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RE: Hypos RE: [IPk] Paradigm 512



Thanks Jackie.

That's very interesting. I have found that the Bolus Wizard is completely 
pointless when it comes to very high readings over a sustained period. I was 
not aware of the fact that it calculates insulin duration for 8 hour period 
only. That's quite a limitation.

This accounts for some recent high readings where I couldnt figure out why 
the BW advised insulin already on board. I had started overriding this but 
was unaware of the rationale behind the BW calculation.

Am I right in understanding that when Sasha has a high reading you 
administer the correction bolus spread over a 3-4 hour period using the 
Square Set function - or do you simply administer CBs manually every hour?

Thanks very much for this info - something I was completely unaware of, let 
alone the acronyms!

Best

Seos


>From: "Jackie Jacombs" <email @ redacted>
>Reply-To: email @ redacted
>To: <email @ redacted>
>Subject: RE: Hypos RE: [IPk] Paradigm 512
>Date: Sat, 17 Jun 2006 18:41:34 +0100
>
>Seos
>
>
>
>
>  IOB is short for" Insulin On Board". This is referring to the fact that 
>on some
>pumps they have a system, which on the Medtronic pumps is called "The Bolus
>Wizard, which can help you calculate what bolus to give based on the 
>insulin
>that is already "active" from the last bolus.     Basically you key in 
>certain
>figures, what your target blood glucose levels are, your correction factor 
>etc.
>Then if you have a high blood sugar level which you want to correct or want 
>to
>bolus for a meal, you key in the info into your pump and the bolus wizard 
>will
>take into account the "active insulin" that is still working from a 
>previous
>bolus.  This is a simplified example of what the bolus wizard is used for.  
>On
>the 512/712 you cannot adjust the duration of insulin action which is 
>"factory
>set" to 8 hours duration.  This means that if you have recently bolused to
>  correct a high BG levels and it is still high 2-3 hours later the pump is
>likely
>to "tell" you than a further correction is not needed because it "assumes" 
>that
>the insulin action from the previous correct/bolus is still working.  
>Medtronic
>have newer models available in the US that have an adjustable "duration of
>Insulin action.  Most people, adults and children that I have come across, 
>have
>their "duration of insulin action" set to between 3.0 hrs to 4.5  hours, 
>the
>most usually figure seems to be 3.5 hours.   So for Sasha we do not use the
>bolus wizard on the model of the Medtronic pump we have. 712, as the bolus
>wizard would "tell" us that no correction is needed, whereas experience has
>  shown us that for Sasha, 12 years old, that the duration of insulin 
>action
>would
>probably work best if set to about  around 3.5 - 4 hours.  When we do
>corrections we tend to work them out in our head or use a calculator  using
>3.5 - 4 hours as our basis for the duration of insulin action.
>
>  There are other pumps in the UK like the Cozmo, Animas and the newly, or 
>soon
>to
>be released Medtronic 522 sensor augmented pump that all have adjustable
>"duration of insulin action" features.
>
>The Dual or Square wave functions are a different things.
>
>For instance if you were eating a meal with a lot of fat or protein you may
>calculate the total carbs and you might choose to bolus half with the meal 
>but
>deliver the rest of the bolus over two to three hours.
>
>Some more info about IOB here
>
>http://www.childrenwithdiabetes.com/sports/iob.htm
>
>http://www.diabetesnet.com/diabetes_technology/pump_durinslact_danger.php
>
>
>Jackie mum of Sasha aged 12 years
>
> > Hi Melissa
> >
> > What's an IOB feature?
> >
> > Also, what do you mean about adjusting the duration of insulin action? I
> > thought the Dual Wave and Square Set functions did that - or is there
> > something smarter available on some of the other pumps?
> >
> > Thanks!
> >
> > Seos
> >
> >
> > >From: "Melissa P. Ford" <email @ redacted>
> > >Reply-To: email @ redacted
> > >To: email @ redacted
> > >Subject: Hypos RE: [IPk] Paradigm 512
> > >Date: Sat, 17 Jun 2006 01:11:59 -0500
> > >
> > >Hi June,
> > >
> > >It sounds to me like you may be a candidate for the old "aim-for-8 
>mmol/L
> > >for 3 weeks/do everything to prevent going hypo" trick for restoring 
>hypo
> > >unawareness. The frequent hypos that you have had may mean that your 
>liver
> > >is basically empty of glycogen (because of the first few bad hypos) and 
>you
> > >need to rebuild the glycogen stores. The new pump definitely won't 
>hurt:
> > >having the IOB feature, even though you can't adjust the duration of
> > >insulin action on a 512, may help you prevent hypos too.
> > >
> > >If you want references on avoiding hypos for 3 weeks to restore hypo
> > >awareness, I can find some. But your DSN should know the technique too.
> > >
> > >Good luck getting this situation sorted. It must be No Fun :[
> > >
> > >Melissa
> > >Type 1 13 years, MiniMed pumper 7.5 years; Animas pumper 2 years 5 
>months
> > >.
> >
> > _________________________________________________________________
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