- advertisement -

Help!!!! New pumping to cozmo

Discussion in 'Parents of Children with Type 1' started by tuckerk, Jul 9, 2008.

  1. tuckerk

    tuckerk Approved members

    Joined:
    Jul 20, 2007
    Messages:
    136
    Hi everyone,

    I don't know what to do! Yesterday was was our official "insulin" pump start and Caitie numbers have been through the roof! She ran in the 300s-429 immediately after starting the pump. I gave 2 correction boluses via pump with no significant change in BS. BS at 7:50 was (390) I had to give a correction bolus (Novolog) 1 unit (7:50 pm) with syringe which brought her down to 274(10:00 pm), then 88 (1:30 am). Gave juice(10 grams).

    She was 194 this morning---had 34 grams CHO----I:C ratio (1:30)/Correction Factor is BS-120/120. Now here is where it gets really scary, rechecked at (9:40) with CozMonitor and BS read "Over 500, Check Ketones":eek:-----rechecked with Ascenia Countor---BS (377). Ketones(neg), gave correction bolus with insulin syringe(1.5 units Novolog). Her Basal is 0.1 unit/hr. Called the insulin pump nurse and she suggested to give correction by syringe, monitor ketones, call back this afternoon.

    Is this normal, during the first days on the pump. What are some suggestions to get a handle on this? Thanks so much for any suggestions.
     
  2. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    We had crazy highs at pump start. Turns out both his basal and his I:C needs went up considerably on the pump. It took us a few days to adjust them enough so that the crazy highs started coming down.

    Talk to your CDE, but it sounds like both her basal and her I:C needs to be adjusted. It's not uncommon for kids to need more insulin on the pump.
     
  3. tuckerk

    tuckerk Approved members

    Joined:
    Jul 20, 2007
    Messages:
    136
    Would you suggest changing the infusion set, even though we did one yesterday?
     
  4. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    A few questions.

    How old is your daughter?
    What was prior MDI I:C ratio?
    Which infusion set are you using?

    I'm leaning in the direction that the ratios were set very conservatively, too conservatively perhaps.

    Try not to worry too much. It can be tough in the beginning.
     
  5. tuckerk

    tuckerk Approved members

    Joined:
    Jul 20, 2007
    Messages:
    136
    She is 2 years/old. We acutually never used a I:C ratio (Odd I know!!!!)
    Correction Factor has been for awhile: BS-120/120
    MDI: Lantus(split dose 2.0/1), Novolog (1.5/1/1)
    We are using the Cleo 90
     
  6. susan

    susan Approved members

    Joined:
    Apr 28, 2006
    Messages:
    1,101
    Seeing how we use the same office, and I'm pretty sure what pump person you talked to, I can tell you that when they first started Davis on the pump his ratios were way off..We had crazy highs the first few days and had to change his ratios several times before we got them close to being right..I'm sure Lynn will be calling you soon to adjust stuff..
     
  7. tuckerk

    tuckerk Approved members

    Joined:
    Jul 20, 2007
    Messages:
    136
    Hi!!!!!
    Ronnie was the nurse yesterday and we spoke with Suzanne this morning. She seemed pretty calm, but I am on the phone now with Cozmo Cust. Service for trouble shooting with the CozMonitor. Is Lynn one of the nurses? I have not met her.
     
  8. susan

    susan Approved members

    Joined:
    Apr 28, 2006
    Messages:
    1,101
    Ronnie is new and I haven't met her yet, but Lynn is like the "head" pump nurse or whatever..She is the one that usually deals with changes and stuff, and least with us..
     
  9. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    When the corrections don't work, we find that usually the site is bad or the basal is too low. I would try doing a temp basal for short time, say 4 hours. You can always cancel it if goes down too fast.

    If you find your corrections start working then the site is probably good and the basal needs to increase. Ours went up quite a bit on pump start.

    I also find that if Alex doesn't budge 2 hours after a correction, then he's not going to go down at all, so I cancel out the IOB and do another correction at that point.
     
  10. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    Well, given that your DD is only 2 I'm guessing that the ratios we're set very high intentionally.

    Obviously she needs more insulin, and giving it to her by shots is going to cloud your ability to judge to effectiveness of the ratios and the site. My main question with be, how easy is it to manage lows with your child? Is she willing to eat/drink carbs to cover or will you be in a real panic if the the endo adjusts the ratios downward and you have to treat a low with an unhappy, uncooperative babe? I would also not want to make changes unless I knew that she would be awake for most of the time, so changing late in the day might not be a good idea.

    Also, you may be having a site issue. Did the insertion go ok? does it look good now?

    I'm sorry I'm not being specific, I don't want to suggest anything that will put your daughter at risk.

    Hang in there, let us know what endo suggests.
     
  11. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157

    I can tell you that FOR US, bad sites are very, very rare. As in we've had one in three months of pumping, and it was very obvious. (The cannula had come out, and was lying on TOP of the skin.)

    I think that since you've never done I:C ratios before that they've started you very conservatively, and that, combined with the propensity for kids to need more basal on the pump than on Lantus, is causing your high numbers.

    I'd test her every two hours at night and see what is happening there. It's a place to start.
     
  12. tuckerk

    tuckerk Approved members

    Joined:
    Jul 20, 2007
    Messages:
    136
    Update on Caitie

    Did a BS check at 1:45 (108) with CozMonitor, so the correction with the syringe worked, except that she had lunch will at school (40 grams CHO). So as I go down the list of what may or may not be the problem, my guess it that:

    1. Novolog is good
    2. Need to change Basal and I:C ratio (being that we were doing 1 1/2 units of Novolog for breakfast (30) carbs because she became insulin resistent in the mornings)
    3. Must have been a bad test strip----- Ascencia meter(BS=94) Cozmonitor(BS=108) at this last check

    Thanks everyone. I am certain that I will need you all again SOON!!!!!:eek:
     
  13. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    Glad things are feeling calmer ;)

    Pumping is not easy at first, but imho, it does make life with D simpler. Good luck tonight!
     
  14. Burlew

    Burlew Approved members

    Joined:
    Feb 4, 2008
    Messages:
    332
    Noah had the same thing happen when he started his Cozmo pump.


    The Cleo's were our headache and getting his dosage set....or me more or less getting the hang of such a complex pump.

    I would call the endo and see what needs to be adjusted.

    Sounds like the correction factor is a bit low...or it could be that the Cloe's are not the infusion set for your kiddo. We changed to the comfort shorts...a bit intimidating in the beginning...but they work great.

    We are heading into our second month of pumping and still trying to get things in check. Its gong to take some time...

    It so hard to put your finger on the exact problem at this time...due to so many things being new and sooo many questions.

    Hang in there things will get better.:cwds:
     
  15. Twinklet

    Twinklet Approved members

    Joined:
    Jun 29, 2006
    Messages:
    2,123
    Our first 4-6 weeks of pumping were a nightmare! I was ready to throw the pump out the window and was certain we made a mistake in trying to pump.

    It's hard to tell what the problem is. It could be that the correction factor is way off. I agree with Sax, when a 2nd correction after 1 hour doesn't bring the number down we find it won't. At that point, we give a shot and change the set.

    Like Burlew said, most people have terrible luck with Cleos. We are one of the few here who have amazing luck with them. We've used them exclusively for almost 2 years and have never had an issue (we did get ketones with Quicksets last week, though...ACK!!!!). Are your sites kinked at all when they're pulled? You may want to ask for a trial of a different set to see if that is the problem.
     
  16. Mama Belle

    Mama Belle Approved members

    Joined:
    Jan 23, 2007
    Messages:
    4,540
    As others have said it could be the Cleos. We used to use them, but switched to the Insets, which are soooo much better for us.

    I remember being exactly where you are and, as Andie said, I was ready to pitch the pump out the nearest window. It is hard to know in the beginning if sets are bad or if the settings just aren't right. We found that our correction factor and basals were way off, especially at night. We lowered them both considerably. I would try tweaking some of the settings and see where that gets you. A tried and true method for us in determining if it is a set issue or a settings issue is to test ketones. Generally if we are talking about a set ketones will go up very quickly.
     
  17. jendean

    jendean Approved members

    Joined:
    Aug 28, 2007
    Messages:
    1,427
    If its your first day on insulin with the pump, you simply need to call the endo, and report the sugars. You can give shots with to correct, but only if the endo says.
    It is not meant to be perfect right away. The endo should want to tweak it... It will get better.
    :)
     
  18. tuckerk

    tuckerk Approved members

    Joined:
    Jul 20, 2007
    Messages:
    136
    Caitie's Day Today

    Hi everyone,

    Today started very well----142(7:15 am), and it went downhill from there. My thoughts are the the I:C ratio is off. Talked to the Insulin Pump Nurse today and she instructs us to change the I:C ration to 1:40 (for all meals and snacks).

    I really don't agree or I am totally confused. My thoughts are if after a BS 2 hours after a meal is high (insulin given to match carbs is correct), then perhaps the I:C needs to be lowered. For example instead 1:30 maybe 1:20!!
    Why would she increase the breakfast to 1:40, if that is where the numbers start to go haywire:confused:

    Anyway I am going to do a site change this evening and see if that is the problem. I have not noticed any kinks will removing the others. With the high BS she has had no ketone (Thank God for that!!!!!!)
     
  19. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    Did they change her basal rates?

    I'm also a bit confused. :confused: If her numbers are going up ( 2 hours or more ) after a meal bolus then yes, her I:C ratio should be raised, as in MORE insulin per carb, which would mean that her ratio would look something like 1:25. Are you sure you heard her say 1:40? The whole language of ratios, what's "raising" the ratio or "lowering" the number of carbs per unit could possibly be miscommunicated.

    That said, I would not advise you to change her ratios without taking with the endo or CDE. I know this is frustrating. I hope that other parents with very young pumpers will chime in.

    Good news on the ketones, and I'm assuming that site changes are going OK, so that's all good. Keep great logs and keep us posted ;)
     
  20. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623
    That is odd if she wants the ratio's higher like that.. Did she change any basals?

    what was your daughter on before, lantus an novolog? typically the insulin needs increases quite a bit once you start pumping.. the first few weeks of pumping can be tough because you never know what is off, carb ratios, basals, bad site.. etc..
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice