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Re: [IP] New pump--Day 2+ (long)--Help!



> 
Ernie,

Congrats on trying pump therapy. Relax! BGs in the lower 200s happen on
pumps too-they could be a lot higher. Even you said that this is not as
high as with your old routine. You should expect some high BG-some
unexpected readings, because this is new. As long as you are not getting
symptoms of ketoacidosis (DKA) and you are testing for ketones, you don't
seem to be in immediate danger. Although changing your site is not a bad
idea, the rule of thumb is that if you get 2 BG in a row that are over 240
and you don't know why they are high, change your site.

The first most obvious problem that I see, is that you are not carb
counting. It sounds like you take the same meal bolus-7 units regardless of
what you eat.  That could account for the 200s.  Perhaps your NPH was still
active when you were getting the more ideal BG- or maybe you were just
eating differently. I would highly recommend asking for education on carb
counting. I wear a pump(x 9 yrs) and am also a dietitian and a CDE and most
of the "mysteries" I see in patients are food related-even for myself. For
some reason, the assumption seems to be that if you are bright enough to
wear a pump, then you must have the basic food stuff figured out.

> 187 (7:40pm), 215 (11:21PM)-not sure what to do, I bolused 1 unit. (Even
> here, this is NOT as high as I've been-prepump).

 You should have some type of sliding scale that would tell you how much
extra insulin to take for highs. I like everything very objective so I use
ratios to correct highs. I believe "Pumping Insulin" has details of what an
appropriate ratio would be. There is another book that MiniMed puts out for
free called "The Insulin Pump Therapy Handbook." I love it because it is
easy to access the charts I need, without reading all through the
narrative.  According to the second book, in someone who is on 40 units of
insulin per day, 1 unit would drop that person 38 points. I would likely
round that to 35 or 40 pts, so you can easily remember it. So if your
target BG is 150 which is usually the case for new pumpers, a BG of 215
would require you to bolus 1.6 units, using a ratio of 1:40. To calculate
this take 
(215-150)/40=1.6, which is in addition to any meal bolus that you might be
taking.

You can also use ratios to bolus for meals, so your meal bolus would likely
be different every time to account for the varied carb content of your
meals.  During this adjustment phase, it is often recommended that you eat
very consistently- either following an exchange type meal plan or just
eating the same things over and over.

It usually takes at least 3-6 months to get all the details worked out.
There is a lot to learn and adjust. Good luck!  Gina Goveas