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re: [IPp] stubborn high counts, how often to change

Hi Fayeron,

 From our bountiful three weeks of experience, here's my two cents:

(1)  My day-care provider and I have independently noticed that my 
daughter will often have high blood sugar on waking from a nap, then 
her blood sugar will drop quite a lot right afterward without any food. 
  I suspect that this means that when she is sleeping (and inactive), 
sometimes the insulin just pools up under her skin without being 
absorbed well - and then when she wakes up and starts moving around, 
the circulation gets going and the remaining insulin gets absorbed all 
at once.  Maybe this is what the "dawn phenomenon" is - simply poor 
absorption of insulin when one is asleep and inactive?  (I'm just 
making this up, but it makes sense to me so far.  Certainly the high 
sugars weren't caused by bad sites.)

(2) Like several others with wee ones, we were told to change the site 
every second day.  In addition to the reasons stated, there is the 
issue that the insulin might not be stable enough to use in the pump 
for longer than that.  We are using Humalog in Sigrid's pump (as most 
people do), but Humalog isn't recommended by the manufacturer for use 
above 86 degrees F (I just talked to them about this last week).  This 
doesn't necessarily mean that it isn't stable above that temperature - 
it probably only means that they haven't tested it at higher 
temperatures.  However, wearing a pump close to the body, as a toddler 
must, will keep the insulin at just a little below body temperature 
(probably about 92 - 95F?).  Maybe hotter on a scorcher summer day.   I 
have heard, anecdotally, that Humalog doesn't do well in the heat.

Note that Novolog (unlike Humalog) has been tested for pump use, and 
the labeling for Novolog says that you should change the insulin in the 
pump every two days, or if the pump insulin has been exposed to heat 
greater than 98.6 degrees F.  In fact, the labeling says in bold type 

So that's why we change the insulin every two days.  Yes we throw a lot 

- Maria
mom to Sigrid, dx'd @ 11 mos. 09/02;  pumping since 17 mos.

Date: Sun, 27 Apr 2003 19:28:40 -0700
From: "Fayeron Morrison" <email @ redacted>
Subject: [IPp] stubborn high counts

OK, I'd love to have some input.  Last night was the night of the
stubborn high.  Basically, despite consistent bolusing every 2 hours,
Alex stayed at 275-305 the bulk of the night.  Around 5:30 am he went to
68, I treated very mildly, he woke up at 120.  At lunch time he was 375.
He just left for baseball, 201-which is ok.  Now, old pros out there,
here are my questions:

1.  I don't think the site is technically bad, but it seems like
something must be going on with the absorption.  I'm thinking when he
gets back I should probably change the site.  It would be a day early
and I'm out of EMLA, so I don't really want to...what do you all think?

2.  Even at the end of 3 days , we throw out alot of insulin.  If you
change the site early, do you just throw out more insulin or is there
anyway to use what is left in the reservoir?  If I change his site
today, I will throw out 48ml of insulin-what a waste.  I keep trying to
fill the reservoir with less but I hate it when I get those low
reservoir messages.
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