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[IPp] Cooking Insulin, Extended Boluses & Fasting Basals [long]
In a message dated 4/9/2002 10:06:21 AM Mountain Daylight Time,
email @ redacted writes:
> Do you change out everything (cartridge, tubing,site) every 3 days or just
> the site and wait until you get low on insulin to chage it?
This is one of those questions that you'll get many answers to . . . When
Katie first started pumping (about 10 months ago) we changed the cartridge
every other set change. It wasted a little insulin, but it was very
convenient and it meant that her cartridge never got too low (something I try
to avoid for two reasons -- one is in case of an emergency that delayed a set
change she wouldn't run out of insulin and, second, because, we've only had
problems with bubbles suddenly apprearing from nowhere the couple times when
we did let the cartridge get down under 20 units).
Now that she's grown (A LOT!) and her insulin needs have increased a bit (at
least during growth spurts which seem to occur almost monthly), I can't let
her go for quite 6 days without that cartridge getting lower than I'm
comfortable with -- so we change the cartridge as needed (when we get down to
about 40 units -- which is where we set the low cartridge warning level).
Sometimes that coincides with a set change sometimes it doesn't . . . It
doesn't take very long to do, no more than a couple of minutes to fill the
reservoir and prime the tubing.
You're still new to pumping, but things do get faster. Now, with two of us
dong it together I fill the cartridge while Katie preps her site and puts on
the Mastisol). We can fill an cartridge, prime the tubing (and Katie prefers
the sets with the long 43" tubing!), prep a new site (including Mastisol), do
the insertion, and remove the old site and clean it off in 5-6 minutes
(including setting out the stuff and putting it back in the cupboard) . . .
This is why I don't agree people who say the pumping is more work than shots.
I mean we only do this every few days. Now, I will agree that you can have
mediocre or lousy control for less work in total (like if you're not carb
counting, not doing MDI with sliding scales or carb ratios etc.) while on
shots . . . but (at least for this pumpmama) pumping is way less work and
definitely way less stress than shots ever was (and control is much better --
and quality of life for Katie and our whole family is IMMENSELY better than
when she was on shots).
> I was just wondering if the
> insulin gets warm being so close to the body all the time and therefore
> doesn't work as well after many days.
The IP list had a thread about this recently and nobody reported any problems
with decreased protency from body heat. I know of any number of parents
whose little kids have the same insulin cartridge in their pumps for up to
That said, I also believe in making life easier for yourself where you can .
Heaven knows diabetes throws enough uncertainly into our lives. If it makes
things simpler for you (especially in the beginning) to not have to wonder
about whether a high could be due to insulin getting too warm, then change
the cartridge out with every set change. I did that for three weeks this
summer when we were vacationing in Hawaii. It was in the upper 80s every day
and Katie was in the sun a fair amount (when she wasn't in the water) -- it
was my vacation too and I just didn't want to worry about the insulin getting
cooked . . .
> Also, do you find extended boluses help? Teresa had a huge breakfast this
> morning and I haven't used that yet, but was wondering if it might have
> worked better tha a regular bolus?
Extended boluses are useful if your child has an problems with delayed
digestion (in general) or if you see a pattern of delayed highs after certain
foods (pizza, pasta, chinese, mexican, any high fat foods are often found to
be culprits). Katie doesn't have any digestion issues and so far we've found
no consistent patterns with any of the usual problem foods so I'm afraid I
can offer any specific advice re: extended boluses . . .
> One more question....when testing basal rates, did you test them once or a
> couple of times each? She really hates the fasting but I really think I
> to recheck a couple of time periods throughout the day.
Our endo generally doesn't do fasting basals on kids for two reasons: it's
very hard on the kids, and kids are changing and growing almost continuously
-- so by the time you really got sufficient testing done (i.e several days of
data for each same time period), you'd need to start all over any ways. She
does, however, place a lot of emphasis on getting the overnight basal rates
Katie is happy to cooperate on "fasting" until late in the morning on
weekends (I think that's one of the things we love the most about pumping --
she can sleep in and her numbers stay perfect). As a result, I've actually
been able to "test" about 14 hours worth of basals (roughly 9 pm to 11 am).
As her doc says, you can usually tell if the other daytime basals are
significantly off (especially if you do BG checks before each meal and then 1
1/2 to 2 hours after -- we test at least 8X a day and often 10-12 when she's
active). For example, shortly after school started, she was getting the
munchies after school (HUNGRY! is one of her signs of an possible low coming
on -- among other things, of course! -- so we started checking her after
school for a while and it was clear that while she wasn't crashing, she was
getting into the low 70s to mid 60s in the afternoons, so we cut back on her
afternoon basals a bit).
There's nothing wrong with doing fasting basal testing -- you can get a lot
of useful data from it. I just like to let parents know that you can do well
without it, too. After 10 months of pumping, Katie's consistenly had A1cs in
the sixes (her best on shots was 7.4) and those sixes include many periods of
serious night time insulin resistance from hormones (growth and puberty) . .
. There are probably worse hormone-insulin wars to come and I am tremendously
grateful to have an insulin pump to help me deal with those challenges . . .
Oh, one last idea about fasting basals . . . I've heard some parents do
semi-fasting basal testing where they feed their kids at least a little
something but avoid carbs (scrambled eggs, hamburger patty, etc.) . . . you
don't get quite as clear of data, but it's an option to consider . . .
Pumpmama to Katie (11, dx @9) happily pumping with her Animas pump "Elvis"
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