Working out the rates

[LittleSue]

I keep reading that folks usually need less insulin on a pump compared to MDI.

Haven't got my pump yet, but they said you work out starting basal by:
- Add up a typical day's basal + boluses to arrive at total daily dose (TDD)
- Reduce TDD by 20%
- Divide by 24, the answer is hourly basal rate
-Then add boluses for food as per DAFNE-style ratios

Strikes me that unless your meal boluses are 20% or less of your TDD on MDI, you're going to be taking more insulin in total. Because the TDD includes food, but you calculate basal rate then ADD food boluses in again.

Is this a very rough formula which is rarely accurate? Or do you need less because you get a 'honeymoon' when you start pumping?

Does anyone know?

 

[iHs]

Hi

The basal rate will be somewhere near accurate as the daily total but you'll find that you will need to adjust it up or down at different times of the day according to what your bg levels are, so it won't be the same amount for every hour; only some of them. I'm using the Combo pump which might deliver insulin in a different way to the Veo as I have to enter my basal rates for every hour whereas other pumps allow people to enter whatever basal rate is ok for them by using time slots.

The bolus carb ratio is calculated using the 500 rule but is rarely accurate so you will need to definately adjust that. What helped me a lot is that I already knew what my carb ratios were using MDI so I just used them and deducted 20% off the 1u insulin so for example if on MDI your ratio was 1u for 10g, on a pump you could try 0.8u for 10g. This will get you somewhere towards being ok bg wise but will still need you to tweak them up or down. I would wait for a few weeks before you start basal testing as most people find that their insulin needs either drop or increase simply because it takes time for the body to adjust to just using a bolus insulin I think.

 

[LittleSue]

Hi iHs

Thanks for your informative reply. I was slightly concerned because when I switched from lantus to levemir they said I'd need a bigger dose, but actually needed 30% less. Weeks of night hypos left me drained til we got the dose down, then split the levemir. Although I wasn't on DAFNE then and my basal/ratio needs weren't clear, I want to avoid a similar situation when I get my pump.

I'm perhaps spending too much time thinking about the ins and outs while I wait for confirmation from the PCT. Maybe all my questions will be answered by the DSNs, but I think there'll be things they don't tell me and this forum will be a lifeline.

 

[donnellysdogs]

My dosage was set up at 30% lower too, not 20%. Probably to try and stave off the hypo's at start up.

Because my daily TDD's were never the same, I made a note of mine for 2 weeks prior to going on to pump and these were then used as an average figure rather than just looking at the previous days TDD or the previous week's TDD.

From my original start up dosages, I haven't got one single basal or bolus the same anymore. Do be prepared to have to tweak them. My TDD's aren't hugely different, but just that it gives so much flexibility to give the right amount at the right time of day with adjusting.

Since Christmas I have realised more that the 50/50 ratio for basals and bolus's do work out pretty much right without thinking about them. I realised over Christmas with eating so much more food and drink that I need to give more basals as well. So the set up ratio's were for me pretty good, just that they needed more and less at different times of the day.

Your DSN and Pump Rep are used to set up's but don't be suprised if they do it to a 30% reduction and not 20%.

iHs is spot on with her information, she helped me so much during my preparation for the pump and start up. I would never have managed it without the advice and help she gave me.

 

[ams162]

hi

we have had 4 years of stress and worry with dylan and diabetes as we could never get him stable he would yoyo from hi to low to hi again and didnt matter what we did to change it, now since being on the pump things arnt perfect but they are so much better than when he was on MDI i can predict where he will be more reliably now i dont worry half so much.

being on a pump is hard work but its def worth the work and the wait to get it, things havent been plain sailing but they are better than they ever were on MDI it will be the best thing u do honestly

anna marie

 

[LittleSue]

Hi DD

I'd struggle to know what a 'typical' day's doses were too LOL. I currently need twice as much levemir overnight as during the day though, so I 'm not confident that the 'divide by 24 = basal rate' bit would be very accurate. Expecting lots of tweaking, but want to avoid severe hypos (or indeed highs) if possible. The DSNs know I'm fairly sensitive so maybe will reduce TDD by 30% or something. From what she said, I think the DSN who uses a Veo is also on small rates, which might be handy.

 

[donnellysdogs]

Sue
You sound so much like me and the thoughts that were going round my head before I went on to the pump. Fortunately for me I only had a 3 week wait for it to happen, but during that time there was just so many questions-I hadn't even seen a pump before the day of getting attached to the new best friend in my life....
I was lucky that I was also sent sets to try before hand and so much info, and of course buying John Walsh's book-which prior to actually using the pump I found was a bit hard reading and giving me even more questions...help and support was and still remains fantastic. I think it was the biggest change in my life since going on to the MDI 25 years ago. Best wishes Sha x

 

[SophiaW]

Our DSN worked that all out for us in consultation with our consultant. I thought the dose she had calculated would not be enough but she was pretty much spot on. We have reduced it gradually since but at the time of starting on the pump that initial calculated dose worked very well.

 

[LittleSue]

hi
now since being on the pump things arnt perfect but they are so much better than when he was on MDI i can predict where he will be more reliably now i dont worry half so much.

being on a pump is hard work but its def worth the work and the wait to get it, things havent been plain sailing but they are better than they ever were on MDI it will be the best thing u do honestly

Glad to hear you're still positive about pumping despite the recent difficulties. Your words "Dylan loves his Veo" really struck me, I doubt I'd have coped with it at his age. Your positive attitude shines through your posts (and encourages me that I've made the right decision), so I was sorry to hear you were struggling a bit. Hope Dylan carries on loving his Veo.

 

[ams162]

was just a blip i think dylan has always been challenging with his blood sugars so the pump was the natural choice really, its so much easier to tweak things on a pump and correcting highs is a doddle where as on MDI i was terrified to correct as it sent him the other way no matter how little we gave. we have just submitted a blood sample for HBA1C with 2 months worth of pump results altho it wont be perfect it will be better im sure im keeping everything crossed for under 10.

i think it was better to do it at his age i know a teenager who was offered a pump but he refuses dylan took my guidance and he now says i def did the right thing in fighting for that pump. im sure u will be on here in a few months championing the pump also like i say hard work but worth it all

anna marie