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tweaking levels

martina

Well-Known Member
Messages
87
Hello everyone.Im just looking for a bit of advise on fixing my daughters high bloodsugars.She is on a combo pump.Shes back at school and each lunchtime she has been around 13.As the day goes on her sugars do come down which is good,however as she has lunch at 12pm I have made change to the basal rate from 9am-10am is this the correct hour to affect her lunchtime bloodsugar and would i just change that one hour?At the moment we also seem to be having a lot of highs due to blockages or air bubbles,we dont usually get many so I was just wondering if they could be down to the sets.????Its really frustrating at times because just when we get one problem sorted along comes another and they seem take ages to sort out.Perhaps I dont raise the levels enough.
 
Hi Martina

I too have the Combo.

Presuming that your daughter eats breakfast around 7.30am does she test her bg level mid morning about 10am? That should give you an idea as to whether she needs to either increase her bolus insulin to carb ratio if her bg levels are above her target bg at 10am. If they are ok, she will then just need to increase the basal rates from 10am and 11am so that she is not so high at 12pm. When altering my basal rates I tend to do them for the 2hrs before I get the high. Usually I start off by altering by 0.01 for each hour so if I was on 0.50, I would increase to 0.51 and then see how much of a difference the adjustments made to bg level and go from there.

Air bubbles are a problem and it takes more haste and less speed in filling up the cartridges. There are various ways to fill the cartridges. Some say use room temp insulin and inject air downwards into the vial while the old fashion way (nursey style) is to inject air upwards into the insulin and then withdraw it slowly. Although you do get an air bubble you can push the plunger up and then withdraw again. After a couple of goes of pushing the plunger up and then withdrawing again, you should get a cartridge without any air in it. Next step is to remove the insulin from the blue vial adaptor and then pull off the vial adaptor from the cartridge and put the cap on it. I then get the cartridge to body temp for about 4hrs to make sure that as insulin warms up, any more bubbles will rise to the top.

Before I put the cartridge in the pump I attach the black cartridge adaptor and a new tube and then abruptly flick my thumb nail against it a few times to try and knock any bubbles up to the neck of the cartridge and then really bang the cartridge up and down to try and send the bubbles partly up into the tube. I usually then attach the plunger and then manually prime some of the insulin up into the tube just for good measure before I put the cartridge in the pump and then go through the prime sequence that the pump does. I tend to need about 200u for 7 days so I fill cartridge up to 240u and then that allows me to do my bubble prime thing. Touch wood I think I've sorted a way to avoid the bubble problem but I do tend to wear my pump with the tube pointing downwards anyway so that if a bubble does magically appear it will just rise to the top of the cartridge and won't go down the tube.

Hope the above helps and you can understand my way of filling the cartridge :))
 
About the air bubbles - I have noticed that bubbles in my reservoir have disappeared since I've started to completely fill it! I used to only put in the amount I was going to need for the three days in between set changes, and I used to get a lot of big bubbles in my reservoir especially on day two (even after flicking all the initial bubbles out when I filled it!)

Now I've started doing reservoir changes separately from set changes, and I just go with one reservoir until all the insulin has been used. I haven't had nearly any bubbles developing at all!
 
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