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Pump Hypos

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cmcilwraith

Newbie
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4
Hi,

My wife has been struggling with her control on her Animas pump for a while now and she is talking to the Care Nurse about rates to sort it out, which has improved things. She has always needed very small amounts of insulin (she has had diabetes for 30 years), however, at lunchtime and around 4pm, she is on the minimum rate (0.025u) and she is still going hypo. The other issue is that at these low rates, we suspect there are miniscule bubbles in the tube, which is stopping the flow completely, so instead of being hypo, she can be very high with keytones.

We have tried setting the rates earlier in the day, so that we are sure the rate has 'kicked in' by the time she needs the lower rate. She could eat more, I suppose but this is treating the symptom, rather than the cause.

We can't think of a way to get round this and I wondered if anyone here can help.

Thanks,
 
I would discuss with her team about changing to an Accu-Chek Spirit Combo Pump, as these have a minimum rate of 0.01u which would allow her to substantially decrease her dosage rate.
Also, perhaps her carb ratios are not right? Perhaps she needs a lower ratio for beakfast and lunch as if her levels are dropping at luchtime and 4pm, it would seem to be following these meals,
Please be aware that I cannot offer medical advice, I'm only saying what I would try if it were me! I wish her luck. Do let me know how you get on. :thumbup:
 
Hi cmcilwraith,
Sorry to hear that your wife isn't having a great time. A few suggestions, I need a lot more insulin than your wife but these may be of some use to you.
1. You can set the basal level at 0 for an hour or two during the day if needed.
2. you can set a temp basal at -50% etc to decrease it even further
3. don't forget about lag timings for example the insulin will take a while to work so if the basal is set at 0.025u at 12pm but it's set at 0.5u from 10am-12pm and she is going low at 12.30pm. it may be worth adjusting the basal before the timings when she's going low. These vary for every person HCP's can give an indication of how long to start but you need to figure this out yourself with lots of testing.
4. Bubbles! Most peoples worst nightmare, I've never had a problem with them but I think this is because I take quite a high dose in comparison to others so the insulin is moving through quite quickly all the time. But I also wear my pump close to my skin it keeps it at a constant temp and I also wear it upside down so that if there are any bubbles (not that I ever see any) they rise to the top of the reservoir and don't come near the tubing/me. The animas clip stays on most of my clothes quite firmly upside down. I've also managed to sew in some baby socks that I've adjusted for my pump into dresses etc.
5. A cgm may be useful to trial for a week to see if any patterns are easier to see.
6. Differing basal rates, try and make sure that there are at least 3 different basals to use throughout the week I have mine planned around different activity, stress, concentration levels. It's good to be able to flip between them once you know what sort of day you are having.
7. Differing blous ratios If I ever eat breakfast in the morning (I tend not to except for weekends) I have to give 1u;7g sometimes even 1u;5g, eating effects me that badly in the morning. However later in the afternoon any time between 2-5pm I always naturally dip so my ratio is 12-15g;1u. In the evening is easy with 1;10g. I would say also that I vary my ratios as well as my basals depending on what sort of day I'm having.
I don't know if any of that is usefull but that's what works for me. Good Luck Laura
 
Hi I'm on a accused check spirit combo pump and find this has the best versatility for how low or how hi I need to put my dosage. The animas is probably not the right kind of pump due to limitations on it. I hope you get it sorted hun. Xxxxx
 
I know of a fsn that adbised to alter the bassl rate for the actual hour that a child pump user was going low. Another dsn I had told me to alter 3 hours-1hour before the time of a hypo. What time(s) has your partner lowered for the hypo?
A cgm for a week (some hospitals do this).. Would help to find out the exact time when the levels start to drop... The big difference in a drop may be earlier. Well worth testing 1hourly for 4 hours before hypo's if they occur the same time, just to check which hour is dropping most...
I.e your partner may go from say 6.9 to 5.3 in an hour, then 4.5, then 4.2 then under... The hour that would need to be more significantly changed would be the 6.9 to 5.3 hour.. More so than the hypo hour...
 
I have to set my pump to 0 units from 11.00-12.00 as I am always low by 11.30. ( fasting and testing is the only way to find out the exact amounts you need, though I hate doing it so much). Also, don't forget about the insulin she's had with breakfast-this can still be working 4 hrs later. I have recently started having a very low carb breakfast as I have such resistance to insulin at breakfast time, the huge amounts I need seem to cause the midday hypos. This is working really well.
I recommend the accuchek pump/meter combo. It's great for setting different time blocks throughout the day.
 
If you're going hypo at 11.30... Why are you altering the 11.00-12.00 basal rate?
 
I would be doing 1/2hrly check from 9.30 to 11.30 to establish when my levels actually dip most....

If I was going low at 11.30 After the 1/2 hrly testing I would change the dose for the most significant dip - 2hrs ahead of that dip...

Eg you may find something like the following:-
9am 5.6
9.30am 5.2
10.00 4.4
10.30 4.2
11.00 4.1
11.30 3.9

Your most significant drop would not be 11.30... It would have been between 9.30 and 10.00am. So you altering your 11.00-12.00 dosage would be the wrong oe. It is wrong time anyway.... For a definite 11.30am drop you should not be altering the 11am dose.

At least thats what I would be doing....
 
I have done hourly (fasting) testing through the morning and all the levels seem fine on the basal rates set. I apparently have the dawn phenomenon so the higher amounts I need to keep my levels stable earlier in the morning are, I think, still affecting me later in the morning when I naturally need less. It's always been a problem for me but at least on the pump I have the ability to adjust. I don't know how I managed before-well I didn't really!
 
How long does your insulin last? Even with DP you would not be advised to alter 11am rate for 11.30 hypo.

What is your acting time and offset time set up to on your pump?
 
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