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These are a list of tips that have worked for
other pumpers. Please remember to consult your diabetes team before
making any changes to your personal regimen.
Combating fat
: One parent has learned the fineart of
dosing for fat by using the Combination Bolus in her daughter's Cozmo
pump. She takes the number of carbs (46 g for example) and the number
of grams of fat (say 25g). Next she divides the number of grams of fat
by the number of grams of carbs to get a ratio of fat to carbs
(25/46=.54). You know have a percentage (54%). This is the amount that
you bolus on the "back end" You would do a combination bolus for 46g
CHO with 45% up front and 55% extended over 2-2.5 hours. The higher the
back end number, the further the bolus is extended.
Please remember to consult with a physician
before making changes to your insulin regimen.
Untethered Regimen by Dr. Steven
Edeleman
Discusses the idea of using a basal insulin such as Lantus to compensate
for extended periods of time when disconnected from the pump.
http://www.childrenwithdiabetes.com/clinic/untethered.htm
The Super Bolus by John T. Walsh
The "Super bolus" borrows
from the basal insulin effectively loading more of the insulin up front
where you need it. Add up the total of the basal that would be
delivered before the food is gone, or for a couple of hours. You would
then drop the basal rate to zero for a chosen period of time as that
basal insulin was bolused as a single dose. This makes more insulin
available right away, when needed most bringing the blood glucose level
down sooner, thus taking care of the food that is hitting faster than
the bolus normally would. It leaves the latter part of the meal bolus to
act in the place of the basal insulin, since the Super bolus took care
of the high from the food already and the bolus "tail" is no longer
needed to deal with the meal. This works very well for high glycemic
index meals. See the links below for more detailed information.
super_bolus.phpFebruary 10, 2008
PowerPoint Presentation - Super Bolus and Projected BG Alert
Amended Basal Testing. (by Rosanna Hannum) This
allows you to check your basals and also get a quick check on your
boluses. It may not be quite as precise as the fasting technique,
but it works pretty well, and allows you to get a check of your
whole 24-hour regimen at once. If you detect a problem, then you
may want to follow the traditional basal/bolus check procedures to
confirm it and make precise adjustments.
·
Do NOT
correct high blood sugar in between meals (if it is extreme, suspend the
test and treat, make adjustments, and retest another day)
·
Eat low fat
foods with known carbohydrate count
·
If blood
glucose levels are hypoglycemic at any point, treat the low, suspend the
test, make appropriate adjustments to the regime, and then test again
another day.
|
TIME |
|
BREAKFAST |
|
GLUCOSE |
|
Eat breakfast.
Give breakfast insulin and correction if needed. |
|
READING |
|
Don't eat again
for 5 hours |
|
|
|
|
|
TIME |
|
3 HOUR MARK
(from breakfast) |
|
GLUCOSE |
|
If this number
is hyperglycemic or hypoglycemic, your boluses need |
|
READING |
|
to be
adjusted. (Either meal or correction, or both) |
|
|
|
|
|
TIME |
|
4 HOUR MARK
(from breakfast) |
|
GLUCOSE |
|
This number
should not be >1.67mmol (30mg/dl) different from the 3 hour number. |
|
READING |
|
If it is, the
basals are off. |
|
|
|
|
|
TIME |
|
5 HOUR MARK
(from breakfast)/LUNCH |
|
GLUCOSE |
|
This number
should not be >1.67 mmol (30mg/dl) different from the 3 hour number. |
|
READING |
|
If it is, the
basals are off. |
|
|
|
Eat Lunch. Give
lunch insulin and correction if needed. |
|
|
|
Don't eat again
for 6 hours |
|
|
|
|
|
TIME |
|
3 HOUR MARK
(from lunch) |
|
GLUCOSE |
|
If this number
is hyperglycemic or hypoglycemic, |
|
READING |
|
your boluses
need to be adjusted. (Either meal or correction, or both) |
|
|
|
|
|
TIME |
|
4 HOUR MARK
(from lunch) |
|
GLUCOSE |
|
This number
should not be >1.67 mmol (30mg/dl) different from the 3 hour number. |
|
READING |
|
If it is, the
basals are off. |
|
|
|
|
|
TIME |
|
5 HOUR MARK
(from lunch) |
|
GLUCOSE |
|
This number
should not be >1.67 mmol(30mg/dl) different from the 3 hour number. |
|
READING |
|
If it is, the
basals are off. |
|
|
|
|
|
TIME |
|
6 HOUR MARK
(from lunch)/DINNER |
|
GLUCOSE |
|
This number
should not be >1.67 mmol(30mg/dl) different from the 1ST 3 hour number. |
|
READING |
|
(FROM BEFORE
LUNCH.) If it is, the basals are off. |
|
|
|
Eat dinner.
