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[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.

INSTEAD, pumper disconnects the pump.

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.

Total insulin received 7.5 units.

- ---------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 
answer.

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