Pump arrives on 18th June, advice needed please

[dani-a]

Hi everyone,

I have posted a couple of times before with general questions on pump therapy but have now been given the date for the pump on 11th June (saline) and then on 18th June for insulin.
I was apprenhensive as been a T1 for 40 years (with a couple of complications)on MDI but after reading all the posts I am now very excited and just a tad nervous.
I have just a couple of questions that hopefully some people might be able to help me with.
Current regime is Lantus (15u at 22.30pm) and Humalog (brekkie ratio is 1.3:1, lunch is 1.2:1 and tea is 0.6:1), so when I go onto the pump with insulin my DSN says I will be testing all day to get the basal dose correct, won't I still have some Lantus on board for the next couple of days that will still be active so do I have to then reset my basal again to counteract when the Lantus is completly gone?
Also do you think that my CP to Insulin ratios remain the same or will I have to adjust those as well?
Do we follow the DAFNE principles on the pump, i.e. have the same targets before meal times, and just another niggle that's in my mind, I have several coffees in the morning, I guess I'll have to do a bolus to conteract these as well, or would I follow DAFNE and correct for these at meal times?
I have ordered the Pumpers Bible by John Walsh due to all the good press on theis site, so am confident that I'll get there in the end.
Apprecaite any advice/knowledge that my fellow pumpers can give me prior to the start of my new regime
Thanks
Dani

 

[noblehead]

Dani,

I can't help with your pump questions but would just like to say good luck and hope all goes well

 

[iHs]

Hi everyone,

I have posted a couple of times before with general questions on pump therapy but have now been given the date for the pump on 11th June (saline) and then on 18th June for insulin.
I was apprenhensive as been a T1 for 40 years (with a couple of complications)on MDI but after reading all the posts I am now very excited and just a tad nervous.
I have just a couple of questions that hopefully some people might be able to help me with.
Current regime is Lantus (15u at 22.30pm) and Humalog (brekkie ratio is 1.3:1, lunch is 1.2:1 and tea is 0.6:1), so when I go onto the pump with insulin my DSN says I will be testing all day to get the basal dose correct, won't I still have some Lantus on board for the next couple of days that will still be active so do I have to then reset my basal again to counteract when the Lantus is completly gone?
Also do you think that my CP to Insulin ratios remain the same or will I have to adjust those as well?
Do we follow the DAFNE principles on the pump, i.e. have the same targets before meal times, and just another niggle that's in my mind, I have several coffees in the morning, I guess I'll have to do a bolus to conteract these as well, or would I follow DAFNE and correct for these at meal times?
I have ordered the Pumpers Bible by John Walsh due to all the good press on theis site, so am confident that I'll get there in the end.
Apprecaite any advice/knowledge that my fellow pumpers can give me prior to the start of my new regime
Thanks
Dani

Hello Dani

In answer to yr question about how long the basal effect from Lantus and Levemir will linger on in your bloodstream after you start pumping is that it varies from person to person. You will have to adjust your basals the first week and then probably the second week as well. It's good that you've worked out your carb ratios on MDI. They will be something similar only 20-30% less on the bolus insulin.

On the bolus wizard on the pump a target is usually set........ my target is 6mmol so my pump tries to bolus me enough insulin to get my bg levels to the target but to get the target to work correct, I also need to get my basal rates somewhere near being correct and also the carb bolus too.

What pump are you getting?

 

[dani-a]

Thanks iHs for your comments, all very reassuring, think I'm having a mild panic about the pump before I've even got it!
Well orginally I was going for the Omnipod but have changed my mind and am now getting the Accu Chek Combi, thought as I already used the Aviva Expert BG Monitor it would be a bit easier.
I understand about the targets but didn't know if pump users used the lower limit of 4.5 on DAFNE principles, or maybe have that a little higher for pre-meals
With regards to the coffee question, I tend to have three or 4 cups in the morning, and probably tend to have it a bit milky, so a good half a mug full in the mornings, should I worry about this or again am I panicking about nothing?
Thanks
Dani

 

[iHs]

I've also got the Accu chek Combi and have been type 1 like yourself for a long long time lol.

The Accu chek Combi bg meter is exactly the same as the Expert so you'll be fine. By default the target is set between 4-8mmol on the Combi so it tends to go to the middle of the two readings and uses 6mmol but you can set it to be as low or as high as you want it to be. 6mmol is a good level to aim for although there will be times when you do a bg test and find that you are either on the low side or a bit higher than 8mmol. The pump will take all this into consideration though and will work out a correct bolus for you or if you are lower than 4mmol will tell you to eat some glucose first.

With regards to drinking coffee and tea....... I am not working at the moment and do tend to drink some cuppas, so have included all the cups of tea, coffee with milk in them as part of my basal rates. In other words, ... I dont bolus for the milk. It's a rare day when I dont drink any coffee and tea so that's why I have included them in the basal rate. It's up to you though what you do.....

 

[jopar]

iHs, given you the main details I was going to say that I don't bolus for my tea/coffee was going to say that I don't add it to my bolus, but then realised that as iHs said I actually include it in my basal, as when fasting I still drink tea/coffee!

A lot of the DAFNE principles are still valid for pumping, but you don't have to wait to the meal to correct or cover a snack you eating near a meal time... Just take your BG, your wizard will do the rest, if your BG it will say how much, if you enter your carbs it will to all the calculations for you, such as any insulin you've still got active from your last bolus/correction...

There is one thing to remember, the wizards doesn't take into consideration any temp basal rates you set, the calculation for correction/carbs are based on what bolus insulin you've used and carbs you've eaten..

So when it comes to changing cannula's, if you've changed the tubing as well, you use the prime feature for this, but when you prime your cannula, Couple of tips here..

Change cannula and/or tubing, and do the priming before you take your BG,

As you use the main prime feature for tubing only,,, when it comes to the actually cannula, you need to use the bolus wizard, enter enough carbs to correspond the amount of insulin required to prime the cannula, then press ok, it will warn you, that you haven't taken a BG, and do you want to go ahead! press yes!

Once you've done this, then take your BG,

By doing it this way round, you keep your bolus wizard on track.. As if you just deliver enough insulin to prime the cannula, without fibbing you eating some carbs, it will then see the insulin a spare insulin, so the next time you eat it will automatically deduct this off the insulin needed for the carbs you are about to eat... Faffing up the wizard for that BG...

Another tip, best time to change your sets is before a meal/snack as you can pick up any problems with the new set quicker this way...

Oh, I've got my range setting slightly different depending on time of day, overnight it's 4.5-6.5mmol/l and during the main day it's tighter 4.5mmol/l-5.5mmol/l and a max meal rise of 2.8mmol/l

 

[dani-a]

Thanks guys, really appreciate ur tips and advice, Dani

 

[kellyrae]

I get mine 26th of june and i hope it goes well for you, i too feel a little nervous about it but i'm sure we will love it!!!

Good luck

 

[MarkbUK]

I get mine on the 26th as well, I'm a bit nervous too, but expect it will be fine
Mark

 

[shop]

Dani,

I can't help with your pump questions but would just like to say good luck and hope all goes well

Ditto

Lucy xxx