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Dosing when switching from MDI to pump?

Discussion in 'Parents of Children with Type 1' started by KHS22, Feb 21, 2014.

  1. KHS22

    KHS22 Approved members

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    So, I am very familiar with the pump. I worked with Medtronic for years, and would start adults on the pump, do all the calculations from MDI-pump initial settings, follow them for 6 weeks or so until their numbers were stable.

    And, one thing we always did, was decrease their TDD by about 25% when going on the pump. Do they do this for kids too?

    I'm asking, because I just heard the orders my doctor gave for little E's initial settings on her pump, and I'm a bit worried, as they are pretty well exactly what she is taking now, no decrease at all.

    She gets Levemir 1.5u in the Am, and Humalog 1:40. Her TDD is usually at most 3 units.

    He asked for her pump settings to be Basal at 0.075u/hr (would mean a total of 1.8u from basal) and her ratio to stay at 1:40.

    What do you think? Did they decrease your kids when they started?
     
  2. hawkeyegirl

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    They did, and we had screaming highs until we increased things substantially. Jack actually required more insulin on the pump than he did on MDI, and that is apparently not particularly unusual.

    It's a guessing game, and you just have to test a lot, and be prepared to make changes quickly.
     
  3. virgo39

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    My recollection is that we had crazy highs too. DD needed a lot more insulin in the first half of the night than Lantus every provided, even after we split the dose. I think we started changing settings almost immediately and actually for a few weeks before things seemed to settle down ("settle down" being a very relative term).
     
  4. KHS22

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    Okay, good to know. Makes me a little less worried!! She's just soooo sensitive still, I mean when we upped her levemir from 1.5u to 2units, she went low.All.Day.Long!!!!!!
     
  5. mmgirls

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    same here, needed more on pump.
     
  6. sincity2003

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    Seems we're in the minority, but DS got 16 units of Levemir and now gets 12 units (or less) basal. We did keep his ratios the same at first; however, we just upped his lunch from 1:20 to 1:25.
     
  7. roo'smom

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    It was awhile ago, but she definitely needed more insulin pumping than she did on MDI.
     
  8. TheFormerLantusFiend

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    I am an adult, and I started pumping two months ago and the medtronic people recommending lowering my basal and I didn't do it and I'm really glad because my basal needs are about 50% higher on the pump.

    I think they reduce it because anytime you switch insulins (in this case from long acting to short), you can't be sure which ones lower your bg more, unit for unit, and medtronic does everything such that you risk highs rather than lows.
     
  9. KHS22

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    Okay that makes sense. Interesting that most people seem to end up on more insulin than before!

    I am planning on taking a few days off when she first starts, as I know how labour intensive it is. So that will hopefully help ease my mind that if she has lows then at least I'll be around!! :)
     
  10. shannong

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    I think I went with the initial settings that they gave us - for about 2 hours and then at his first meal, I changed the I:C ratio, because I just knew that it would be way too much insulin for meals. I tested a lot and changed basals as needed. I would say that if you feel it is too much, trust yourself and then you can always change the settings.
     
  11. susanlindstrom16

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    They did not have us decrease the basal when we first started. But we ended up decreasing a little because she was going low in the early morning hours. In all, she was getting 11 units of Levemir/ day and now she gets just under 9 units in basal/day.
     
  12. obtainedmist

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    Just a FYI...the first few days you might see some lower numbers because of the residual Lantus. We freaked and lowered all the basals only to have to up them after a week. Hope it goes smoothly!
     
  13. kirsteng

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    We were not on MDI before we switched to the pump -we were on novorapid and NPH. But our TDD has increased on the pump - from about 11 units a day before to 14-15/day now on the pump. At first it felt like it had decreased, as the hospital started the pump settings by taking our TDD and subtracting 25%. But on that <9 units/day, we were also on a meal plan with no snacking between meals.. so we were not only high all the time, but my son was also not eating his usual amount. When we got things ironed out and he could again eat on demand, it surged right up to 14-15 units/day. I thought it was unusual too until I read this thread!
     
  14. KHS22

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    I wonder if this might be part of the reason many people go up on the pump! There are often many times/day that my daughter wants something to eat, and I apply her with non-carb snacks to avoid an extra needle, and stacking etc. Sometimes, she does jsut eat the extra carbs and get an extra needle. But, one of the things I'm looking most forward to about the pump, is TRULY being able to say -you can eat whatever you would like!!! (within reason of course, we are a very healthy family to begin with anyways, so that helps!). So, if I now say "yes" to extra fruit etc, then her TDD would definitely go up!

    Thanks for the reminder about the remaining basal. We are on levemir just in the AM and her start is at 10am... so I'm really really hoping there won't be much left?
     
  15. kirsteng

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    I wondered the same thing - likely true IMO. In my house there has certainly been a bit of 'celebrating' by allowing between meal treats that before were largely avoided... ;)

    As far as the residual levemir goes, I think you'll have little effect, if any. We also went live at 10am, but had done our regular Levemir at 6pm the previous night. Comparing the cgm graphs from day 1 and 2 on the pump, you can see that there was a bit of basal still running that first morning and afternoon. After that, the two days were pretty similar. Since your levemir will be 10 hours previous, I think you should be okay.
     
  16. KHS22

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    Our Levemir will be like 26 hours previous - we only give in the AM. She doesn't get night time basal, so the last dose will be like the day before right? I'll just give her humalog with breakfast but skip the basal I figured??

     
  17. kirsteng

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    Right - I meant 10 hours previous to when my son had had his last dose. Clear as mud, eh?! ;)

    That's what they told us to do at our hospital - basal morning and night the day before as usual, nothing on the day of. So for you it will be more than 24 hours.. be prepared for highs. Hard to see.. :(
     
  18. KHS22

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    Ugh. We've been having swings like crazy recently!! One day she's high all day, the next low all day. Part of the whole 'honeymooning' phenomenon i guess? I mean she's still only on about 3units TDD - which is like .15u/kg. So I am excited abotu the pump, but more ups and downs... Oy! :$
     

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