ACCU CHEK COMBO PUMP

Best time to change to do a planned infusion set change, is before a meal this helps bring any problems to your attention a lot quicker due to having to bolus for food..

If he's at school, either before breakfast or before his tea, some depends on what arrangements you've have about dealing with problems while he's in school!

Sounds like you all getting on with it, it's tiring to start with; just so much testing ect, but it does settle down..

My first cartridge and full infusion set change, took me absolute ages to do, as I read the instruction twice before starting, the re-read the again every stage of the way... Now I do a couple infusion change in a flash, well not quite as I have to wait for the piston to return, which holds the process up a smidge lol

Hello Yvonne

Try not to panick over the pump... its early days for James so dont try to run before you know how to walk. When I got my pump 2 years ago the Accu chek rep gave me an A4 size training manual with step by step picture by picture instructions on how to do everything on the pump so have a look through it and find the TBR menu. You can get to it by using the pump and also by using the handset and scrolling down to Pump ... enter it (middle button) and then keep pressing the left arrow button until you see the TBR and then press the right arrow button. The 100% will flash at you and from there you can use the up arrow or the down arrow to select the TBR that you want, then press the left arrow and select the duration (the hours) that you want to use the TBR (the up or down arrows) and then press the right arrow button to confirm the hours that you want the TBR to run for.
Remember that TBR's need ideally to be set about 1hr before James starts the football and about 1/2hr before the end of the football match but if you are not sure on how long the match is going on for, then just set the TBR to run for about 2hrs. When the TBR is finished, the pump will bleep so James will need to press the Tick button on the button to turn the bleep off.

Regarding the biscuit... if James's bg was on 6.4mmol in the morning after eating the biscuit at bedtime, then I would say that he would have probably gone low during the night. 6.4mmol is a fairly good level to start the day with anyway so not sure why your DSN said what she did.........

The Flexlink is fairly easy to put in with the inserter. After it has been put in, pull back the blue cover, and then lift up the blue introducer pin. To prime the set... what I do is connect the tube to the set and then put the pump into stop mode and then use the prime mode to prime 1u of insulin and then quickly press stop so that no more insulin is sent through the set. Another way is to just bolus 1u to prime but then the 1u will count as a correction so that is why I use the prime. Instructions for how to do a cartridge change, attach new tube etc are all in the training manual.
Just thought... another way to prime the set is to put a new one in before a meal and then use the bolus wizard to select the carb with the insulin needed and then increase the carb just so that 1 more unit of insulin is added to the final bolus and then that will also act to prime the set.....

Hi

I too sometimes eat some carb if I dont feel ok and just ignore the pump. A pump doesnt always get things right so just go with how James feels. A bg of 6mmol is probably going to go lower if bolus insulin hasnt long been injected so you and James need to keep doing bg tests and then from making any mistakes (there will be loads...) you then find your way with knowing when to eat some food and when not to... Everything gets revealed with the bg tests that James does. It is of course arguable that once basal levels are set correctly, James shouldnt need to eat food when he doesnt want to but even with doing basal tests and fasting and getting all the basal rates correct for the time the fasting is done, that doesnt mean to say that the same basal rates are also going to be ok the following week etc... The weather temp can change and also someone's bg levels can just start to alter for no real appararent reason. Baffling I know but there it is.......... I sometimes just make changes to my carb ratio if my bg levels are higher than usual 2hrs after eating but if bg levels are higher the next day after altering the carb ratio 3 and 4hrs later, I then start to slowly alter some of the basal rates but not by very much - usually 0.01 or 0.02 depending on high bg levels start to be and then of course monitor bg levels the next to see if what I have done to the pump setting is having the desired effect........... Pumps can be challenging at times but on the whole should help to eliminate serious hypo levels dropping down to 2mmol or below so all the frustrating times seem worth putting up with

I think if James gets a few bg levels of 4mmol, then you need to look at the time that bg level was at and then decide on whether the carb ratio needs to be altered a tiny bit or whether the basal rate needs to be altered. Eventually you will start to get a better picture building up regarding your basal rate levels and changes and also your carb ratios and any changes you have made. By writing everything down (I use the Accu chek pump bg diaries) and studying 'form' you will be able to get some degree of stability.

Ideally through fasting...... bg levels should be around 6mmol every 60 or 90 mins and then the default target level of 6mmol ( 4mmol - 8mmol) will also serve as a way of the pump being able to calculate the correct amount of insulin or even carb if for some unknown reason, bg levels are lower than the target. Unfortunately though.... the Combo pump doesnt have a very good IOB feature so wont tell you exactly how much insulin is still active from using the bolus wizard. Instead it uses the target levels (which need to be at whatever target level has been set through fasting) and bg tests to determine any food to eaten to bring up bg levels and also if a corection is needed the pump will use the hourly basal rate set to give its calculation.

I think that's correct but maybe Jopar might know a bit more and explain things correctly if Ive misunderstood how the pump goes about its calculations.....