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Thread: Your pump learning curve? Early success, failures, and "wish I knew that" moments

  1. #1

    Default Your pump learning curve? Early success, failures, and "wish I knew that" moments

    Matt's pumping saline this week, with the switch over to insulin on Friday. I have this image in my head of the "switch" being turned at the end of the week and suddenly his blood sugar levels having less swings. I am probably delusional.

    So, with that said, I thought I'd throw out a few questions that might help myself and others on the verge of pumping....

    1) What were your first few weeks like?

    2) Did you start off with square boluses, pattern basals, and other stuff I assume are a bit "advanced", or did you add that stuff later? And if later, how much later?

    3) What was the effect on your next A1C? ----- higher? lower?

    4) Any tips?
    -------------

    father of Matt, age 11, diagnosed November of 2009,

    11/09-10/11: MDI humulog, Levemir nightly

    10/11-present: MM 523

  2. #2

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    I will be following this thread closely. We're starting the process, got our DVD and manual, just waiting for our training appt to be set, and I have so many questions.
    Lisa, Mom to:
    Cooper, 14, 11-7-1997
    Alexander, 12, 12-15-1999
    Sophia, 9, 10-8-2002. Diagnosed T1 on December 5th, 2010.
    Humalog and Levimer-12-5-10 through 11-14-11
    Pumping with One-touch Animas PING11-14-11 through present day

  3. #3

    Default

    Quote Originally Posted by rutgers1 View Post
    Matt's pumping saline this week, with the switch over to insulin on Friday. I have this image in my head of the "switch" being turned at the end of the week and suddenly his blood sugar levels having less swings. I am probably delusional.

    So, with that said, I thought I'd throw out a few questions that might help myself and others on the verge of pumping....

    1) What were your first few weeks like?
    Quite a few nights of lost sleep. It was a lot of work getting the basals & ratios tweaked, with lots of calls/faxes to the CDE (she was still in a very strong honeymoon at the time), but well worth it.

    2) Did you start off with square boluses, pattern basals, and other stuff I assume are a bit "advanced", or did you add that stuff later? And if later, how much later?
    We tried our first temp basal about 2 weeks after pump start. Combos took a little longer...maybe 4 months?, with lots of failures in the beginning. Once we learned what worked, it was much easier & I gained enough confidence to keep trying new things.

    3) What was the effect on your next A1C? ----- higher? lower?
    Our A1C in Jan 2010 was 6.9, pump start was Feb 8, & our next A1C was not until Aug. It was 6.3.

    4) Any tips?
    Relax. Be prepared for lots of testing. Don't let your expectations get out of hand.


    And congratulations!
    Mom to 16 yr old dd, dx 7/2009
    Animas Ping 2/2010
    Dexcom 7 Plus 9/2010
    Dexcom G4 11/2012
    Metformin

    Take pride in how far you've come.
    Have faith in how far you can go.

  4. #4

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    The first few weeks stank. The settings we started off with were too conservative, so he ran high constantly. Then, as we started playing with the numbers to get BG down, he fluctuated widely. We were miserable for two weeks and frustrated for a couple more until we got things straightened out.

    We did not start off with the advanced settings until at least two months after we started, and then it was gradual. We were on a fixed carb/fixed insulin plan until we started pumping, though, so we had a steep learning curve just trying to figure out how to carb count, etc.

    My son's a1c went down slightly after we started (0.2%, I think). I was shocked, because his numbers had not been great. His numbers had been fluctuating more widely since we started pumping, but I guess he was averaging lower than he had been while on injections.

    One thing I had to keep in mind was that I was checking more, particularly in the first few weeks while we were working on settings. Of course, the more often you check, the more often you will find numbers you don't like.

    I hope it all comes together like magic for you, but if it doesn't, remember it will get better in a short period of time!
    Caroline

    K, 2008, dx 2010-12-02 - blue MM Revel with blue Dexcom G4
    E, 2010
    W, 2013

  5. #5

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    1) The first 2 weeks we did not sleep much and faxed/talked to our endo or CPN every day. By one month things started running really smooth, which for us was just in time for Halloween.

    2) We stuck to the basics for the first month, then started working with combo boluses and temp basals. It has taken me a 8 months of trial and error to perfect mac n cheese and pizza.

    3) A1C went down.

    Only real advice I have is have low expectations in the beginning. If you don't have expectations of immediate perfection then you won't be disappointed if it takes a little bit to get everything hammered out. The pump is an amazing tool, but this tool has a learning curve. Once you get through the learning curve, you learn how to use the tool in the way that is best for your child. After a year with the pump, I still change basals/boluses frequently. The magic of the pump is that I can more easily fix my changes if I guess wrong.
    Andi

    Mom to :
    William, 5 YO, DXD at 13 months
    Samantha 8 YO - nonD
    Pumping with Blue Animas Ping since 9/30/2010
    Also using Dexcom G4

  6. #6

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    It took us around 6-7 weeks before we felt we had it down fairly well. The first week was like magic...everything worked great...the next week we actually yanked a set and went on Lantus for a day, we were so defeated! However, we kept trying and trying to get it all down and finally it was the best thing ever for the whole family! =] Basal testing REALLY works! Still, we've had to tweak the basals a bunch as time has gone by. I know that Molly will go up or down .025-.05 if she sees a pattern at a certain time of day (and she won't do an actual basal test...though I don't advocate that...just saying!).

