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[IP] Re: Questions for Pumpers

Hi Marion!

LOL! Glad to see you're keeping a sense of humor
through this. :)

I don't want to sound vague, but you'll just *know*
when the basals need to be changed because no matter
what you do, your child will seem to run high (or low,
as the case may be) all the time until you do. We
don't make basal changes very often. I'd say in the
last year, probably twice. If your child grows a lot
all at once you'll probably need to change them. If
they lose weight, you'll probably need to change them.
This is very YMMV because it really depends on the
particular child at the time, and what stage of
development they are in. But like I said, you'll just
know. :) You'll know if it's a basal problem when you
do the fasting tests. If there is no influence from
food or insulin to cover carbs, the only thing it CAN
be is basal. There are guidelines to test boluses too,
but usually you get the basals set first, then the
boluses. You'll probably keep carb intake consistent
at each meal the first month to see if the boluses are
working properly (and this will also help determine if
the problem is basal or bolus.) After this, you'll
probably need to do fasting tests from time to time. I
only do 4-5hrs at a time with my daughter, and I do
the bedtime-to-breakfast ones first as they are the
easiest to do. 
As for exercise, we have found with my daughter that
if she swims, she needs to have a temp basal at 70%
starting about 1.5hrs before she swims. For softball,
we only need to decrease the basals to 90%, starting
1.5hrs beforehand. For impromptu things like skating
and biking, we check the bg first and determine what
to do from there (if her bg is higher, we do nothing
as the exercise will lower her, if the bg is lower we
have her eat carbs and *may* reduce the basals to
80-90%). Everyone is different in their needs and how
they handle it. You'll find what works best for Gabe
over time. 

--- email @ redacted wrote:
> 1) The Pumping Insulin book continously refers to
> Humalog finishing in 3.5 
> hours.  A Humalog injection given in the arm, as far
> as we can see, continues 
> to effect b.g. for up to 5 hours.  Is it because the
> pump is connected to the 
> abdomen that the insulin finishes faster?  We did
> one drop profile many 
> months ago for Humalog injected in the abdomen.  The
> Humalog started working 
> in 5 minutes and dropped Gabe 150 points in 1.5
> hours and then stopped 
> working.  Now, that was without food.
> 2. The reason the 3.5 hour Humalog finish  is
> curious to me is that you can 
> then correct high and low numbers sooner.  Does
> everybody use the 3.5 hour 
> mark as the time when corrections can be made?
> 3. One of the pumps, apparently the Animas, measures
> in .05 units.  Is that 
> for basal and bolus?  DOES ANYBODY have good enough
> control that they can see 
> a difference of .05 units.  That is, does anyone
> control the meal size, 
> glycemic index of the foods in the meal, activity
> and etc., enough to see 
> that the .05 is significant?
> I know someone posted they love that .05 feature,
> but how could you tell?
> 4. How often do you have to change basals as your
> child grows?  Do you really 
> have a set of guidelines that tell you that the
> basal is the problem and not 
> the bolus? Do you periodically do fasting tests in
> the different time slots 
> (the book mentions four time slots involving
> skipping different 
> meals/snacks)?  The pump literature says that it is
> much easier with One 
> insulin  in the pump and not a basal and meal
> insulin to tell what is 
> effecting b.g.  But how is that the case?  You still
> have to do a fasting 
> test to see if a problem is from basal or bolus, do
> you not?
> One of my biggest problems with Gabe is knowing if a
> basal needs to be raised 
> or lowered (raised because of growth and lowered
> because of exercise) or if a 
> meal dose has failed.
> Example
> b.g. before dinner 94
> b.g  2 hours after dinner  81
> b.g. at 4 hours after dinner  136
> b.g. at 6 hours after dinner 180
> Is that a failure of the morning Ultralente or is
> that a meal that digested 
> slowly and finished digesting after the Humalog
> finished?  That is another 
> reason I am asking about the 3.5 hours.  Gabe is a
> real slow digester.  If 
> the pump then allows the bolus to be given split up,
> it is a real plus for 
> him.  
> 5).  I am daunted by the idea of "adjusting basals
> for exercise".  You all 
> must be very sophisticated in your control to know
> how much basal is needed 
> during any given period of activity.  Just knowing
> that the overall basals 
> are correct seems like an enormous task.
> Well, I hope I haven't given anyone a headache this
> morning.
> Thank you for your help.
> Marion
> not an M.D.
> opinons for Gabe only
> > 
> > 
> > 

Take care, Kerri, mom of Shannon-11, dxT1 5.2yrs, pumping 2.2yrs 
founder - Military Families of Children with Diabetes [MFCWD] 
parent network of WA email @ redacted, diabetes 
& pump mentor, future CDE, but most importantly, mom to 8 
beautiful blessings :)

~*~Integrity is how you behave when no one is looking~*~

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