About to go on a pump. Help please.

Hi,

I would say you really need your son's consultant's input as far as adjusting his carb/insulin ratios whilst playing intensive sport. In fact, the team should set up ALL his doses for you, his basal, bolus ratios and insulin sensitivity ratios. They have formulas for working these things out, based on his data before going on the pump, and then doing lots of testing and record keeping for some time after. In some ways it's a bit of trial and error, but it should not be left up to you to try and work it all out.

Have they given you and your son any carb counting training? You really need some. At the very least buy a carb counting book to refer to. You also need to retest his BG 2 hours or so after his food and insulin to see if the bolus given has been enough to return his BG to the pre-meal level - that's how you know if the ratio was correct or not, although obviously intensive exercise, illness etc can all have an effect. To give you an idea, my daughter's ratio (she is 14) is 3 units insulin to 10grams carbohydrate, but everyone will be different, so your son will almost certainly have a different ratio. I wouldn't try changing his insulin until you've done lots of data collecting (your spreadsheet sounds great) and discovered how close he's getting to bringing his BG level down to the pre-meal level 2 hours later - then talk to his DSN or consultant, armed with that info.

You are right, though, it is going to be up to him to carb count for himself, you cannot always be there, and if it's not done properly it causes problems. What sort of pump is he getting? Hopefully one with a built in 'wizard bolus' that can calculate his 'insulin on board', that is, the insulin still working from the last time. I say this because my daughter's worst hypos have happened as a result of insulin 'stacking', when we have undersetimated the lingering effects of the previous boluses and it's all caught up with her in the night and she's convulsed etc. As you say, scary! Her pump does not have the wizard bolus, we are trying to get her one that does at the moment.

I would recommend that you read 'Pumping Insulin' by John Walsh (try Amazon), it's very informative and known as the pumper's bible!

Sorry if I've waffled on and told you lots of stuff you already know! If you have any other questions, though, ask away and I'll do my best to help. There are a few other pumpers on the forum too who will probably have some good tips for you, esp about the exercise.
Sue

hi there,
Collins have a great little pocket size carb counting book for approx 3.99,i carry mine everywhere

Learning carb counting is essentrial...

Depending on the area and how they start pumpers off will determin several things.... In my hospital they tend to start pumpers off in a group, it isn't esstentrial that you've had a carb counting course before you start as you have 3 days of training a month before you are due to start pumping, you attend your first day of training a carb training day!!! (I was lucky because I've done the DAFNE course previous (doasge adjustment for normal eating) then you have a month to get your head around it all if you've had no previous training, then we had 2 days with the rep from the pump company (and in our case the rep himself was a insulin pumper) pump nurse and the diabetic dieticain... (and we went straight onto pumping insulin from mid morning)

I started in a group of 4, I had done DAFNE, one already had a younger brother using a pump, another had done his hospitals version of the DAFNE course and one who had actually been the longest serving diabetic had no training at all except the one day trainging that we attended the month before...

The last one struggled big time, I met here on our first visit to the conulstant after 3 months of being on the pump, and she was having a terrible time of it.. she just couldn't get her head around how important knowing your carbs was to pupming....

Another benefit about getting into and using carb counting before starting a pump, is that it makes pumping a lot easier and a lot less scarey.... If you've compentant on counting carbs etc, then when you start the pump all you are learning is how to use the pump which in it self is a learning curve, but having to incorparate learning carb counting along side the pump make for one hell of a learning curve indeed...

Hi again,

On the suject of insulin build up, yes it is just as easy to do, if not easier when on a pump. In fact, my daughter's worst hypos have happened since she went on the pump. I think it's partly to do with being 'trigger happy', it's just so easy to dial up another bolus for a snack or two and then it catches up with you later. Also over-correcting a high BG can get you into trouble - we have found that Novorapid can take longer than the 2 hour peak we have been told to go by to get the BG down, so we have corrected again at 2 or 3 hours later, only for her to hypo severely 6 or 7 hours after the initial correction, both times in the middle of the night! Novorapid has a long 'tail', I think. Sadly there are no absolute guarantees with any of it, and teenagers especially are unpredictable both from physical and emotional standpoints.

My older daughter is on the Roche Accuchek Spirit pump which doesn't have the bolus wizard. Apart from that drawback, I think it is a very good pump. My younger daughter has recently switched to an Animas 2020, and whilst it does have a bolus wizard, there are features of it which I like a lot less than the Spirit eg the whole priming setup, and the way bolus (and other) history is displayed. Our DSN told us that Roche are bringing out some sort of modification to the Spirit to provide a bolus wizard, so we'll see....

Anyway, let us know how you get on!
Sue