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ANY SUGGESTIONS ACCU-CHEK COMBO

S

stoney

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

James is doing very well with his pump and his BG's are good. Here's what happened though yesterday when he came home from school.

BG at 15.59 = 6.2 had a snack of 15g carbs
17.03 = 4.8 had 110g carbs for tea
18.06 just about to go to football training BG 3.9 treated hypo
18.24 = 5.3 took 3 jelly babies and went off training and did a TBR of 60% for 2 1/2 hours
20.17 = 6.7
Back from training 20.46 = 7.2 - went in shower
21.25 = 5.9 had 77g carbs for supper as usual
22.45 = 4.2 - treated hypo
23.14 = 5.6 went to bed
Got up this morning 7.25 BG 11.8 had breakfast 77g carbs
8.25 before going off to school 7.6

For him dropping so low at 18.06 I can only think that I miscalculated the carbs

Should he then have put a TBR of less percentage and for longer as he always drops BG levels later after exercise?

Did he need to treat the BG at 22.45 of 4.2?

Did he rebound this morning with a BG of 11.8?

Any help would be appreciated as he has football training again on Thursday and a football match on Saturday and any suggestions for % of TBR would be appreciated too.

PS Our DSN is on leave at the moment, there is a stand-in but I find seeing any advice in black and white here gives me more confidence.

Oh one more thing, when James bolused for his breakfast, he felt the insulin going in then went and checked how much insulin was left so we need to change the whole set when he comes home. What happened then was when he checked to see if the insulin had gone through on his meter it had not turned blue and did not for some time. Has anyone ever experienced this and if if did not turn blue, what would he have done then as the fact that he felt it going in, he said it will be fine.

Thanks

Yvonne
 
Hi

Not sure exactly... but I think what has happened is that one bolus dose has stacked on top of another bolus dose as the meals have been eaten within a short space of one another causing the lows even though youve got the carb calculation correct. Another reason might be that the basal rates are not correct. Has James done any basal fasting yet? If some of his hourly basal rates are a bit too high and give a low bg level then that wont help with the way insulin will work for him. The same of course is true for basal rates that are too low and cause a higher bg level.

Also, it might be that the insulin to carb ratio needs to be altered to enable James to eat at different times and avoid insulin stacking. This is all going to be 'trial and error' though.

I get on okish with the Accu chek Combo but dont go too much on the way it determines insulin on board. Other pumps function a lot better on this.....

Is James still using the standard bolus menu or have you got the ability to use a multi wave or extended wave? If not, look in the training manual for the pump and you will find out how to activate this feature. It might pay you to maybe use an extended wave to cover eating food over so many hours....

Have a look at www.diabetesnet.com/diabetes_technology/dia.php This is typed btw from reading my copy of Pumping Insulin.

With any luck Jo or someone else who has used the Combo will be able to explain insulin on board and how to stop insulin stacking.

With regards to low bg levels below 4.5mmol play safe and eat a small amount of carb and then test 1hr later to see what the rise is.
 
iHs, has covered most area's to look at, is background correct for those time, bolus rations etc..

If you using the bolus wizard, stacking shouldn't be much of a problem as the bolus wizard should factor this in, a calculation of, IOB (insulin on board) meal bg raise, target range, insulin duration, ect... Unless one of the perimeters are out, normally avoids stacking pretty well..

The only other factor that might had a play... More so if you still using the standard bolus and either the extended or multi-wave..

Is the actually type of carb/meal he ate! If he ate one of the slow adsorbing ones, such as Pasta, Pastry, high fat, high protein etc, this can produce similar effects to what happened, a mismatch of insulin and carbs, the insulin bringing the BG down, before a raising again, and yes foods such as Pasta, Rice, even pastry can still be impacting on the blood glucose levels the next morning... So it's is worth noting what type of carb he's eating as well as how much...

As to his morning rebound, being based on exercise at the moment, even though some activities carried out, can impact at a later point of time, I at the moment wouldn't be looking in this area just yet..

Not sure if James would be game for this idea or not...

Problem with youngsters (and sometimes with adults) it's not always clear what level of activity been carried out, take James football for example, one match might be a lot faster paced using more energy than the next match played against an easier team! or perhaps lunch time, the lads have sat around talking about the latest computer game, then tomorrow they've decided to have a kick around with a football..

This is where a step counter can be useful, as it can help to indicate what's sort of level of activity has happened, with the more 'steps' logged the more active he's been..
 
Hi iHs

quote="iHs"]Is James still using the standard bolus menu or have you got the ability to use a multi wave or extended wave? If not, look in the training manual for the pump and you will find out how to activate this feature. It might pay you to maybe use an extended wave to cover eating food over so many hours....[/quote]

Yes we are still in the standard bolus stages. When we mentioned the multiwave and extended wave to the DSN and Roche DSN which I had read about, we were told we do not need that at the moment. We have been down once and had the profiles tweaked and the second time we went the DSN she decided to leave it as she was going off for a week. She is coming to our house next Tuesday to have a look at what's been going on.


