Question Re: First Day on Pump

Hi

Try not to worry as your pump dsn will phone you a day or so before you go on the pump with instructions on what to do about your background Insulatard and bolus Actrapid insulins. Ideally, you will start using the pump first thing in the morning....so you wont go too long without any background help from the Insulatard... but again the dsn will know best as the insulins you are using have a different duration of action compared to the analogue insulins.....

Different clinic's have a different protocol the start of pumping.

Some clinics start their pumpers of using saline for several days or perhaps a week, so when you inject (with the exception of your background) you also make a bolus with the pump

Other Clinic's prefer to go live straight away (this is what I did) the procedure for doing this will be slightly different dependant on how you inject your background insulin..

If you are on a single injection that you take at night, you will be asked to reduce the injection the night prior to starting the pump.
If you have a split injection AM and PM, then you be asked to take your PM injection the night prior to starting the pump as normal, but miss your morning injection...

You don't actually go without insulin as such, as it does actually take a couple of days for your old background insulin to burn completely out of your system. So for the first couple of days, the BG testing you'll be doing will be for monitoring purposes rather than data collection... Then you start collecting your data that enables you to make adjustments to your basal, but when you start this do remember that make one adjustment at a time, make to many in one go you won't know which one worked and which didn't!

Your clinic will also ask you for your last 3 days or so TDD of insulin, they use this information to work out a starting correction dose, and also for background insulin, again here different clinic's have different protocol. some clinics just divide your background insulin evenly over 24 hours, other clinic's will look at your BG Data, and use this to guide them make a variable basal to start off with.

Hi, my daughter started on a pump on Monday so the start is very fresh in my mind!

She did a week long saline trial about 3 weeks before and is using an Accu Chek Combo.
She was having 4units Insulatard at 8am, 30units Insulatard 8pm and Novorapid as and when.

Sunday night she had the usual 30units of Insulatard, the usual amount of Novorapid with breakfast Monday morning but no morning Insulatard.
We were at the hospital from 10am until about 12:45pm.
The pump was running from about 11:45pm, she did dip to 4 late afternoon and early evening which i was expecting as they wouldn't let me set a temp basal reduction to avoid hypos. They are not keen on letting us do much!
Her levels were quite good Monday night, Tuesday day and Tuesday night but have started creeping up since then.
I have made quite a lot of changes to the original hourly basal rates set, i already knew i'd have to change 2 times of day as the profile didn't match what i know she needs.
We have been testing 2 hourly day and night, also gone carb free this week to help set the basals, was able to start proper breakfast yesterday and will be able to start proper lunch tomorrow.
That is how it has been for us so far!

Trina said:

Hi people. Ok first night on the pump. All went well during the day. Ready for bed and tested....9.5, so had a bolus of 0.5. Woke up at 2.00 am felt unwell, tested number was 18,6 :crazy: so gave another bolus as insulin on board was 0. This mornings result was 12.5, which outside my goal but better. I can only think that after having 5 injections a day for the past 40 years and body was having a serious withdrawal.

Will consult the Dan team later this morning. Anyone else had those weird experiences?

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It' just means your basal is wrong nothing else. As nobody has a correct basal when they start it's to be expected having highs and lows.
All you do is battle the highs and lows for a couple of days and then start basal testing and setting your basal to your own needs.
It will involve a lot of hard work and blood testing over the next few weeks.

I think most people set up on a flat rate for 24hrs... And of course our bodies dont work like that. .. It is a safeguard only against hypo's.


You'll have numerous testings and tweaking to do, but you're absolutely normal with high's. Mine too were hugely high... Basals orinally 0.45 per hour... I needed 1.45 on some hours... Nowadays my highest basal 0.93 and lowest 0.32... So do expect to do tweaking to get your nights right.

I was also set up on 1-10g for all meals.. And again thru testing... Needed different ratio's through the day.

Dont expect perfection within a week!!!
You doing great...

You just need to test and correct 2 hourly until you've changed the basal rates to match your body's needs.
I've had to nearly double some of my daughters rates at night to get her to not run high!
We were told to start on the same meal ratios as when on injections but i've had to change them since.

Trina said:

Hi people. Ok first night on the pump. All went well during the day. Ready for bed and tested....9.5, so had a bolus of 0.5. Woke up at 2.00 am felt unwell, tested number was 18,6 :crazy: so gave another bolus as insulin on board was 0. This mornings result was 12.5, which outside my goal but better. I can only think that after having 5 injections a day for the past 40 years and body was having a serious withdrawal.

Will consult the Dan team later this morning. Anyone else had those weird experiences?

Click to expand...

Hi

Not sure what time bedtime was when yr bg level was 9.5 but tonight start testing yr bg levels 3hrs after the basal correction and then every 2hrs. This will hopefully prevent you going very high overnight as you will be able to deliver a correction if you press the bolus button on the remote. The wizard will then tell you how much correction you need to use if any. If your bg levels start to drop too low, then the pump will prompt you to eat some carb or glucose etc....

If you haven't got any.... do ask Accu chek to send you some pump bg monitoring diaries as these will enable you to enter all yr basal rates, carb eaten, bolus, correction, tbr etc. By looking at the entries you have made in the monitoring diary you will be able to see patterns forming and will then be able to make the adjustments to the basal rate or carb ratio....

Yep, forgot to mention I too had 3 nights of testing every 2 hours... And this helped hugely to see when rises start..
I would say try to give yourself 5 hours clear of food if poss before doing nightly 2hr testing then there will be no impact from food on levels.. Or if hungry have something carbfree...
Set changes will get easier and quicker within 2 weeks you'll be able to do set changes blindfolded.. Cartridge changes will be the same too.. By time you done 4 of them you won't think nothing of it.
You'll be fine...

Hi Trina

Sounds good

When your bolus wizard says, 0 Insulin on board, it's referring to Bolus insulin... Any insulin that is delivered via the basal or TBR isn't classed as 'active' insulin, so it ignored by wizard.. So you do have basal insulin on board, about 2 hours worth at any one time.

If like me (I use roche tenderlinks) that come in two version packs, one with tubing the other without, then no you alternate between them, so in my case I use a cannula for 3 days, tubing is changed every 6 days.

When changing cartridges you don't have to change your tubing/cannula if it's not due.

Sounds like you're making good progress Trina

My daughter has had her pump for nearly 4 weeks now and i am still testing overnight, have cut down from 2 hourly to 3 hourly this week though as i have a bad cold and it is killing me to get up overnight!

We were told to change the cannula every 3 days and change the tubing and cartridge every 6 days.
I have noticed that after 2.5 days of a new cannula her levels start to rise so we are now changing the cannula every 2 days, a cartridge doesn't last 6 days, more like 4-5 so we are changing the cartridge and tubing every 4 days.

Don't worry about getting in a muddle with changes, we've had lots of problems on that front :roll: