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Insulin pump + long acting insulin

Discussion in 'Parents of Children with Type 1' started by rulestein, Feb 7, 2013.

  1. rulestein

    rulestein Approved members

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    We met with an endocrinologist last month and he agreed that our daughter should start using a pump as soon as we can. So we took the required pump assessment class.

    The formula they use as a starting point to find basal is:
    ((long acting units)*(0.75))/24.

    In my daughters case, that would be ((0.5)*(0.75))/24 = 0.016 That would below the capabilities of any pump on the market.

    So, my next thought is to use the pump for corrections and meal covering. The long acting would still be used at 0.5/units in the morning.

    Has anyone here had to do some combination like that?
     
  2. Beach bum

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    You will find with the pump that the calculations will vary from long acting. In addition, you will find that the basal plan will vary at different times of the day. The endo will use a formula to come up with the correct amount needed for your child...and it will most likely change a few times. The first few weeks of pumping is a constant dance with adjusting basals and ratios.

    I wouldn't worry about this, because they will be able to make it work. That's the beauty of the pump.
     
  3. Charliesmom

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    They will be able to make it work. Our endo told us not to choose a pump strickly for the small basal dose. They can work around it. It's been awhile but I think she said something about turning the basal off every other hour or something. It's been awhile so I can't remember exactly. We didn't end up needing to do that. Going untethered (pump + long acting) is a possibility but I love being able to fine tune the basal to his needs.
     
  4. nebby3

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    The pump is a great choice for young children because it can give such small doses. My dd started it at age 2 so I am sure you will find a way with a 3yo. Does she really just get .5u of long acting per day? When does she get it, morning or night? If she is honeymooning and needs no lOng acting overnight then you would probably give the minimum the pump can do during the day and have it at 0 for at least some hours overnight. But your endo will tell you specifics.
     
  5. rulestein

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    Thank you. "untethered" is exactly the buzzword I needed. When I suggested pump + long acting, the pump educator thought it was impossible and a waste of a pump. It is also good to know about the alternating hour thing.

    Yes, 0.5u of levemir in the morning. She didn't even start insulin until December of last year. We started her at 2 units but have tapered it down because of night time lows. I like your idea of setting it to 0 at night. I will discuss that possibility with the Dr as well as the alternating hour.
     
  6. cdninct

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    Remember, those are just guidelines. Basal on the pump will likely not be delivered at the same rate every hour. My son had the same issue at night--even the 0.025/hr was bringing him down too far, so as others have said, we just alternated: 1 hour on, 1 hour off. It worked just fine (i.e., his BG did not bounce up and down by the hour, for example).

    There are lots of ways to make a pump work, but some require more thinking than others. If you want to explore going "untethered," that is, using it only for boluses, go for it, but know that you do not have to follow this route.
     
  7. MomofSweetOne

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    If your daughter is on such a small amount, I would figure out a way to have the pump do it. My accuracy with drawing up with syringes never felt very accurate - and we were adjusting by 1/2 units but never went below 3.5 during honeymoon. My guess is that the pump could be more accurate for you with amounts at the times of day your child needs them.
     
  8. skimom

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    Do you dilute the insulin ? If not then you could work with diluted insulin in the pump to reach these levels...
     
  9. rulestein

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    Yes, she does use diluted insulin. Using it in the pump would be a great idea. Does that work? Do you have experience with that?
     
  10. Lee

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    We are untethered, but my kid is 14! And we tried pumping for many years prior. I am one of those that thinks it is important to use a pump fully at first. That way you understand the full benefit, the full functionality, etc. Otherwise, you are using your pump as a fancy calculator and needle (like we are currently ;)).

    Your endo will help you make it work. That is what they do best.
     
  11. maciasfamily

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    Our son uses diluted insulin in the pump. At the time of starting to pump he was on no long acting, because it would bring him down too low, even .5.

    We started using diluted, and at night we would have to completely turn his pump off to deliver no basal. Even .05 of diluted was too much for him, since he was/in a strong honeymoon.

    We're about 7 months into pumping, and he has basal now at night more times than not. We're still on low amounts (.05) several hours at night and a few hours during the day.

    Pumping has been the best thing for us to control his AM and evening highs, but give us the control to set his basal where it's needed.

    You will love pumping and see how much easier it is to control the BG's for our little ones.
     
  12. badshoe

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    Cool thing about the pump is you can account for how your diabetes varies. When we had a CDW who needed basal that fell between what a pump would deliver I programed it to alternate every 90 minutes for a little more then a little less bass. Worked great.
     

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