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ACCU CHEK COMBO PUMP

S

stoney

Well-Known Member
Messages
321
Location
South Wales
Type of diabetes
Parent
Treatment type
Pump
Morning Everyone

Well James is up and running as from Friday 31st August. Took 2 hours to set up and go through everything and all was going well until lunch time on Saturday when he started rising. Then it was rising, correction and so on. Went back to clinic and they expected it to be like that with the last of the Lantus being flushed out. Now they have tweaked it throughout the day and we will wait to see what happens. We all look like zombies at the moment with all the testing during the night but I know it is worth it to get it right.

The next pattern now will be school times, which starts tomorrow.

My next fear so to speak is the first change of the infusion set on Thursday. We have done a change of cannula which was easy but this is now another hurdle to get over. Is there a best time of day to change the infusion set bearing in mind James will be in school and also on Thursday he has football training.

Any advice would be appreciated.

Yvonne x
 
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
 
Thanks for reply Jopar.

Would you believe it, first day back at school and James was woken this morning with his pump bleeping to say he has only 20 units of insulin left. So instead of the planned change over tomorrow before tea, it was sprung on us to do it this morning. Everything I learned just went out of the window, panicking but James managed to get through it. We were also going to see his school nurse and his DSN was also meeting us at the school. So James tested his BG before he left for school and it was 15.5 so we left it until we got to school. So he tested it again and it went to 15.9 and he said the site was hurting. (I have now ordered some tea tree cream to treat the sites). So the nurse suggested the site at the back instead of his tummy. We went through a changeover of cannular again, by this time my head was spinning.

He tested again, at 11am and got back down to 8.4 so everything was ok and for the rest of the day.

I also asked her can we do a temp basal rate of his football as last night he had a reading of 4.9 half way through and took 3 jelly babies to bring him up. She went through it and boy that went out of my head. Can anyone give me an idiots guide how to do this as James has another football training tomorrow night and a match on Saturday His BG was good when he got home at 7.4 before shower. Then before bed after supper was 6.4. James was concerned that he would drop in the night so had a biscuit and went to bed. Reading this morning was 6.4 before breakfast so did the biscuit do anything, did he really need it, nurse said he didn't ?.

Why is there not enough information (Idiots Guide) down to the last detail for changing and priming a Flexlink infusion set . Is there one does anyone know. The Book I don't think gives you enough detail, well in my opinion any way.

Thanks for listening
:wave:
OMG I am rambling. Better go and calm down.
 
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.....
 
Thanks iHs, when I can read things in plain english I can take them in a lot better. Now I think I understand. As far as the TBR, I think we will leave it this evening so James can test again half way through training and from that result I will act on it for the next time, now I know what to do, thanks again. Also a match on saturday again I will leave it and see what results are for next time.

I now have another question for anyone:

James's targets are set at the moment between 4-8mml. He woke up with a reading of dead on 4, and at 4 he does not feel right even before he left home for school he was not feeling right and did his BG again and it was 6.4 and asked will I be alright now or will I drop again (Bless) and I said you will be fine. Now i'm thinking that if it was 3.9 he would have treated a hypo, waited 15 minutes tested again when up, keyed in carbs and bolused etc. for breakfast. So his reading would be probably between 6 and 7 then before keying carbs and breakfast, so acting on 3.9 and not 4 does not seem right to me.

Now I maybe overthinking this but, if he changed his lower level to 5 would there have to be more tweaking of his insulin :roll:

Thanks

Yvonne
 
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.....
 
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