On Novorapid and Medtronic 640 pump

[Jeannie3]

Having problem getting to sort my basal rate on 640 pump (Novorapid) .... Dawn phenomenon means that my basal in morning is 1.10 mmol per hour and then at 12noon it reduces to 0.550mmol per hour - readings fine in morning with this rate and dinner time my BG is about 6 so fine. My bolus ratio is 7g carbs to 1 unit (think this is 1:13) of Novorapid and seems to be spot on. However not sure about adjusting the bolus from noon until ??? what time as not sure how long my Novorapid reaction time is - today my lunch time was 9.9 and then had roughly 83g carbs and put in 13 units at 12 noon - reading at 3.30 pm was BG 13 - not good

 

[Juicyj]

Hello @Jeannie3 unfortunagely no one here can advise you reading your insulin doses, but you would benefit hugely from doing some basal testing to review this which would involve fasting.

 

[dancer]

@Jeannie3 a jump from 9.9 to 13 is a little bit much but there's too much going on here to make any suggestions.

Did you have lunch at 1.30pm, so were 13 two hours later?

Did Bolus Wizard give a correction at lunch? (It should have, unless you still had active insulin from earlier).

You say your bolus ratio is 7g carbs to 1 unit of insulin. You say this is 1:13 but it is actually 1:7. (You can check by going to Menu, Insulin Settings, Bolus Wizard Setup, Carb Ratio).

Not everyone has the same carb ratio throughout the day. Perhaps you could ask your DSN if she thinks a change is necessary at lunchtime.

Also, if you did have a correction this morning and it didn't bring you within target, it could be your Insulin Sensitivity Factor needs to be changed. (We can also have different sensitivity factors for different times of day.)

I presume you have done a basal test by fasting at lunchtime. If not, check that before anything else.

If there's anything you're not sure of, check with your DSN.

 

[Jeannie3]

Hello @Jeannie3 unfortunagely no one here can advise you reading your insulin doses, but you would benefit hugely from doing some basal testing to review this which would involve fasting.

Thanks ..good idea

 

[Jeannie3]

Sorry ...had lunch 12 noon ...bolus wizard put adjustment in too

 

[Jeannie3]

Carb ratio on wizard saying 6.8 g/U

 

[Jeannie3]

@Jeannie3 a jump from 9.9 to 13 is a little bit much but there's too much going on here to make any suggestions.

Did you have lunch at 1.30pm, so were 13 two hours later?

Did Bolus Wizard give a correction at lunch? (It should have, unless you still had active insulin from earlier).

You say your bolus ratio is 7g carbs to 1 unit of insulin. You say this is 1:13 but it is actually 1:7. (You can check by going to Menu, Insulin Settings, Bolus Wizard Setup, Carb Ratio).

Not everyone has the same carb ratio throughout the day. Perhaps you could ask your DSN if she thinks a change is necessary at lunchtime.

Also, if you did have a correction this morning and it didn't bring you within target, it could be your Insulin Sensitivity Factor needs to be changed. (We can also have different sensitivity factors for different times of day.)

I presume you have done a basal test by fasting at lunchtime. If not, check that before anything else.

If there's anything you're not sure of, check with your DSN.

Thank you ....think will discuss at Diabetic Centre in April ...fasting basal seemed ok when done so bolus needs adjusting but normally results in lows around 4 pm ...

 

[buckmr2]

I also "suffer" dawn phenomenon and used to be on Novorapid until almost a year ago
Asked my diabetologist to switch me from it to Fiasp (which is Novorapid with an added vitamin which makes it work much more quickly from 2 mins right up to 5 hours).
I can't understand why people who are on Novorapid aren't changed to Fiasp.
Maybe a change to Fiasp after consulting your diabetologist might help you get the effects of dawn phenomenon back into target range more quickly

 

[porl69]

I also "suffer" dawn phenomenon and used to be on Novorapid until almost a year ago
Asked my diabetologist to switch me from it to Fiasp (which is Novorapid with an added vitamin which makes it work much more quickly from 2 mins right up to 5 hours).
I can't understand why people who are on Novorapid aren't changed to Fiasp.
Maybe a change to Fiasp after consulting your diabetologist might help you get the effects of dawn phenomenon back into target range more quickly

I have been on Fiasp for around a year now and I find that it is pretty much the same as NovoSluggish now. When I first started using it I was amazed on how quick it started working. Seems to have slowed down a lot

 

[Bluey1]

Stop stealing my diabetes, go find your own Same pump, same insulin, same dawn phenomen. At the moment I don’t have after lunch problems as I’m to busy at work to have lunch (or even get a coffee) or have a loo break. On the rare occasion when I do get lunch I go really high and if I adjust my insulin up around lunch that I crash around 4pm. The pump can’t deal with the dawn phenomen as it depends on when I wake up and on weekends I like to sleep in.
I have a soft spot for Hot Cross Buns and at the moment work pays for all meals. If I have one at tea I stay high 12+mol/l all night.
I don’t really have Diabetes, my blood just really likes glucose and it won’t let the glucose go unless I give it, it’s Kryptonite (insulin).

