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INSULIN SUSPEND - When and how often do you use?

Discussion in 'Parents of Children with Type 1' started by DavidN, May 26, 2013.

  1. DavidN

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    A sick child. Can't keep food down. Low BG. I understand and appreciate a full insulin suspend in this situation. But I'm wondering what other situations call for a full insulin suspend.

    I'm asking because we often face the following scenario. Big carb, high fat dinner. We extend bolus. Looks like we overshoot the up-front bolus as we're soon faced with a CGM reading of 75 with two down arrows. A finger prick confirms 75, but the accompanying two down arrows terrifies us because two down arrows suggest BG could fall another 45 points in 15 minutes (before fast carbs can take effect). We hit the panic button. 10 - 20 fast carbs PLUS insulin suspend (during a period when hourly basal is at its peak for my son) and we pay the price two hours later with a trip to 250 or higher). I suspect the answer to this situation is to not panic and give the quick carbs only with no insulin suspend. Our fear is that the fast-acting carbs will not react fast enough with all the slow-acting carbs already on board. Not sure if this is rational, but I suppose we don't want to find out what happens if we're wrong.

    Maybe a couple topics here but as always, thanks for feedback.
     
  2. kiwikid

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    Don't panic, treat and then watch the arrows... You will only need to do it once or twice to see how it works, maybe you'll find it works differently with different foods. Experiment! Have fun with it..
    Do you have the new Omnipod with food IOB showing?
     
  3. SarahKelly

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    we were having the same issue for while then I had a lightbulb moment, why not wait to give that insulin for the high fat portion until AFTER his BG started to rise and now that's what we do. So, say we have tacos...we bolus for about 40% up front, then give the rest at bedtime when his BG has a single digit going up, depending upon the number we either give it all then or over two hours.
    We use insulin suspend ONLY after we try to things 1) when we've already tried to use just carbs to get the BG to stay stable, 2)if that fails or we notice a nose dive we usually then go to a decreased basal for 30 min (usually half amount of insulin), then if that doesn't work we suspend until the BG is over 75. We found if we wait for his BG to rise above above 100 it's too late and we'll then be chasing highs all night so for us something magical happens at 75, then we turn the basal back up or restart depending upon which we were doing.
    Does that make sense?
    It also depends a lot on what the food is that we just ate - for example tonight we had chicken soft tacos...a long walk...and no sugar added sorbet. For Isaac both tacos and sorbet require a square wave. We square waved the tacos (over 2 hrs), but because of the walk we didn't bolus for the sorbet. Then at bedtime he was 100 with one arrow up (with a lot active), we bolused for the sorbet (another 2 hr square wave) and now 3 hours later he is at 180 with insulin working...a good start to our night :)
    Hopefully, right?!
    Maybe others have found other tips, I have just seen that a lot depends upon the food that is still being digested, the type of previous bolus, and how quickly your child responds to fast acting carbs typically.
     
  4. Joretta

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    We would suspend for a half hour and monitor instead of treat but we are trying to watch excessive eating.
     
  5. ecs1516

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    We do not suspend but use temp rates for a half to a full hour when sick and watch the numbers. We also do a half or full hour to help a BG rise when not really wanting to eating more when going toward a low. Also, if a bad low we will give glucose tabs etc. plus do an off temp do help bring them up. We also use them for sports. Cross country and sometimes soccer.Usually do -70% for an hour. We have done 1 1/2 hours off but that is pushing it. Have to watch that you don't get ketones after some point. In other words, we do them a lot!
     
    Last edited: Jun 1, 2013
  6. Sarah Maddie's Mom

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    We almost never suspend. I will drop basal down to 25% but as you noted, suspending generally comes back to bit one in the rear.
     
  7. T-bird

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    I never ever suspend. If I am low we drop the basal to 20%. I am not sure how it works on other pumps but on my pump we would have to remember to unsuspend and I could totally see myself forgetting to do that! :eek:
     
  8. Amy C.

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    I know the Animas pump starts making noises when suspended and I imagine that the Medtronic does as well.
     
  9. quiltinmom

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    Yes, Medtronic pumps will beep from time to time if left suspended. But my de tends to tune out the beeps (the other day lit beeped three different times before I asked him about it. He said it didn't beep. Lol).
    If you are concerned about forgetting to turn it back on you can do a temp basal of 0% which is essentially the same thing. But 20% is fine too.

    We suspend when he's disconnected for more Than a minute or two. That's basically the only time. Once in a while we lower basal due to a mild low but even then we don't turn it completely off.
     
  10. StacyMM

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    We typically only suspend when we are changing pods or uploading data from the PDM. For lows, we will do temp basals but very, very rarely would I suspend for lows.

    That said, for DD, suspending stops 1-1.2 units per hour and that's quite a bit. We can do an 80% decrease and she is still getting some insulin. For DS, his doses are lower (0.1-0.2 per hour) so temp basals are more limited. We've had to do a suspend just because we can't reduce the amount we want - but that was illness-related and we'd already been feeding lows.
     
  11. hawkeyegirl

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    I'm not sure we've ever suspended his pump.
     
  12. Flutterby

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    We hardly suspend I insulin...in your situation above we would have given fast acting carbs until she stopped falling and then watched bg very closely, because at some point that food will start to absorb and then you'll be dealing with highs if you suspend and over correct...we had had that happened..it's hard not to panic..it's easiest to give an extended bolus for high fat meals..or if you use injections, wait to give the injections to try and time the insulin better with the food...it's all trial and error.
     
  13. swimmom

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    My DD has used it when she can't easily even take tabs. She recently suspended during a lengthy concert band performance. She was feeling like she was going low shortly before her band went on stage, so she suspended. Was around 105 an hour later. She's also suspended during marching competitions and it's worked well.
     
  14. missmakaliasmomma

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    I seem to be one of the only ones who suspend the pump more regularly. My daughter is 5 though and not in any sports and not EXTREMELY active either so that might have somethingto do with it. Her dr said it was ok to suspend it for no more than an hour. So if she wanted to go swimming, I would suspend it and then just recheck her within that hour. As of right now, I always suspend it when she's bathing even though she has a waterproof ping. We never really have that much of an issue either. I suspend it when uploading and changing sites obviously
     
  15. MomofSweetOne

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    In 2.5 years, I've suspended once for 30 minutes followed by a 15% temp basal for the next four hours. Circumstance was vomiting up the juice for lows. I watched the CGM closely for when to turn the basal up. The problem with a complete suspend is that the stage is being set for highs and ketones later.

    I was prepared to give mini-glucagon if needed. Have you learned about it?
     
  16. Marcia

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    We do not suspend. Period. We set a very low temporary basal because there is the possibility of forgetting to restart the basal after suspending. It is what our MM pump trainer taught us in the beginning and has worked.
     
  17. ecs1516

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    I wrote the first post incorrectly . I went back and changed the wording. We don't suspend, we use temp rates to turn pump off or down. This way after the temp rate goes off the pump comes back on normally. We never use suspend except when you have to to download pump to Diasend software.
     
  18. mmgirls

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    I think the only time the pump is ever suspended is at a Dr apptment when they take it to download. And when the hand it back I have to rack my brain as to how to get it going again!

    I woud just disconnect, or run temp basals.
     
  19. Ti'sMom

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    We used to suspend when my son first started on the pump. He's a picky eater so we never knew if the insulin was too much. If he didn't finish his meal we would add up the carbs missed and suspend as needed. When he was on mdi we just bolused after meals. Pumping is so much easier for a pIcky eater. Love that we can suspend if needed.
     

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