Before or after?

[LittleSue]

Hi all

Started on my pump on Tuesday so I'm due for my first real set change Friday morning.

Should I do this before or after breakfast? I've been advised to test before and 1-2 hours after the new set, to make sure it's working. But if I've had breakfast my BG will be raised and I won't know if its high because the set/insertion isn't right or simply because I've eaten. My starting ratios and basal are pure guesswork at the moment so I don't know my "usual" post-breakfast pattern.

My readings are gradually rising as Levemir fades out. By tomorrow morning I may reach the point where I need to correct. That might make the disconnected time have more impact than it normally would.

If I bolus, breakfast, then change set the bolus may help cover the disconnected time.
If I set change, then bolus and breakfast the bolus would help show up any problem in the tubing.

It's a work day and although I can be late for work if necessary, I can't take all day over it. I plan to get up 30 mins early to allow extra time but this may also interfere with my plan to keep timings of tests/meals consistent.

Was also going to ask where disconnecting for a shower would fit into the plan, but will shower tonight and hopefully can skip that in the morning.

Grateful for any advice.

 

[iHs]

If you've got time, I would do the set change about 1/2hr after you've bolused for breakfast using the set that you've already got in. If the new set has not been put in ok you will see that your bg levels will start rising unexpected by mid morning. Don't worry about bolusing for the time you are disconnected, you will only be disconnected for about 10-20mins if that.

 

[LittleSue]

Thanks iHs, but that's partly the problem. I wouldn't know if a rise is "unexpected" and due to a set problem, or because Levemir's all gone and basal rate possibly too low.

Sorry wasn't suggesting I should add in the basal missed while disconnected. More that the disconnection would cause bigger rise if I was already high and I wondered if a high starting BG would affect the order of doing things.

 

[iHs]

I think that by now Levemir will more or less be out of your system and that the bg levels are due to the way the basal is working on the pump with the carb ratio. I would start to look in the Veo manual at how to go about adjusting the basal using the time blocks. I just altered a few of daytime basals to begin with so that my bg levels were somewhere near being ok and also altered my carb ratio but a while later, I then did a bit of 5hr fasting to see how my background levels were.

 

[LittleSue]

Will discuss basal changes with DSN tomorrow. She wanted me to just observe till then, to be sure Levemir was gone before adjusting rates/ratios. I've read the manual and in Pumping Insulin about time blocks, I know your advice is right. But to an extent have to see what DSN says first, to maintain good relationship with her. Having told me my previous ratios and basal/bolus proportions are now irrelevant, she won't want me calling the shots about adjustments after just 3 days.

 

[MushyPeaBrain]

Hi LittleSue! I change my set and then eat my meal (normally lunch). I then test 2 hours afterwards. At that point if my BG is higher than I'd like I also do a correction. However I can't be sure a set is working with one BG so I wait another 40-60 mins and test again. By then your BG should be dropping so the set will be working. Hope that helps

 

[irishrichard]

My Pump Rep advised me to change set in morning before breakfast as when i bosul for it, it should alarm if not put on properly! It seems to work well for me this way so always change before i have meal, i.e. breakfast or lunch!

 

[SophiaW]

We change the set before the evening meal, that way if there's a problem it will be picked up 2 hours from the evening meal bolus. Also the evening suits us better because if there is a problem we're not rushing out the door for school run etc so we have time to sort it out.

 

[phoenix]

I'm another one who always changes a set before a meal. I don't think anyone ever told me to do this but I've just found it works better for me. I think the larger amount of insulin with a meal seems to make the new site 'active' quicker.
The second reason is that I only take around 0.4u an hour for much of the day. At that level of basal it would take many hours of non delivery to trigger an alarm. If I give a bolus and the cannula was badly kinked etc I'd get an alarm straight away.

 

[Dragonflye]

I was advised to change before a meal, preferably breakfast but lunch would be OK too also like phoenix atm I only take a very small amount per hour so would take an age to trigger the non delivery alarm (and had a LOT of issues in the first 2 weeks with the non delivery alarm)

 

[LittleSue]

Didn't check on here before breakfast this morning, so I changed the set after breakfast as iHs suggested LOL. I could see the advantages of both methods.

