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Set bolus in advance

M

missiemilla

Member
Messages
9
Hi!

This is probably a silly question but is there any insulin pump that allows you to set up a bolus with a time delay? I.e. tell the pump to deliver a standard bolus in one hour's time?

I should explain that I use my pump for hydrocortisone rather than insulin so overdose is not a problem.

I realise that's probably not possible because of the risk of hypos if you don't need the bolus after all and forget to cancel, but it would be really helpful for me as I often know in advance that I will need a bolus at a certain time, and can't always use my hands well enough to programme the pump when it
is needed.

Any thoughts much appreciated!
 
I know there is a dual wave bolus function that allows you to give x amount up front, then deliver y over a number of minutes/hours.....

i think with bolus doses though all pumps require manual input at the time of the dose as your circumstances may have changed from what you originally planned for......
 
Thanks, that's pretty much what I thought. Unfortunately the dual wave is kind of the wrong way round for me - I'd need the spike at the end rather than the beginning. Never mind, will just have to do what I can with the basal rate pattern.
Still love pumping though!
 
Combo pump allows you to deliver nothing upfront and to give rest over the time that you want it using the multiwave...


Loving life
 
Yeah I know, thing is I need the bolus to be a spike, not a constant infusion, I just need the spike to happen later. i.e. the opposite way round to the mulltiwave.
It's ok, it's never going to be ideal using if for a different hormone. They just don't make purpose built hydrocortisone pumps so have to make do. Still much better than dying of adrenal crisis because you can't absorb the tablets!
 
I wonder if you might be able to get something closer to what you need by combining:
(i) increased basal at specific time (you could set up multiple programs for this in advance, then pick the one you need), and
(ii) multi/dual wave, with nothing up front.

Like you say, it isn't going to be a spike, but perhaps you could get "almost a spike" by using both in combination?
 
Hi, thanks for the response. Multiwave with nothing up front is the same as an extended bolus, which is what I need to avoid in this case, but yes, I am using the basal to get as close as possible. I currently have an Accu-chek Spirit Combo but I think perhaps a Paradigm Veo might be more suitable as it lets you programme in half hour parts rather than whole hours, so I could deliver a higher rate for a shorter time, plus I could start it at half past the hour if needed.
 
I have Addison's as well, so am curious to know how much HC you use in your pump each day. I had major problems with absorption of HC as in I metabolized it so quickly it was almost useless so use pred and HC combination.
 
Hi, nice to meet another who can't just take a few HC tabs and feel ok!

From what I've been reading, very fast metabolism might actually be a bonus if you can get a pump for the hydrocortisone.

I started a few months ago trying to model a more or less smooth curve based on the usual idea of 'normal' cortisol. For me, that takes around 15mg in total, with infusion rates that vary almost every hour through the morning but then more constant in the afternoon and evening. Then again, I'm small and have fairly slow metabolism so you'd probably need much more.

However, I haven't been doing as well as hoped, and have recently been in touch with Prof Stafford Lightman in Bristol, who has discovered that healthy people actually produce cortisol in frequent sharp spikes with big dips in between, rather than a smooth curve, and that this pulsatility can be vital for health because when exposed to constant cortisol (e.g. from constant infusion or long acting steroids like pred), the glucocorticoid responsive genes can actually shut down.

The reason most people aren't aware of that is because studies usually only measure cortisol every hour or even less, then average the results across several people, which essentially cancels out most of the variation.

That's why I'd like to be able to set boluses in advance. An hour long infusion is really a bit too long for me because my slower metabolism means that both the build up and clearance are slower, which doesn't allow such clear pulses. It'd be better to deliver a large amount in one go then nothing until the next one. I can obviously do that manually when I'm properly awake, but not at night or when I'm too ill to work the pump or remember how much to give. If you have rapid metabolism it'd be quite easy to design a basal pattern that mimics healthy cortisol more closely.

If you're interested I'd recommend this paper - Cardio-metabolic consequences of glucocorticoid replacement: relevance of ultradian signalling.
 
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