Give dinner insulin and correction if needed. |
|
|
|
Don't eat again
until breakfast. |
|
|
|
|
|
TIME |
|
3 HOUR MARK
(from dinner) |
|
GLUCOSE |
|
|
|
|
|
|
|
TIME |
|
6 HOUR MARK
(from dinner)/BEDTIME |
|
GLUCOSE |
|
This number
should not be >1.67mmol(30mg/dl) different from the previous number. |
|
READING |
|
If it is, the
basals are off. |
|
|
|
|
|
TIME |
|
3 HOUR MARK
(from bedtime) |
|
GLUCOSE |
|
This number
should not be >1.67mmol(30mg/dl) different from the previous number. |
|
READING |
|
If it is, the
basals are off. |
|
|
|
|
|
TIME |
|
6 HOUR MARK
(from bedtime) |
|
GLUCOSE |
|
This number
should not be >1.67mmol(30mg/dl) different from the previous number. |
|
READING |
|
If it is, the
basals are off. |
|
|
|
|
|
TIME |
|
9 HOUR MARK
(from bedtime) |
|
GLUCOSE |
|
This number
should not be >1.67(30mg/dl) different from the previous number. |
|
READING |
|
If it is, the
basals are off. |
Site
Rotation: We all know that site rotation is very
important whether on MDI or on pump therapy. Recently we came across a
"new" way of thinking about site rotation. The idea is to say start on
the left arm. Move each site over 1 inch until you have done all sites
on that arm. Next move to the right arm and do the same. This continues
for all sites--bum, legs, belly. The idea is that by intensively doing
one area at a time, the other areas literally may end up with a month or
more before being used again and seriously decreasing the risk of
hypertrophy developing.
Increasing and
Decreasing Basal Rates:
|
|
|
|
Temporary Basal INCREASE Percentage |
|
|
|
|
10% |
20% |
30% |
40% |
50% |
60% |
70% |
80% |
90% |
100% |
|
0.200 |
0.220 |
0.240 |
0.260 |
0.280 |
0.300 |
0.320 |
0.340 |
0.360 |
0.380 |
0.400 |
|
0.225 |
0.248 |
0.270 |
0.293 |
0.315 |
0.338 |
0.360 |
0.383 |
0.405 |
0.428 |
0.450 |
|
0.250 |
0.275 |
0.300 |
0.325 |
0.350 |
0.375 |
0.400 |
0.425 |
0.450 |
0.475 |
0.500 |
|
0.275 |
0.303 |
0.330 |
0.358 |
0.385 |
0.413 |
0.440 |
0.468 |
0.495 |
0.523 |
0.550 |
|
0.300 |
0.330 |
0.360 |
0.390 |
0.420 |
0.450 |
0.480 |
0.510 |
0.540 |
0.570 |
0.600 |
|
0.325 |
0.358 |
0.390 |
0.423 |
0.455 |
0.488 |
0.520 |
0.553 |
0.585 |
0.618 |
0.650 |
|
0.350 |
0.385 |
0.420 |
0.455 |
0.490 |
0.525 |
0.560 |
0.595 |
0.630 |
0.665 |
0.700 |
|
0.375 |
0.413 |
0.450 |
0.488 |
0.525 |
0.563 |
0.600 |
0.638 |
0.675 |
0.713 |
0.750 |
|
0.400 |
0.440 |
0.480 |
0.520 |
0.560 |
0.600 |
0.640 |
0.680 |
0.720 |
0.760 |
0.800 |
|
0.425 |
0.468 |
0.510 |
0.553 |
0.595 |
0.638 |
0.680 |
0.723 |
0.765 |
0.808 |
0.850 |
|
0.450 |
0.495 |
0.540 |
0.585 |
0.630 |
0.675 |
0.720 |
0.765 |
0.810 |
0.855 |
0.900 |
|
0.475 |
0.523 |
0.570 |
0.618 |
0.665 |
0.713 |
|