Hi Jopar

jopar said:
If you using the bolus wizard, stacking shouldn't be much of a problem as the bolus wizard should factor this in, a calculation of, IOB (insulin on board) meal bg raise, target range, insulin duration, ect... Unless one of the perimeters are out, normally avoids stacking pretty well..
Click to expand...
[

James is using the Bolus Wizard. What he had for his meal was 60g oven chips, 3 gluten free sausages, 20g mediterranean rice and a choc chip muffin 30g. The only thing he had not had before was the rice.

The step counter mmmmmmm not sure

Any ideas on what I said here
Oh one more thing, when James bolused for his breakfast, he felt the insulin going in then went and checked how much insulin was left so we need to change the whole set when he comes home. What happened then was when he checked to see if the insulin had gone through on his meter it had not turned blue and did not for some time. Has anyone ever experienced this and if if did not turn blue, what would he have done then as the fact that he felt it going in, he said it will be fine.



Thanks for the replies both

Yvonne
 
Any ideas on what I said here
Oh one more thing, when James bolused for his breakfast, he felt the insulin going in then went and checked how much insulin was left so we need to change the whole set when he comes home. What happened then was when he checked to see if the insulin had gone through on his meter it had not turned blue and did not for some time. Has anyone ever experienced this and if if did not turn blue, what would he have done then as the fact that he felt it going in, he said it will be fine.


Hi

When you say that it had not turned blue, do you mean in the My Data menu as on my remote that is the only thing that I can find that highlights in blue all the bg readings and insulin etc.......

If James felt the pump vibrate when he delivered the bolus then it probably went through but you can check what was delivered by pressing the 'tick' button on the pump 2 times. You will then see how much bolus was delivered and by doing another bg test 2hrs after eating you should see then if the bolus has been delivered as it will show in the bg.


Talk to the DSN when you next see her about using multiwave or extended and also get James to do a lot of bg tests so that the DSN can tweak some of the basals a bit more using the 360 Pro programme.....?

Until you are able to determine exactly what basal rate James needs to have to keep his bg levels stable every hour... then what you can do although it's still going to be 'trial and error', is to do a bg test, bolus for carb, deliver the insulin and then when James eats again within 1.5hrs do another bg test but whatever carb bolus you get.. deduct about 0.2u off the bolus and then see how that goes with the bg levels. You will know if things are going ok by the bg tests that are done..... James might still go a bit low or maybe he will be ok or a bit high... You find out as you go along :lol:

Gluten free food probably digests much quicker than food with gluten. My OH is also coeliac and is always starving :lol:
 
Hi Stoney..

I hope I can make some sense, but at the moment I'm a bit sleep deprived, as my daughter went into early stages of labour Monday dinner time, the hospital dash seemed pretty imminent, until Stan decided perhaps not, and now playing the maybe I might, nah not just yet game!

It seems his hypo. was based around a mismatch to a certain extent of insulin dose, based on using a standard bolus being used, I suspect that if an multi-wave had been used, a much different outcome would have happened... He wouldn't have had te hypo, his TBR would given a clearer indicator, both of tea adsorption, and better guidance to what sort of time lag he carries concerning his football training..

Looking at his evening/night time...

A lot of this is based around, the TBR it seems that it might need to go on slightly longer to counteract the time lag of training..

His morning levels..

I wouldn't think is a rebound, but based on a couple of factors..

For most people, There is a time lag between insulin adjustment to impact being seen, so if you set a TBR, the main impact wouldn't start happening until about an hour or two later, and would carry on for an hour or 2 afterwards.. So it could have been when he treated his 4.2mmol/l he the insulin at that point, still hadn't quite adjusted back probably, and it was acting as though it was 60% less, this would then mean, hypo treatment would impact more on the blood glucose levels more..

Dependent on how well his basal is set overnight, the rise in Blood glucose could have been higher, and if at some point the basal setting is out, this could cause a further increase based on insulin resistance...

so I think, that you need to rule out basal settings first.. With some fasting checks to see if there's any problems here..

If no problems are found, then problems derive from not having the different boluses in play!

Personally I think that your clinic is doing you a bit of a disservices really..

As you are a smart lady, whose getting to grips and head around insulin pumping and it seems being held back by their assistant of doing simple things like basal settings or using various bolus's.. The whole point of pumps is for the patient to take the full control over the pump. Their job is to guide you in doing this, not doing it for you!

Your son seems sensible enough to ensure that he's doing his BG testing enough to monitor what's going on, and ensure action is taken if necessary..
 
Thanks iHs and jopar for replies. Will see what happens in the next few days and what the DSN decides to do next Tuesday.

Also the time has now come for me to go back to work next Wednesday :cry: I am off to physio again today for my wrist it is improving but not quick enough for my liking but the bonus of my fracture was that I have been able to be at home, come on the forum in the daytime and find out a lot of information and be here for James when he gets home from school.

Be back soon

Yvonne
 
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