    A1c did go down and has stayed consistantly down. However, Molly is still honeymooning I'm sure.

    We didn't do the extended bolus (on the Ping) for a while. Now, my daughter uses it a lot, especially for oatmeal and high fat dinners.

    What we found really helpful after lots of trial and error:

    1. Try to put in a new infusion set well before bedtime and hopefully right before you are dosing for a snack/meal. That way, you'll know if it is working well before going to sleep. We spent many late nights trying to problem solve high numbers that "could be" due to the set failing.

    2. We had lots of trouble with inserting the insets properly. Finally, we got Animas on the line and had someone give us some tips (like using one hand to hold it flush to the skin and the other hand to squeeze the area that got the set in).

    3. For some strange reason, sitting while inserting the infusion set helped us a lot. I think the muscles were more relaxed and the "fat" a bit more bunched up!

    4. You don't have to switch out the cartridge when you switch out the infusion set. We filled the cartridge with 3 days worth of insulin, but we had to switch out the set every 2 days. For some reason, Molly liked not having to do both at the same time.

    5. After 2 days, if you notice consistantly that the numbers are running higher, you might need to keep to an every 2 day routine. It just made our life so much easier, though it's more costly, for sure. We had our endo write a script for the 2 day and the insurance allowed it.

    6. Even though you might want to throw the pump in the trash after a trying day of problem solving...stick with it!

    Hope it's smooth sailing for you!
    Last edited by obtainedmist; 10-24-2011 at 09:40 AM.
    mom to Molly, 21, dx 7/9/10
    Pumping with Animas Ping 11/10
    Dave, 24, non D
    Wife to Bob...great guy!!

  7. #7
    Join Date
    Oct 2005
    Location
    Central Texas
    Posts
    5,560

    Default

    Our transition was fairly smooth, but I had been managing the MDI very much like it was a pump.

    The basals were right and the ratios not far off. It went really well after we switched to Apidra from Humalog.
    Amy
    Mom to a young adult Animas Ping pumper and DexCom G4 user. 2nd year college student, now living in a co-op house. Dx'd over 16 years ago at 3 years old.

  8. #8

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    It's important to get the basals right as soon as you can, or at least in the neighborhood. Our CDE put us on half of what we'd been using for Lantus when we actually needed twice the Lantus dose, so that made our pump start an absolute nightmare. If your kid is one of the odd ducks like mine that needs more pump basal than Levemir/Lantus instead of less like I think the majority does, it can really throw stuff off.

    If you have issues and have a hard time telling what they are, the steel sets can take a lot of things out of the mix -- for example, if you run very high you wonder if the basals are wrong or the cannula is kinked, but with the steel set you know the second can't be true. It helps to clarify things when you don't yet know how to recognize an obvious "bad" site, etc. We spent a lot of time thinking we had a bad site or bubbles in the tubing. We quit and did a second pump start, and using the steel sets made it clear we didn't have enough basal.

    Keep the rep in the loop, they can be very sharp on the stuff you only learn from feedback.

    Have fun and my best to you!!

  9. #9

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    The only advice I have is this:
    Pumping can be seen as this amazing, wonderful thing, but there will be bumps in the road no matter which delivery you choose for insulin. Many people raise pumping to this pedestal, but it's not always rainbows and unicorns - especially in the beginning. DO NOT feel defeated if you HATE pumping initially - that's NORMAL!!! Give pumping a fair chance before judging whether you love it, like it, are indifferent to it, dislike it, or hate it. You will also go through the full spectrum of emotions about pumping at various times.
    I have had diabetes for 17+ years, and have been pumping (with various devices) for 11+ years. I have days where I love pumping, days where I HATE pumping and would give my right arm for a pump break, and days with every emotion in between- that's simply life with diabetes.
    Also remember that pumping is not a permanent thing - you can do untethered, you can do full pumping, you can take pump breaks... nothing is definite with diabetes.
    Tricia

    28, dxd D @ 8 (9/1994)
    Current Diabetes Accessories: Dexcom G4Platinum (6/2013); Animas Ping (again)
    Nurse, trying desperately to become a CDE!!

  10. #10
    Join Date
    Apr 2011
    Location
    South Carolina
    Posts
    537

    Default Be patient

    Be patient - my son tended to run high and I was frustrated by that. It takes a little while to dial in pump settings that will work for your child.

    Trying to decide on infusion sets was a little hard. Our endo had us using the sure -t with manual insertion. I hated the two separate taped pieces on my three year old's bottom and I hated manual insertion. We went to mios that were spring loaded and flat on his bottom.

    We never did any fancy boluses until much later.

    On my child - we HAVE to change sites every two days or he will go high. We tend to change every other day in the morning. My husband (also on a pump - can get 3-4 days out of a site - but not my little one.)
    Kelly

    Mom to Parker (6) d/x 11/09 MM Revel pump with mios; DexG4 (2/2013)

    Mom to Marley (10) non-d

    Wife to Dan (43) d/x 1978 MM Revel with quick sets

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