# [IP] Re: question

```> To: email @ redacted
>
> -> For extended periods without the pump (up to 5 hours) I have
> -> developed a bolus technique that allows you to shoot regular into the
> -> QR and compensate for the 2.5 units in the short piece that remains
> -> attached. This must be done at meal time when a large bolus is
> -> available to flush the line.  If anyone is interested, ask and I will
> -> explain.
>
> I am interested, and would appreciate an explanation.
>
> What does it mean: "This must be done at meal time when a large bolus
> is available to flush the line?"  Why flush the line?

For the purpose of explanation, I will assume that the reader is
using a MiniMed sof-set or bent needle with a QR (quick release)
fitting.  I know the amount of insulin in the short piece from the QR
fitting to the pumper to be approximately 2.5 units.  The technique
described may be used with other quick release devices, but the
pumper must first determine the residual insulin contained in the
device that is still attached to pumper and adjust the following
description accordingly.

Problem:
The pumper wishes to go rafting on the nearby river with friends all
afternoon.  It is unwise to wear his/her pump since it will drown if
the raft flips in the rapids and pumper does not wish to wear a
sport-guard that sometimes leaks.

For this example, let us assume that the pumper has an insulin to
carb ratio of 10 (to make the example easy) and that his/her daytime
basal rate is 0.3 units/hr. AND the pumper uses HUMALOG.

Pumper eats lunch consisting of 60 grams of carbo but DOES NOT BOLUS.
Instead, pumper performs the following exercise.

First, for the above meal, pumper would have bolused a total of 6
units of insulin consisting of 2 units (1/4 to 1/3 of bolus) with the
meal and the remaining 4 units (2/3 to 3/4) in a square bolus over
the next 3.5 hours.

Pumper will need a total of 6 units for his/her meal and
0.3 * 5 = 1.5 units for basal over the next 5 hours for a total of
7.5 units of insulin.

Pumper will receive 2.5 units of Humalog and 5 units of regular as
follows:

Pumper draws 5 units of regular in a syringe and injects it into the
QR fitting thereby receiving 2.5 units of Humalog that was in the
line (flushing the line of Humalog) and 2.5 units of regular for a
total of 5 units.  The QR fitting and line are now full of regular
(2.5 units).  Pumper connects his/her pump and boluses 2.5 units to
flush the line of regular, thereby receiving the rest of his insulin
dose and refilling the QR line with Humalog.

- ---------to repeat-----------
Shoot 5 units of regular -- get 2.5 units H + 2.5 units R
Bolus 2.5 units of H -- get 2.5 units or R (in the line)

- -----------------------------------------------------------------
This technique requires that enough insulin be taken so that the
initial 2.5 units of Humalog received approximates the initial 1/3
requirement for the meal bolus. If the 1/3 requirement is higher,
more can be added but this is the minimum.

If there are any questions, please post them and I will do my best to

The senario presented is real, this summer while camping, Lily used
this technique every day while riding inner tubes down the American
River all day.  It worked well and allowed her to have fun and not
worry about her pump while going over class 3 rapids.  She did not
have to check and bolus every hour or so as would be necessary on
Humalog with your pump removed. The only difference is that her
ratio is 11 and she eats more (teenager you know) so her boluses were
typically in the 10 to 14 unit range which required a little more
Humalog..  I will leave the calculation to you folks.
If you need specific help figuring this out, send me an example meal
and I will send you back the answer.
email @ redacted

```