 

[dancer]

Stop stealing my diabetes, go find your own Same pump, same insulin, same dawn phenomen. At the moment I don’t have after lunch problems as I’m to busy at work to have lunch (or even get a coffee) or have a loo break. On the rare occasion when I do get lunch I go really high and if I adjust my insulin up around lunch that I crash around 4pm. The pump can’t deal with the dawn phenomen as it depends on when I wake up and on weekends I like to sleep in.
I have a soft spot for Hot Cross Buns and at the moment work pays for all meals. If I have one at tea I stay high 12+mol/l all night.
I don’t really have Diabetes, my blood just really likes glucose and it won’t let the glucose go unless I give it, it’s Kryptonite (insulin).

You can always create a basal for weekends and just switch to it on a Friday night.

 

[dancer]

Thank you ....think will discuss at Diabetic Centre in April ...fasting basal seemed ok when done so bolus needs adjusting but normally results in lows around 4 pm ...

When I was working, my BG used to jump to high teens 2 hours after breakfast but when I increased bolus I would go hypo later in morning. My DSN suggested using an increased temporary basal for 30 minutes at breakfast, instead of the increased bolus. It took a bit of trial and error (starting low and working up) but eventually I found a level that worked for me. Maybe you need something like this at lunchtime.

 

[Jeannie3]

That sounds good to me ...will try a bit at a time so hypos are kept to a minimum ...thanks for info

 

[Jeannie3]

Current basal at 1.10 per hour 8am till 12 then 0.550 onwards ...might try 0.650 12 until 1..see what happens

 

[Jeannie3]

Ha ha ....yes hot cross buns hard to resist

 

[leeweeks]

My nurse said something about these pumps but did not explain how they work . I know that most stuff is trial and error just want to know if they are easy to use . As I would like an alternative to injections . My metformin have just about ran their course. Any feedback would be welcome

 

[Bluey1]

You can always create a basal for weekends and just switch to it on a Friday night.

I'm not that organised. I have a sick day setup on my pump. A week latter I couldn't work out why I was always low and started days before. You guessed it it forgot to change over to my normal settings

 

[Jeannie3]

My nurse said something about these pumps but did not explain how they work . I know that most stuff is trial and error just want to know if they are easy to use . As I would like an alternative to injections . My metformin have just about ran their course. Any feedback would be welcome

They are quite good in that only have to inject the cannula every 2 to 3 days ...however its a task to get your overall rates of insulin input right and get overall good BG control ...everyone is different tho im sure you will find it good

 

[Jeannie3]

I'm not that organised. I have a sick day setup on my pump. A week latter I couldn't work out why I was always low and started days before. You guessed it it forgot to change over to my normal settings

yep easily done ....hard to keep remembering everything

 

[Jeannie3]

@Jeannie3 a jump from 9.9 to 13 is a little bit much but there's too much going on here to make any suggestions.

Did you have lunch at 1.30pm, so were 13 two hours later?

Did Bolus Wizard give a correction at lunch? (It should have, unless you still had active insulin from earlier).

You say your bolus ratio is 7g carbs to 1 unit of insulin. You say this is 1:13 but it is actually 1:7. (You can check by going to Menu, Insulin Settings, Bolus Wizard Setup, Carb Ratio).

Not everyone has the same carb ratio throughout the day. Perhaps you could ask your DSN if she thinks a change is necessary at lunchtime.

Also, if you did have a correction this morning and it didn't bring you within target, it could be your Insulin Sensitivity Factor needs to be changed. (We can also have different sensitivity factors for different times of day.)

I presume you have done a basal test by fasting at lunchtime. If not, check that before anything else.

If there's anything you're not sure of, check with your DSN.

Thank you ...not sure if im replying to you ...wanted to follow your advice but not sure how i can do this ...will have to try n find info