Help! Just started Minimed 640g - when should I resume bolus after hypo?

[neryscm]

Hello,
I'm looking for some help. I've been on my pump since about 5pm and just tested my BG - it was 2.7. I treated the hypo and suspended the bolus. When should I resume the bolus? The pump is showing 5.7 units still acting.
Thank you in advance.

 

[dancer]

That is a lot of active insulin. Presumably you ate the carbs necessary for this bolus!

The usual treatment for a hypo, when using the pump, is to take 10-15g of quick acting carbs, retest in 15 minutes and repeat if necessary. There is normally no need to suspend the pump, as long as you have treated the hypo.

 

[neryscm]

Thank you for your reply @dancer. I had a bowl of pasta as I was starving! But looking back the bolus was too high, which is why my BG was/is still low. They're still 3.3 now my first reading of 2.6 was two hours ago) and I still have 1.9 units active insulin. I'm thinking of resuming the bolus once the active insulin has cleared - do you think this is the correct thing to do? I'm quite tempted to eat a packet of sweets just to pick my BG up off the floor, where it's been for the last 2 hours!

 

[noblehead]

Do you mean resume your basal @neryscm?

Treat the hypo then have some toast or something for you active bolus to work on.

 

[neryscm]

Yes resume basal sorry - after nearly 3 hours of training on the pump this afternoon my brain is fried! I have been treating this hypo for more than 2 hours now - my kitchen cupboards are getting emptier!
So just to clarify, when I resume the basal the pump will just give me whatever it's set up to give me? As in the 1.9ish units still active, along with the bolus? Been paranoid that I would receive whatever the basal dose was set at when I suspended it (roughly 9 units!)

 

[dancer]

Thank you for your reply @dancer. I had a bowl of pasta as I was starving! But looking back the bolus was too high, which is why my BG was/is still low. They're still 3.3 now my first reading of 2.6 was two hours ago) and I still have 1.9 units active insulin. I'm thinking of resuming the bolus once the active insulin has cleared - do you think this is the correct thing to do? I'm quite tempted to eat a packet of sweets just to pick my BG up off the floor, where it's been for the last 2 hours!

I hope you didn't have a high fat sauce with your pasta, otherwise you'll be sky high when the pasta is digested! (Dual wave is great for fatty meals.)

If it wasn't a high fat meal, @noblehead has given good advice. You might go hyper but you don't want further hypos through the night.

 

[noblehead]

Don't use the Minimed640 pump but can you not just cancel the bolus dose if it's still not been delivered, your basal will just resume at the rate in which it was programmed as with any other pump.

If you got a tin of rice pudding try eating that to keep your bg levels up, don't forget you can also ring the pump manufacturers helpline.

 

[dancer]

Yes resume basal sorry - after nearly 3 hours of training on the pump this afternoon my brain is fried! I have been treating this hypo for more than 2 hours now - my kitchen cupboards are getting emptier!
So just to clarify, when I resume the basal the pump will just give me whatever it's set up to give me? As in the 1.9ish units still active, along with the bolus? Been paranoid that I would receive whatever the basal dose was set at when I suspended it (roughly 9 units!)

You have nothing to worry about. It just gives you the present basal.

 

[tigger]

Remember that the basal will generally be acting 2 hrs in the future so suspending it now will not affect current hypo but will send you high later unless your insulin is very fast acting. I know they tell you only to treat hypos with quick acting carbs on a pump (and it works for me now) but at tge beginning i found taking 20g long acting carb as well very helpful. You have to get your head round the fact that the basal is small amounts given slowly so you're not overdosing by continuing with it. It took me a while to get there. I assume if you've just started they gave you a flat rate for 24 hrs? I knew it wouldn't work for me so started ecperimenting based on my usual highs and lows as soon as i left the hospital.

You can call medtronic but i found then singularly unhelpful. Padt 5.30 you get Americans who read from a script. The next line to i've had a hypo is "have you suffered an injury or needed medical assistance? "(No i wouldn't be on the phone to you if i did!). They won't help you with rates and will tell you to suspend the basal but this won't deal with the immediate or next hypo.

The other thing if you're with it enough to do is use the bolus calculator to worj out how much you should eat To cater for insulin on board. Also remember if you do bolus soon after a hypo to tske away the insulin on board as the bolus calculator won't do this.

It does get better but the first few weeks are hard work. Good luck!

 

[irrationalJohn]

Hello,
I'm looking for some help. I've been on my pump since about 5pm and just tested my BG - it was 2.7. I treated the hypo and suspended the bolus. When should I resume the bolus? The pump is showing 5.7 units still acting.

I hope this doesn't come across the wrong way, but the only person who has access to the details to answer your questions is, well, you.

Let's start with the pump showing you have active insulin of 5.7 units. OK. Sure, but then again, maybe not? The pump comes up with this as a "good guess" based on the amount of insulin you bolused factored in with whatever guess was used for your Duration of Insulin Action (DIA).

However, the only person who can discover whether or not the pump's current guess is close to reality is you. Certainly pay attention to your pump's guess at how much active insulin you still have on board. But also try to find out by testing as you go whether it is a good guess or needs to be tweaked.

Other's have already asked for more details about what was in that meal you bolused for and consequently went low afterwards. The reason to try to dig into this a little deeper is to get a feel for whether or not the settings for you carb ratio are good for you or have been … how might you put it? Bollocksed up, perhaps?

When you first start out on a pump you need to feel your way along because your settings still need to be refined. Even worse, the insulin you need for bolus and basal can change as your body gets used to the rhythm of the pump. It's annoying if this happens, but all it takes is a bit of extra caution as is required when doing anything new to you.

Think of it as though you only learned to ride a bike at 5PM this evening. When starting out you'll want to pay even more attention to the traffic & traffic signs until you get a feel for how things flow. No?

The advice I often see for starting/stopping a basal change is to do it about 2 hours before you want the change to be in effect. If it were me, I'd probably resume as soon as I saw my BG was 6 or higher and rising. Depending on exactly what was in that meal you ate you may be in for a bit of a roller coaster BG ride.

 

[neryscm]

Thanks for all of your replies! It was pasta with tomato based sauce (average fat content) with a little (low fat) cheese. My BGs have stabilised, just in time for bed! I'll be checking them overnight to ensure everything is still ok. My DSN asked for me to ring her tomorrow to let her know how my first evening/night on the pump went - we're in for a long conversation!
Thanks again everybody - very helpful.

 

[Spicey245]

I was told by my DSN if I went hypo to reduce my basal by half and take 15g fast acting carbs and then 'mop up' the remaining Insulin On Board with something a bit more substantial and test after 15 minutes. It's a roller coaster when you first get put on a pump but once you start to get the hang of it you won't look back.

 

[neryscm]

Thanks for your advice @Spicey245

 

[Spicey245]

No problem! Only been on my 640G for 7 weeks so I'm still learning too! I love it!