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Re: [IP] To H or not to H

Hi, Sam:

I'm going to snip a lot of this, otherwise folks will be sending me
invoices for their download time ;-)


>How do you tell when a site has lost it's "effectiveness" and needs to be
You might notice that BGs don't respond to a bolus (or boluses) to bring
down a high, for example. You might also notice a shift in your normal BG
patterns for no reason - diet is the same, activity and stress is not a
factor, etc.


Re:  DKA risk:

>Although, this is a general risk for all pumpers, but I can certainly
>understand why it would be even more so for Humalog. I think I recall
>reading that there is some sort of alarm if the pump is not able to do its
>job (for whatever reason). Does this work as advertised?
The alarm which you are probably referring to is a "No Delivery" alarm.
Pumps have a means of determining that insulin flow has been interrupted
and will sound an alarm to alert you. An example might be a kink in the
tubing, an occlusion at the site itself, or the insulin cartridge /
reservoir has run out of insulin. Alarms simply alert you to the problem
after it has occurred - they do not prevent or ward off DKA.

For a long time, I used a pump which was set to alarm after approximately
2.5 units of insulin had *not* been delivered. My basal rates then were .2
units per hour for long periods of the day. At this rate of delivery, it
would take about 12.5 hours to reach the threshold of 2.5 units for the
alarm to sound. With Humalog, I could very easily have been in DKA by the
time the alarm went off. I made sure I tested more frequently and I paid
very close attention to the pump and infusion sets.

As you said, there is always a slightly higher statistical risk of DKA
while pumping. I think the statistical risk is even slightly higher with
Humalog, due to its short life span. On the good news side, I don't know
that this is more of a problem among Humalog pumpers. I don't know of
anyone who has gone DKA while using Humalog. If you're out there lurking,
please speak up - it's important.


>I've been using Humalog for about a year now... no adverse reactions yet...
>but then, I'm just using it occasionally not all the time. I can understand
>that using Humalog exclusively might cause reactions that may not show up
>during occasional use.

This is possible, as it is with any medication. It may take some time to
notice changes. It may also take some time to realize the full benefits of
Humalog as well, so users might want to give it a good solid try before
they decide it is not for them. I'm certainly glad I worked with it for as
long as I did.


>he wouldn't oppose it either. However, maybe a mixture of R and H might be
>a better approach.
There are many users working with a mixture, in an attempt to "get the best
of both". This offers some interesting potential.

Bob Burnett

mailto:email @ redacted
Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/