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[IPk] Re: ip-uk-digest V2 #459 Constant basal requirements

Glargine, pumps etc.

Hi all

I'm two weeks into pumping and notice a real difference between pumping and
having glargine as a back up.  My requirements are small, sensitivity great
and I'm finding a variable basal rate wonderful.  I too had great problems
really with glargine covering the 24hours.  I managed by having quite a
small dose in the morning to cover the 24 hours which did prevent night time
hypos when I had the dose low enough.  However, I had to bolus inject
humalog for even the tiniest snack and when stress levels were up had to
bolus inject at work etc to keep bs levels down.  It was annoying as giving
up bd insulatard to prevent feeling hypo and doing my brain in worked,  but
left me with other problems and obviously less flexibility which I could
overcome to an extent with the inconveniences of more bolus injections.  Now
I'm in the novice stage  with pumping.  I  discovered that reducing the
total daily amount I took was unnecessary as with glargine and humalog I had
already reduced from about 30 total to 20 to 25 units per day.  Initially it
was suggested I start on 0.3 basal and a total would work out about 15-17
units per day with insulin/carb  ratio of about 1 unit to 25 to 30 gm.  I
had a lot of highs and have gradually increased to a total of 20 - 24 units
and a variable rate of between 0.5 in the mornings and evenings 0.3 -0.4 at
other times and 0.2 for a few hours when asleep and when running and things
seem to be stable. The carb ratio seems to be best for me 1unit to 15-20gm
and even 1 unit to 10gm  at breakfast.

However, I did encounter my first problem a couple of days ago.  Following a
site change I firstly had a pump occlusion alarm on bolusing, I then gave
the remainder of the bolus about 1.3units by pump which didn't alarm.  Blood
sugar was then high after a meal and the pump alarmed when I tried to bolus.
I injected humalog and changed the site.  BS came down after injection, I
went running BS 4.1mmol, after that bolused for supper and went to work on
night duty.   BS 3 hours later was 12  but as it was a pasta meal and that
had been causing no end of problems on glargine I thought I had got the
extended bolus and dose wrong so I bolused a unit and upped the square wave
bolus.  A couple of hours later I felt thirsty, not unusual in a neonatal
intensive care nursery, checked BS and found it was 23mmols!!  Something I
never see.  I was not happy,  had plenty of other things to think about and
felt like throwing the pump out the window!! Sense prevailed and I injected
3units, checked again 2 hours later and it was 18mmols so I injected another
3 units cursing, changed the site and upped the basal rate to 0.8units/hour.
The quick set 6mm catheter appeared to be bent at right angles so problem
solved!! Abdomen is unfortunately criss crossed with scars from
appendicectomy and three caesareans so limits sites!! By the morning BS was
4.2mmol and basal rate back down to 0.4/hr.  Any advice on sites, cannula
etc. would be appreciated. Advised I may find the silhouette better and to
try that next?

Appreciate all I've learnt from this site and from Insulin Pumpers book as
I'm really on my own here and  feel a responsibility to make sure it works
and to educate medical folk around me about pumps and insulin etc.  It's
amazing the glazed look that comes over faces and comments about it all
being far too complicated!!

DM 36yrs. Novice Paradigm User 2 wks.
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