[IPp] Just started pumping... lots of questions...
Andrea started pumping insulin in the Cozmo two days ago (Thursday,
October 2). Prior to that, she was on NPH and Novolog - 3 shots a day.
The ratios we (pump trainer and I) came to based on the rule of 1800, the
rule of 500 and her TDD produced correction and carb ratios TWICE what I
thought they should be. I had been using 1/2 unit of insulin to lower
her 200 points and 1/2 unit of insulin to cover about 45 grams of carbs.
The rule of 1800 and rule of 500 gave a correction factor of 200 and a
carb factor of 50 for each unit of insulin (rather than 1/2 unit of
insulin). Our pump trainer said that seemed odd, and that maybe the NPH
had been covering more of her meals than we thought, but we decided to
start with the standard model.
After starting the pump, I gave her a correction to bring her down a bit.
An hour and a half later, and after a blood sugar of 35 (!!!) and a not
very conscious child, we decided that we would try the ratios that we,
her parents, had been using on injections. However, the Deltec cannot
accept ratios higher than 200 and 50 (for correction and carbs,
respectively), so we were still doing math every time we tried to deliver
insulin. That was one of the things I hoped the Deltec pump would
eliminate. We started by giving 25 - 35% of the amount recommended by
the ratios. I pushed to switch to U50 insulin - which I guess our doctor
tries to avoid - because I guessed that she would eventually return to
ratios we had used with shots which would mean that - with U50 insulin -
we could use the 200 correction factor and 50 carb ratio in the pump.
Once I decided to switch to U50 insulin, however, I had to search for
quite a while to find a pharmacy that would mix U50 insulin for us. Any
of you had that problem?
Yesterday we switched to U50 insulin. We still have lots of tweaking to
do and she still is more sensitive to insulin than when she was on shots,
but she hasn't had another serious low. Our pump trainer warned that
parents often see a dramatic dip in needed TDD when children start the
pump, but that their needs gradually increase to what they were before.
So after all of that (sorry...), my questions are these...
(1) How many people are using U50 Humalog and has that worked well for
you? How long does mixed insulin keep since it is obviously already an
open vial as it was mixed at the pharmacy. Is U50 more expensive than
(2) Do many of you have children with a correction factor of 400 and a
carb factor of 90 to 100? Is this kid still honeymooning or is she just
really sensitive to insulin? Her TDD on shots was 10.5 units/day (7 N, 2
A at breakfast, 1/2 A at dinner and 1 N at bedtime). She is four and
weighs 35-36 pounds. We are blessed that she has had good HbA1c's since
diagnosis (6.7 and then 6.4), so her doctor felt pretty confident they
knew how much insulin she would need on the pump. Maybe she was really
sensitive to Novolog and not at all sensitive to NPH. What do you think?
(3) Did you see a drop in TDD when your child when on the pump? Did it
increase? If so, when? and did it return to the TDD your child had
previous to using the pump?
I know we still have a while before we settle into this pump thing, but
your input will speed the process I'm sure. Thanks so much!
Mom to Andrea 4 (dx 1/29/03, pumping Cozmo 10/2/03), Alicia 2, Carlos 4
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