Replies to This Discussion

Permalink Reply by KatieT1 on May 11, 2012 at 7:29am

Hi, I started the pump on tuesday but took it off last night..just couldn't get my blood sugars down. Just curious, did your pump team get your numbers, especially your I:CR pretty close in terms of going from MDI's to pump. Mine were so WAY off. How much lower did they adjust your rates for your pump? I think many have different basal rates during a 24 hour period, that's the beauty of the pump, it's supposed to work more like our pancreas. Good luck!

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Permalink Reply by t.clayton on May 11, 2012 at 8:19am

My basal was close I guess at initial setup, 4.8u vs 6u lantus, was my call, they would have had my basal more than my lantus dosage.

I:C ratios they wanted me to do uniform 1:20, before I was doing around 1:15 for breakfast and dinner and 1:20 for lunch so I compromised and did a set up close to 1:16(b), 1:20(l), 1:16(d). Adjusted lunch down to 1:17 within a week, others to 1:14.

All have stayed the same until recently, been slowly bumping up breakfast and dinner ratios 1:16 each now due to being actively riding my mountain bike again 3-4 times per week.

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Permalink Reply by KatieT1 on May 11, 2012 at 12:20pm

geez, you're lucky. i was doing 10 levemir, they did 5 basal rate on my pump. My I:CR on MDI's were 1:6 morning, 1:8 - 1:9 lunch, 1:9 - 1:10 dinner and they set my I:CR on pump to 1:40...

Sounds like you're kinda honeymooning, no?

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Permalink Reply by t.clayton on May 11, 2012 at 12:51pm

Ya, probably still a little bit.

Seeing what your old ratios were compared to where your pump trainer set you I can totally see why your sugar readings have been so messed up since you started. If I were in your shoes I would have already went into my pump settings and reset everything already close to what the MDI settings were, probably basal around 8.4-8.6u for the day with a I:C ratio no more than 1:12. Those settings are ridiculous for your initial pump set up based on your pre-pump dosing ratios in my opinion.

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Permalink Reply by t.clayton on May 11, 2012 at 8:11am

When I went in to my pump setup appointment I already had a good idea of what settings I wanted for my pump. Originally started with 1 for 24 hours but now have like 8 different rates through the day. My original basal rate was set to .200 per hour, 4.8u/day, had been on 6u of lantus, nurses original suggestion was to run a rate that would have put me closer to 8u a day using their base calculation which I refused to set up, knowing I would be fighting lows non-stop the first couple of days if I did that. Currently at 4.6u/day after tweaks to daytime rates and for DP.

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Permalink Reply by still_young_at_heart on May 11, 2012 at 8:32am

My TDD and total basal turned out to be very close to what I was doing with MDI but I ended up with about 4 different rates during the day/night. I'm currently running with about 6.

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Permalink Reply by Capin101 on May 11, 2012 at 9:01am

I had adjustments all over the place when I started my pump. The main reason being is that I have a pronounced dawn phenomenon. My endo set up basal rates that were signifigantly higer during the night hours, but they were still not high enough. My basal rates were also too high around dinner time and needed to be adjusted down. I was talking with a CDE every day or two to make adjustments and try to get all the settings on track. After getting settings a little closer to normal you may want to try basal testing?

My insulin needs went down 5-10% when I started pumping.

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Permalink Reply by MyBustedPancreas on May 11, 2012 at 9:18am

My insulin needs did go down a little when I changed to the pump. I initially started on a fairly low basal rate of 0.25 u/h and then adjusted from there. This did result in running high for a couple of weeks, but I felt safer this way as compared to chancing going too low. I now have 5 different basal rates on one pattern, and two basal rates set within two other patterns.

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Permalink Reply by smileandnod on May 11, 2012 at 10:07am

I just started pumping two months ago and my insulin needs are very close to where I was on MDI. My endo started me with 2 basal rates, daytime basal was 10% lower than my lantus dose would have equated to and nightime basal was 10% higher than my lantus dose. My numbers were pretty good from the beginning. I did not have extended highs because of this.

I had to fax my readings in to the CDE every day for the first week and she would call me back with adjustments from the endo. My endo requires that you start at the beginning of a week so you have a week's worth of adjustments before you go through a weekend alone.

After the first week, I started making adjustments myself from what I've learned here and just making the smallest adjustment at a time. I have a pronounced dawn phenomenon so that was and still is the hardest part for me to get right.

My I:C ratios have stayed pretty consistently close to where I was before pumping and did not change much.

Now the endo makes "suggestions" for changes but it's usually something I was already planning to try. I currently have 7 different basal rates within a 24 hour pattern.
I also have a different pattern that I set up for days that I have to travel for work that is a reduced basal during travel times.

I use a Dexcom cgm and that tool makes it much easier to make basal adjustments because you can see clearly when it starts drifting up or down. I keep a close eye on my Dex and if I see it starting to move I will make a note of the time in my manual log. The logging and the Dexcom data have made this alot easier for me.

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Permalink Reply by Zoe on May 11, 2012 at 10:49am

I don't remember exactly, but the basal rates suggested by the Animas trainer were 10-20% lower than I used on Levemir. I have made lots of tweaks in the year plus since then but still remain a bit under what I used on MDI. I recall they suggested I might want to use a bit less insulin for my boluses at first but told me in general that remains pretty stable which it has. I rarely adjust my I:C ratios. I have 9 different rates which I've established slowly through trial and error. Every once in awhile a tweak makes two of my rates the same but I don't eliminate the "time zones" in case I need to change them again.

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Permalink Reply by KatieT1 on May 11, 2012 at 12:24pm

sounds like you're doing well. i too have DP...think I'll have many different pump basal rates too. hum, i still cannot figure out why my endo set my I:CR at 1:40 for every meal. From what I read, it seems that everyone's pump I:CR were pretty close to what their I:CR were on MDIs give or take a few carbs.

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Permalink Reply by Zoe on May 11, 2012 at 12:28pm

Because she's an idiot? I think the nicer answer is that many doctors fear their patients having lows more than they fear highs (they don't have to live with the complications!). So they always recommend conservative doses, though that is beyond conservative! If we want to be fair we can say that attitude is for the protection of the patients; if we want to be cynical we can say it's to avoid malpractice suits.

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