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RE: [IPp] Re: First week over

I think it's important for us to keep letting Deltec know what we want in a
 pump. They originally designed it based on input from endos and patients. Also,
they don't plan to charge for software upgrades like Minimed.  That means that
all our suggestions mean better software, and a better pump for ALL who use it,
not just the latest users.

We're also diluting our insulin to U50.  I really pushed to do it so we could
use the carb counting feature.  Emma's ratios are close to not needing to
dilute, but I like it because we can get into really precise measurements.  I
 got brave this weekend and started fiddling with ratios on my own. I've had her
between 77 and 145 for 2 days now. (Can you hear me singing??)  It's made me so
brave, I'm going to try the dual wave and square wave boluses soon.

What would REALLY be great, is if they wrote a Pumping Insulin geared toward
pediatric patients.  I flip through the book, but the insulin amounts are HUGE,
and it throws me off. I can't absorb the math and concepts and re-calculate to
 our needs all at the same time. Sometimes diabetes makes me feel really stupid.

Mom to Madeline 9, Austin 7, Emma 4 dx 10/9/02 - pumping Cozmo 9/22/03, Abigail
3, Genevieve & Gracie 1 

-----Original Message-----
From: email @ redacted
[mailto:email @ redacted] On Behalf Of David Jensen
Sent: Sunday, October 19, 2003 9:04 AM
To: email @ redacted
Subject: [IPp] Re: First week over


Good move on the dilution!  Now, if we could get Deltec to grade their 
carbs in tenth's.  Face it, trying to adjust the food coverage by going 
1:6 to 1:7 (which means 1:24 to 1:28 - what happened to 25,26,&27?) is 
a real pain in the behind.

See comments to specific sections below.


> Thank you for your reply!  We are currently diluting the insulin 
> 50/50, although our endo didn't really recommend it.  We think that 
> her insulin needs may still go up slightly, but, if they don't, I 
> think diluting 4 to
> 1 will be our best option.  Especially since her correction factor is 
> 270
> with U50 insulin, and the pump currently does not accept a factor over
> 200.

This is the reason we went to 1:4, so we could tell the pump her 
correction was 1:100 when in reality it's 1:400.

>  At night, we have a six hour period or so where she gets 0.05 unit 
> one hour and then the pump is off for two.  We're working to see if 
> that is too much or too little - she has varied a fair amount from 
> night to night.  I would prefer to dilute the insulin more so that the 
> pump didn't
> shut off for two hours at a time as I worry about clogs.

Sigrid has changed pretty much continuously from day 1.  Until last 
month, her early am basal was 0.15 U/hr (remember, divide by 4!  That's 
= 0.0375 U/hr).  Then we adjusted her late pm basal to cover growth 
hormone issues and within a day or two, we had to increase the early am 
to 0.25U/hr, she was going high.  Plus we had to decrease the late am 
(pre-lunch) since she was going low right after nap.  The learning:  
fiddling in one time affects other times you don't think will be 

>  We'll see how
> her insulin needs go over the next couple of weeks.  We had always 
> used Novolog with NPH when she was on shots, but we switched to 
> Humalog when we decided to dilute.  We found a pharmacy that would 
> make the U50 for us, but I wonder if making it ourselves would be 
> better.  I had them make us two vials of U50 insulin, because I wanted 
> another one on hand in case
> we dropped one.  But, the insulin is already "open" once they have
> diluted it so, at least in theory, I will just have to get rid of that
> extra vial at the end of the month.  If I diluted it myself, I could 
> keep
> extras of diluent and Humalog on hand to mix when needed.  Any
> suggestions?

I usually make two vials at a time (each contains 8 mLs of fluid, 2 of 
insulin + 6 of diluent).  Each vial lasts 2-3 weeks.  I keep them in 
the fridge and don't worry too much about the "open" issue since I've 
only been into the vial once to make it.

> We have also been having a problem of having highs two to four hours 
> after meals.  We are working to sort out if that is a basal or bolus 
> problem.  We are guessing it is a bolus problem because it seems to 
> happen no matter what time her meal is.  I think that her insulin 
> peaks and poops out fairly quickly so we are first trying an extended 
> meal bolus to see if that helps her numbers two hours after eating.  
> Do you find that your insulin action time is shorter with such a young 
> pumper? Do you use the extended bolus feature with your little one?

See above and...  Sigrid is nowhere near "normal" 2 hours post meal.  
We bolus for food after she's done eating.  If we check her at 2hr post 
meal, she's way high, but if we check at 21/2 to 3 hours she'll be 
close to normal, so we wait.  I'm assuming/hoping that this pattern 
will go away once we start bolusing pre-meals (non-toddler!).  We've 
stayed with the default "3 hours" of insulin action on the pump only 
because we haven't tried to measure the time of action in Sigrid (too 
many other things would have to happen first...).  When she was on NPH, 
I can guarantee you that its action was far shorter than advertised 
(peak at 5 hrs, gone by 10 hrs).

We haven't used the extended bolus feature too much yet.  Haven't 
figured out her response to food yet.  Cheese ravioli we cover straight 
up, no problem.  Ice cream seems to send her high for 5 hours post food 
- we think.  Still testing.

Isn't it great that our children are ongoing biology experiments?

David Jensen
Father to Sigrid, Dx 9/02 @ 11 months, Pumping Cozmo 4/03.
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