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[IP] Re: Newly Pumping

Hi Debbie,

We just started our daughter on the Cozmo  a few weeks ago.  The 
numbers you're reporting are not bad, given that you're just starting 
out.  Heck, for us, those are great numbers!  (But Sigrid is a lot 
smaller; if we can keep her in the 100's for 60% of the time, we're 
ecstatic).  But for you, here's what I would suggest:

(1) get the book "Pumping Insulin" by John Walsh.  Your bookstore won't 
have it on the shelf, but they could order it for you, or you could 
order it online (including through the IP website).

(2) be patient.  It will take fine-tuning to get the basal ratios 
right, and the bolus ratios right.  You and your endo team can guess at 
the right numbers based on the insulin your son was using in shots, but 
with the pump things are different, so it's not a one-to-one 
correspondence between the background (NPH) shots to the basal insulin. 
   If your son was doing just NPH shots, without any short-acting 
insulin for meals, then it makes it harder to guess initially at the 
right amount of insulin to give as basals versus as meal boluses.

(3) I will say this though: If several hours after eating your son's 
blood sugar was 354, then two hours after a correction bolus it was 53, 
your correction bolus was too big.  Try a smaller correction bolus next 
time.    You could probably cut the correction bolus by at least a 
third, possibly even in half - once you do that, it will probably be 
too little, and then you can inch back up to find the right ratio.  It 
is possible too that your son's nighttime basal rate is too high 
(though a basal would not have done this dramatic drop by itself, 
unless it were WAYYYYY off).

(4) Again, as so many have said, pizza, ice cream, and other high-fat 
foods will have a delayed effect on your son's blood sugar.  "Pumping 
Insulin" will help you with this.

(5) Actually, you would expect your son's blood sugar to go up after 
eating, but hopefully by two hours post, it should be back down to 
close to the premeal level.  153 for pre and 181 for two hours post 
doesn't sound bad to me at all (though maybe you would have like the 
premeal to have been lower to begin with?  not sure for your child's 

(6) Keep in mind that YOU are the employer of your endo, CDE, and team. 
  YOU (and/or your insurer) are paying them for their services.  If you 
don't understand what's happening, they aren't giving you good service. 
  Now, to be fair, you need to let them know if you're confused.  Keep 
them in the room until they have answered your questions - or until 
they have explained enough that you finally understand well enough to 
know what questions to ask.  I know this can be hard to do; we're 
trained to view doctors as authority figures to be obeyed.  But 
remember, you are the CUSTOMER and you are paying for a SERVICE, and as 
part of that service, your endo and team need to teach you how a pump 
works, and how to troubleshoot it.  Again, don't expect miracles 
overnight.  But it will require a lifetime of adjusting and finetuning, 
and it will be better for both you and your endo team if you understand 
the pump well enough to do some of the finetuning yourself.  Hang in 
there!  It's worth it!  (But you do need more information than just 
what your doctors tell you; you need a "manual" too.)

- Maria
mom to Sigrid, pumping @ 17 mos.

Date: Sat, 26 Apr 2003 10:17:15 -0400
From: "Debbie Crawford" <email @ redacted>
Subject: [IP] Newly pumping

Hello list,
I appreciate this list and all the helpful tips, etc.  We are new to the
list although my 9 (10 tomorrow) son has been diagnosed for 3 1/2 
years.  We
just got on the pump this week (Deltec Cozmo) and things are crazy.  His
sugars are like a roller coaster ride.  As much as I didn't like NPH, 
seems worse.  I have wondered if his set was working properly but he is
getting insulin but it's just "kicking in" at weird times.  Our endo. 
his patients in the hospital for 23 hr. observation so.. when we got 
his sugars were in the low 200's, an hour after the pump was on and a 
of .3 his sugar came down to 93.  Good sign things are working.  
Well... he
then ate lunch and we counted the carbs exactly and gave the correct 
educator standing there watching every step, which was very helpful and
assuring.  He actually ate pizza and ice cream and two hour post was 
Yeah, I like this.  Well, that's when everything seemed to change.  BG 
dinner was 153 and 2 hour post was 181, I thought the BG's were 
supposed to
go DOWN.   10 pm BG was 231 and 12 mid. BG was 211.  Doctor called and
changed the basal from 8 pm to 8 am to .4.  3 a.m BG was 214 and 8 am 
194.  Doc came in that morning and changed basals again.  Now it's .3 
the day from 8 a to 8 p; .4 from 8 p to midnight and .5 from midnight 
to 8
a.  Well yesterday at breakfast we counted carbs exactly again and 2 
after he was 348.   We were leaving the hospital and I stopped by the
educators office and she said she thought that was okay, he wasn't as 
in the hospital, not much to do, so let's wait and see. I thought maybe
something was wrong with the set, but she said she didn't think so.  We 
using quick set.  Well at dinner last night, sugar was 128 and then 2 
later 269 and then at 10 pm. 354.  What?  So instructions were to give a
correction bolus if ever over 300.  I gave the bolus at 10 and woke him 
midnight and he was 53.  I am so confused.  I can't understand it all.  
don't want to freak but something is not making sense to me.  If anyone 
any ideas or similar experiences or insight we would be appreciative.  I
know this is all new to us and we need to give it time but it is just so
confusing.  Thanks for patiently reading my long post.
Debbie Crawford
email @ redacted
Mom to Kendall, dx'd 11/99, 10 yrs. old tomorrow
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