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RE: Hypos RE: [IPk] Paradigm 512



Thanks Tim, agree that Wizard a hugely helpful indicator. I use NovoRapid 
and assume activity period about 3 hours? Will need to get my head around 
that one, but very helpful postings on this forum directing the way.

Seos


>From: email @ redacted
>Reply-To: email @ redacted
>To: email @ redacted
>Subject: RE: Hypos RE: [IPk] Paradigm 512
>Date: Sat, 17 Jun 2006 18:01:11 -0600
>
>Seos,
>
>I just follow the arithmetic of the Wizard and find that superbly useful.  
>It prevents you from banking up insulin and certainly, for me, prevents as 
>many lows.  You have to ensure that you have a good estimate of the 
>activity period.  I use humalog and an activity time of 4 hours.  For my 
>money, this is one of the nicest features of the Paradigm 515, which is 
>what I use.
>
>
>
>>Hi Jackie
>>
>>Thanks for this. You really have explained very clearly and, yes, while 
>>I'm aware of the difference between the correction bolus and using the 
>>Square/Dual Wave function, am pretty hazy about 'insulin on board' (only 
>>just come across the term in the Bolus Wizard) and the Diabetes Mall. I 
>>did DAFNE a few years back but seem to have lost touch with new 
>>developments.
>>
>>I'm definitely going to check out those sites and that book you mention. 
>>Very helpful hearing about your strategy with Sasha and raising temporary 
>>basal for high-fat meals is an option I hadnt considered. Although a 
>>diabetic for over 30 years, I'm definitely a newcomer to such fine-tuning 
>>and thanks for taking the time to clarify it for me.
>>
>>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 21:57:24 +0100
>>>
>>>Hi Seos
>>>
>>>
>>>  Maybe I didn't explain very well about the difference between a 
>>>correction
>>>bolus
>>>and using the Square wave or duel wave functions.
>>>
>>>The Square wave and duel wave functions are not really anything to do 
>>>with
>>>correcting a high blood glucose reading, but to do with bolusing for food 
>>>that
>>>may take much longer to have an effect on the blood sugar levels.  Food 
>>>like
>>>pizza or curry and rice or some pasta meals.  In many people, if they 
>>>bolus the
>>>full number of units calculated for the carbs in that meal they often go 
>>>hypo
>>>and then high again later.  This may be due to the fat slowing down the
>>>absorption of the carbs.   However Sasha rarely goes low just after a 
>>>meal but
> >> does need a higher basal to cope with a rise around 6 hours later due 
>to the
>>>fat
>>>or protein.
>>>
>>>We have tried using the Square wave and Dual bolus feature for various 
>>>meals,
>>>but it didn't work out very well for Sasha.  Most meals, whether they 
>>>contain
>>>fat or protein, seem to need the whole of the insulin amount immediately 
>>>and we
>>>only see a rise from the fat and or protein after 6 to 8 hours later with 
>>>the
>>>  blood sugars in between being at normal levels. So using a fancy bolus 
>>>wouldn't
>>>  help Sasha at all. For curry and rice, which always sends the BG levels 
>>>up high
>>>later, we put on a temporary basal rate at around 6 hours after the meal, 
>>>to
>>>last  for around 3 -4 hours.  We just increase the basal to show 140%.
>>>
>>>If we are correcting a high BG level then we tend to use the chart on the
>>>Diabetes Mall for working out what insulin is still "acting" after the 
>>>last
>>>correction or bolus.  Though John Walsh, one of the writers on Diabetes
>>>mall/IPumping Insulin books, previous had a different table which showed 
>>>the
>>>duration of insulin action to finish at around 4 hours and had almost 
>>>finished
>>>  by 3 hours duration. He has since amended his "Unused Insulin Rule but 
>>>we still
>>>find the original table works best for us.   His new table is on the 
>>>diabetes
>>>mall here.  I printed it off and laminated it so I have it in the middle 
>>>of the
>>>night as a reference.
>>>
>>>Bolus on Board
>>>
>

>>>http://www.diabetesnet.com/diabetes_control_tips/bolus_on_board.php?PHPSESSID=
>>>7ce42496460a
>>>
>>>Try this link if url wraps  http://tinyurl.com/q8kbx
>>>
>>>
>>>
>>>Jackie
>>>
>>>>  ----
>>>>
>>>
>>>>
>>>>  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
>>>>  > > >.
>>>>  > >
>>>>  > > _________________________________________________________________
>>>>  > > Are you using the latest version of MSN Messenger? Download MSN
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>>>>  > > 7.5 today! http://join.msn.com/messenger/overview
>>>>  > > .
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>>>
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>>
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>
>
>--
>Tim C.
>.
>----------------------------------------------------------
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