Anyhow the change went well, didn't take too long and all the adhesive's perfectly flat, for the first time. 2 hrs after the set change BS was lower than it'd been before breakfast. Has risen since, but same pattern as yesterday so probably DP rather than a set problem.

Agreed with DSN to test basal overnight and tomorrow morning then probably increase morning basal slightly. Can also correct any highs, which should make me feel better.

If you hear IPM on radio 4 tomorrow and they read a sentence of listeners's news about 'no injections today for the first time in 38 years because an insulin pump delivers tiny doses every 3 minutes' - it's my news!

 

[jopar]

You should idealy change your set then have your meal/snack bolusing for this using the new set..

On any pump it takes 3 units of insulin to build up enough pressure to set of the non-delivery alarm, so the quicker you pick up any blockages problems the better, hence why you are advised to change before a meal and not after..

Take me for example

It can take over 6 hours before my pump failed to deliver enough insulin to set of the alarm, so by changing my set then bolusing for food I can cut this back down to an hour or so..

This is what my rep explained who himself was an experienced pumper, he also advised that if we had to do an unplanned set change try to eat a snack that requires even a small amount of bolus afterwards..

 

[iHs]

Thinking over my previous msg..... it does make sense if using a teflon cannula to bolus through it as quickly as poss just to make sure that the set has been put in correctly. I'm usually half asleep in the morning so would want to do teflon set and cartridge changes early evening when home from work and would be less likely to make a mistake. With the steel needle sets you don't have to worry about bent needles as they work more or less straight away.

 

[jopar]

There is no diference in the insertion procedure for Teflon or Metal cannualars..

I'm not sure what you mean about mistakes :?

 

[spideog]

Was told to change before eating, and also not to do it before bed. That was at least you are awake to deal with any issues if they occur.

Best reason I have found for changing before breakfast though is that the pump is then fully up to date with it's keeping track of insulin on board, if you bolus and then change the set/ cartridge then it will no longer be keeping track of what it just gave you.

 

[SophiaW]

Best reason I have found for changing before breakfast though is that the pump is then fully up to date with it's keeping track of insulin on board, if you bolus and then change the set/ cartridge then it will no longer be keeping track of what it just gave you.

Which pump are you using? Our Animas does not have that problem. If we bolus, then do a set and/or cartridge change, and then put in a reading for BG correction or carb bolus it still keeps in memory the insulin on board.

 

[LittleSue]

Don't think the Veo has this problem either.

Definitely changing sets before meals now. I'm on 0.35 u/hr mostly, 0.4 for a few hours, so the meal bolus after changing will be an advantage.

Ideally I want to change sets around 6pm, which is when I get home on work days but should always be convenient. Much better than being under time pressure or (as now) getting up an hour early having already woken during the small hours to test. At the moment the DSN wants me to do them in the morning, presumably so I have several hours to correct any problems and contact her if necessary.

 

[spideog]

Best reason I have found for changing before breakfast though is that the pump is then fully up to date with it's keeping track of insulin on board, if you bolus and then change the set/ cartridge then it will no longer be keeping track of what it just gave you.

Which pump are you using? Our Animas does not have that problem. If we bolus, then do a set and/or cartridge change, and then put in a reading for BG correction or carb bolus it still keeps in memory the insulin on board.

:shock: The DSN and Animas rep lied to me then.

I'll still be changing before eating breakfast though.

 

[SophiaW]

spideog, perhaps there was a misunderstanding. The one thing I have found with the pump is that if you do a combo bolus and then prime or reload the cartridge it loses the delivery of the active combo bolus. So if you're going to have pasta or pizza or a food similar that needs a combo bolus make sure you've done any set changes or cartridge changes before you start the bolus otherwise it can't be interrupted until after the combo has finished delivering. Some of Jess' combo boluses are extended over 5.5 hours so on those days we need to make sure the set change is all done before the meal is eaten. It's best to do the change before a meal anyway so I see no real problem with this. I don't think it really matters too much which meal you do it before, at the end of the day the pump has to fit in with our lifestyles as much as possible so if the morning is better for some or the evening better for others then I think we should all do whatever suits us best.