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[IPp] Lisa Lamb: pumpin' toddlers (Cozmo features/limitations)

Hi Lisa,

We just got a Deltec Cozmo yesterday for our daughter Sigrid (diagnosed 
at 11 mos; will be 18 mos. next week).  The fact that the proper amount 
of insulin can be ordered by carb counting, rather than requiring lots 
of complicated calculations, means that we can be confident that our 
day care provider will be able to use the pump correctly.  Also we can 
lock out the keys so that Sigrid and her playmates can't bolus her 
accidentally -there are also several other features that are especially 
helpful on this pump for use with little ones.  And yes, the tiny bolus 
amounts were important for us; a little insulin goes a LONG way for her.

I will say that I was surprised at a few shortcomings of the Cozmo.  
The software is only set up to permit a maximum carbs-to-insulin ratio 
of 40 carbs per unit insulin, and the correction bolus can only handle 
a maximum of 200 points (drop in blood sugar) per unit insulin.   We 
figure however that  Sigrid has a carbs/insulin ratio of about 80/1 
(she weighs 26 pounds and (on shots) uses a total daily dose of 6 units 
of insulin), and if given as a correction bolus (in a shot, over an NPH 
background), one unit of Humalog will drop Sigrid's blood sugar by at 
least 300 points.  SOOOO - how can we get around that with this pump?

Well, one way would be to punch in the actual amount of insulin we want 
to deliver - which would mean doing all the calculations ourselves, 
just as you would with any other pump, thus ignoring all the 
calculating power that this pump has, which was a major reason why we 
chose it.  What we're going to do instead is dilute the insulin (using 
the diluent which our pharmacist obtained FREE from Lilly - no 
prescription needed!).  Unfortunately, there's no way to tell the pump 
that we have diluted the insulin; it always assumes that it is loaded 
with U-100 (the only insulin concentration sold in the US).   But - if, 
say, we dilute the insulin twofold (so it's 50 units/mL instead of 100 
units/mL) then if we tell the Cozmo that we want a bolus of one unit 
insulin per 40 carbs, it will give the correct amount (when what we 
really want is one unit per 80 carbs).   As soon as we get the 
Treatment Assistant software, we'll plaster all over the screens that 
the pump is filled with (whatever concentration we end up using) rather 
than U-100 - and somehow we'll need to indicate that when the pump says 
it's given a certain number of units insulin, those "units" need to be 
divided by our dilution factor.  Just in case of that "emergency 
situation" that might arise where the EMT's and ER personnel might 
assume that the pump has U100 in it.....

By the way, we found out about the diluent through the IP list - no 
thanks to our endo group!  We had been asking them for diluted insulin 
since the first week Sigrid was diagnosed, to no avail.  At one point, 
one of the docs said that she would "look into" how to get diluted 
insulin for us (they're pediatric endocrinology specialists and they 
don't know how to do this?) and she said that she did in fact make 
arrangements with the hospital pharmacy to make this for us - but when 
we called the pharmacy they didn't know what we were talking about.  
Still, at least she was willing to look into it, which is better than I 
can say for some of the others in the group.......

  - Maria
currently hooked up to Sigrid's ice blue Cozmo and pumping diluent into 
myself (waiting on Sigrid's pump start next week).
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