First I need to apologize for all my questions lately. I am exhausted and overloaded with information this week due to DD's pump start, so whatever I read in preparation to pumping is lost to me at this time, and I don't have the energy to flip through the books again..... Just wondering when pumping, when a BG reading is high outside of a meal time, is it "safe" to go into the ezBG menu (PING) punch in the BG #, let pump calculate a correction and give her that unit of insulin? My understanding is that it is safe to do so (and in fact one of the benefits of pumping) to be constantly on top of every high BG reading and doing "little fixes" every time she's high. And I assume it is safe because the pump factors in IOB and will not over give what is required to bring her down to her BG target. Also, even if I corrected a high 1 hour before a meal, and she eats dinner and we bolus for that, the IOB will be accounted for so the meal bolus will not overgive the insulin. Our endo and nurse is not allowing us to correct yet outside of meal boluses, so they don't want to discuss this with us yet. Frustrating, but I understand why they don't want to tell us information about doing this for fear we will start doing it. So, I am coming to you folks to answer my question.
It sure is . One thing I LOVE about the pump! You will have to tweak the duration when you figure out how long insulin stays in her system. I think we have 3.5 hours right now. That is how IOB is figured out.
I'd like to learn from this question if I can... is the question if, say 2 hours post meal, you can punch in a new BG value and the pump will calculate another correction based on that newer value and take into consideration the bolus IOB that is still working?
Yes, you can correct with the pump. I would hesitate at 2 hours after a meal because there is still insulin working on the carbs, unless you miscalculated carbs and she is way high. Yes, the Ping will figure in any Insulin on board before telling you how much to correct.
Actually, any IOB you have for a correction before a meal will be totally separate from figuring out the insulin needed to cover your meal carbs.
We've only corrected one high. Honestly, her numbers have been so beautiful this week that we haven't really had to. Today, was only because I miscalculated her carbs at lunch. But we were told the same thing. We've been in contact with her endo daily since Monday, but was told yesterday that we could leave her settings as they are over the weekend and see how she does.
What would you consider "way high" and at what # would you be comfortable doing a correction 2 hours after meal bolus?
got off phone with nurse 1 hour ago. Still don't want us to correct a high and still no snacking for one more day. Sunday, we can start snacking and doing activities. Didn't mention correcting, and I forgot to ask as I was pulled over while driving to take her call, but I will if needed on Sunday!
Yes, theoretically you can correct any time, but we've found that we shouldn't correct before 2 hours because of how insulin works in our dd's body. Her meal doses are most active at 1.5-2 hours post-dose, so she may spike high but it will come down, so dosing an additional correction before 2 hours will send her low. This is something we figured out from experience, so give it time and you'll figure out what works for you.
After you get to know how many units of insulin will bring her BG down by a certain number, you will know when to correct. If her 2 hour meal BG was high and the IOB would not bring her within range, we would correct. Generally, she has to be above 250 - 300 for us to correct 2 hours after a meal.
Pumping is great. It is, however, only as good as the numbers you have programmed into it. If you know the carb ratio needed for each time of day, the sensitivity at each time of the day and have your basal worked out - for each time of the day, then it does all the calculations for you. The endo will just be taking a precautionary approach because the basal will likely be a little different and need more precise tweaking than mdi. IMHO basal is king with calculations - get that right and everything else falls into place. Sounds as though you have had a wonderful start with your pumping.
If they don't want you correcting, then you really shouldn't do it yet. They are making adjustments to the basal and bolus doses based on the info that you give. If you are doing corrections without their knowledge, they will assume settings are correct when they actually need to be bumped up.
I second listening to them for now. They are definitely trying to figure out if all of the initial settings are correct. If you tinker, they'll never know. Snacking and stuff like that just make it even harder to figure out if the starting settings are right. We are only a month into pumping, but we love it thus far. I love how it calculates insulin on board. Before pumping, Matt was often going low at midnight. I couldn't understand why. Yet after pumping for a few days, I realized that our tendency to eat late was causing a situation (while on injections) whereby we were correcting him before bed even though he had active insulin still in his blood. Here is what I do: 1) If I check his blood sugar 2 or 3 hours after eating and it is quite high, I begin by looking at the insulin on board. 2) If the insulin on board is enough to bring him into range, I just kick back and relax for a while. 3) If the insulin on board is NOT enough to bring him into range, I give him a bit more. 4) From there, I check more often than I would normally to make sure it all works out well.
