still .9 on board after over an hour. Why haven't I ever noticed that before?! :confused:

[Abby-Dabby-Doo]

That's one of things you have or will figure out very soon... insulin duration (how long the pump considers insulin still working).
If I'm not mistaken, the pump factory will send them out set at 6 hours. We've adjusted our setting of insulin duration to 4 hours. Everyone differs. Do you know how long his insulin lasts him?

[clb1968]

Insulin duration varies for each diabetic, I have my pump set at 4 hours.
So if I check 2 hours after eating, it will show the insulin still on board.
Depending on what your son' s it set at it should show different amounts till you get to the point that it is supposed to be all gone, then it will read 000.

[SamsMom]

No, I don't know how long the insulin lasts for him but I will find out. He is so ready for a cgm. I would like to know myself what his bg is doing between basals, after meals, during sports, the middle of the night.

I am going to have him test again. I am keeping my fingers crossed he came down. Thanks for the help!

[clb1968]

No, I don't know how long the insulin lasts for him but I will find out. He is so ready for a cgm. I would like to know myself what his bg is doing between basals, after meals, during sports, the middle of the night.

I am going to have him test again. I am keeping my fingers crossed he came down. Thanks for the help!


On the MM, you can look under review Wizard settings to see what the
Active Insulin Time is. Just go to Bolus, then bolus wizard setup, then review settings, scroll thru to the end of the settings and you will see the active time. That will give you a starting point.


PS What area of Texas are you in? I am in Ft Worth.

[SamsMom]

Hi Charlotte, we are in Georgetown, north of Austin. We love it here, still a small town, but not too small. We lived in Colleyville and Plano some years ago.

YAY!!! Sam tested and was 138--yippee. I guess I was impatient and did not allow Novolog enough time to do the trick.

[SamsMom]

40 minutes later he was at 77 with no more active insulin. I had him eat dinner and bolus the carbs accordingingly but now I am concerned he will go low. We will see what the bedtime check reveals.

[Boo]

Thanks, so I had him test too soon it sounds like? I don't know why I thought ALL of the insulin would go in immediately. It surprised me that there was still .9 on board after over an hour. Why haven't I ever noticed that before?! :confused:

All of the insulin does go in immediately (unless you do a dual wave or square wave bolus). The "active insulin" has already been delivered into the body, but has not yet been used. It is simply the estimated amount of insulin that is still working from the bolus. The estimate is figured out automatically by the pump based on how long it has been since the bolus occurred, as well as what YOU have entered into the pump with regards to the "active insulin time setting" (ours is set at 3 hours).

[Nancy in VA]

Thanks, so I had him test too soon it sounds like? I don't know why I thought ALL of the insulin would go in immediately. It surprised me that there was still .9 on board after over an hour. Why haven't I ever noticed that before?! :confused:

The insulin all goes into his body immediately. The IOB means that its still working in his system - not that its still in the pump waiting to inject.

[coni1523]

My son has his active time set at 2 hrs. His endo did that. It seems to help alot. We are still having some lows and highs. but we are still working on that. The cgm works real good on catching the lows and highs. I really like it alot. The insulin is all going in for a correction bolus. but if you use the dual wave or the square wave for the food it breaks it up into a percentage. Normal bolus all goes in at one time to. I like using the dual or square bolus. It helps with alot of lows. My son will drop real fast sometimes. My son is 8 yrs old by the way. Hope this helps !!!

Connie

[Heather(CA)]

Okay, you pump pros out there can you help a novice?

Sam was 263 at 4:30 this afternoon (pump site came out at school, long story.)

He had an 84gram chocolate milk. The pump said take a total of 2.6 units for the correction and carbs.

Rechecked at 6:15 and he was 220. Pump said .9 Active insulin still on board.

Then at 6:30, pump said .7 Active insulin still on board.

Did I miss something? I thought the bolus would do the trick even with the carb drink and put him back in range after about an hour. I know Novolog can take a while to peak so was it just too soon to check?

Should he have not had the chocolate milk until his numbers got back within range?

Should I expect him to fall back into range at the 2 hour mark? 3 hour mark?

We are going to be eating dinner soon and now I am nervous about giving him even more insulin on top of what is still on board.

Advice appreciated. Thanks!!!

YDMV, AND were not pumping, but for us...It took 3 hours for the Novolog to finish working. If I tested 1 or 2 hours, Seth was still higher then he was going to be....

[wilf]

YDMV, AND were not pumping, but for us...It took 3 hours for the Novolog to finish working. If I tested 1 or 2 hours, Seth was still higher then he was going to be....

Same story here - watching our DD respond to Novolog, it is clear that it doesn't finish working until after 4-5 hours. Based on what I've observed with our DD I tend to use a rule of thumb that for any Novolog injection, it's used up in DD about as follows:
- after 1 hour 25%
- after 2 hours 60-65%
- after 3 hours 85%
- after 4 hours 95%
- after 5 hours 100%

So after 2 hours, you'd only be about 2/3 of the way through the full BG drop of a correction (if it were my DD, though of course YDMV). That may help explain what you're seeing.

[Lee]

Hey - our endo helped us figure out how long Insulin took to finish working...she had a formula based on weight, Total daily amount, and what her #'s were before and after...it is a very individual thing.

From what I understand, as they get older, the insulin gets used quicker, so a 4 yr old might have it set to 5, and a 9 yr old will sue 4, and a 15 yr old will use 3. That means that the body has processed all of the insulin in the blood stream in 3 hours and there is no more of the BOLUS left in the body (the basal is still working though).

The great thing about the pump is it figures out your IOB...so if your son test 1 1/2 hrs after eating, and he is in perfect range, then he might want to check his IOB.

Just have him use the Bolus Wizard and enter 0 carbs, it will say how much is still working inside of him.

I LOVE this - it has prevented many lows. If my daughter is at 89 1 hour after a meal, and I look and she has 1.5 active insulin, that means that she will go low, so I need to give her some carbs before that happens. It is like feeding the low before she is low.

[LJS118]

That's one of things you have or will figure out very soon... insulin duration (how long the pump considers insulin still working).
If I'm not mistaken, the pump factory will send them out set at 6 hours. We've adjusted our setting of insulin duration to 4 hours. Everyone differs. Do you know how long his insulin lasts him?

This is exactly what I was going to say. Ryan's insulin is only active for 2 hours tops! Therefore we've adjusted this setting on his pump, it made a world of a difference.