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Re: [IPp] Just started pumping... lots of questions...

 We diluted the insulin ourselves. Used huge 5cc needles to do it. Lilly will
supply the diluent (they'll send it to the pharmacy, not directly to you) and I
mixed it. Pain it the butt, but it was well worth it.

---------- Original Message ----------------------------------
From: Natalie G Rodgers <email @ redacted>
Reply-To: email @ redacted
Date:  Sat, 4 Oct 2003 19:04:12 -0600

>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
>U100 Humalog?
>(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
>The best thing to hit the internet in years - Juno SpeedBand!
>Surf the web up to FIVE TIMES FASTER!
>Only $14.95/ month - visit www.juno.com to sign up today!
>for HELP or to subscribe/unsubscribe, contact:

Kelly, mom to Jillian 13, dx'd 2/6/01, Patrick 11 and Erin 3 
Happily married to Steve

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