I'm starting the pump (Ping) tomorrow, and I was only diagnosed three
months ago, so I'm perfectly willing to accept that I probably just
don't get all of this yet... but I seem to hear a lot of different things about when I can do a correction bolus.
I
take Novolog, and my CDE said I can correct at the two and a half hour
mark after eating. My endo came pretty close to this by commenting
that it generally takes about three hours for there to be little enough
insulin left. In talking to a different CDE about my pump start appointment in the morning (she was double checking my usual doses in order to send orders over to my endo for confirmation),
and she said that they'd need to make my Insulin on Board limit FOUR hours, and that I "really need to be careful about correcting after
meals."
So, is there some reason why I'd need to wait longer with the pump than with injections? Or is this likely to be a temporary thing while I adjust to the pump? Or are these just common differences of opinion among medical professionals? Because if it's not based on a hard rule of some kind, I'm tempted to reset the dang IOB for three hours.
I'll ask her point blank, of course, because maybe there is a reason I don't know about.
Here's where switch from asking to info to rambling about my frustrations...
One of the toughest things I'm facing is that I'm independent and have never before had a health issue that I couldn't handle myself or with a single trip to the GP for a prescription... and even then, I was much more likely to research and try a natural/herbal remedy if one existed. But now I have a major health issue that requires detailed attention and maintenance from me, but it's based entirely on What I'm Told to Do (capital letters and all). I know that I'll eventually be given the green flag to make decisions on things like basal rates and I:C ratios as the need comes up, but my current situation frustrates me more than I can express in family-friendly language...
It probably doesn't help that my current job is Doing What I'm Told to Do, right down to how to do my to-do list. Zero autonomy, which is their loss as much as mine because I know I could totally rock my job if I would just be allowed to function the way I function best. And now, along comes stupid diabetes to take away even more of my independence in other areas of life.
Let it all out.........from the questions you are asking, I think you will be your own master very quickly. I've had the D for almost 20 years, and using the ping (mine is balck) for 18 months. My pump trainer set my IOB for 3hrs from day one. So, there must not be a hard and fast rule. Regarding the correction bolus, my understanding is that anytime you are willing to test your bg you can enter the reading into your pump and see if it wants you to take a correction or not. The pump of course knows your bg target, and your iob. If you use the ezBG function you can enter your bg and the pump will tell you what correction to take or not. The IOB function does come into play....but like I said mine has been at 3hr since day one.
I bought the above mentioned book after pumping for a month or so. Just last week I was reading it again because I had a question. Just keep things simple for now. You will do great, I hope you find this helpful.
Thank you both, this is helpful. I'll definately check out the book.
I've actually been asked not to correct between meals at all for two days (unless I'm 240+ and have moderate/high ketones), so they can look at my BG patterns and see what needs to be changed. She also said to call her if I have any concerns, so I'll probably do so if it seems like I'm high often, or more high than I'm willing to accept.
I get it, though. And I'll probably change my IOB to three hours as soon as I'm allowed to do after-meal corrections. :p
Elizabeth, don't have a set time in mind for IOB because we are all different. That is why the pump settings are variable. The early pumps didn't have this and folks had a lot of problems. Originally they thought that the insulin would hang around for as much as 5 or 6 hours and that was the setting in earlier pumps. For myself, through testing by the 1/2 hour I was able to determine that I lost all practical effect of the insulin at 3 hours (with a peak at about 1 h 45 min). But you will only find your correct time by frequent testing. This is also why they don't want you to correct for quite a long period of time even after the 2 hour mark. It was through this sort of testing and not correcting that I found out that Novo Rapid (what rapid was called here in Canada) acted like regular for me and only peaked at about the 3 or 4 hour mark. Humalog worked much better for me.
I know the feeling of wanting to get going, but don't try to micro manage right away. You can only adjust one thing at a time because you want to know exactly where you stand and how your one change affected things.
Like stated above insulin peaks at different times for different people. Even different fast acting insulins have different peak times. Most pumpers are on Humalog, Novalog, or Apidra.
The idea behind testing 2-3 hours after you eat and doing a correction is this is past the peak, and with the correct IOB or Active Insulin Time will take in account what is left in your system so you do not over correct and go low. After a meal your BG will raise even with a boulus to as high as 200+, and with the waiting of several hours the pump will tell you how much more insulin is needed.
Through trial and error you will find the correct setting for IOB, carb ratio, and the other functions that go into the ezBoulus/Boulus Wizard to make pumping that much easier.
I would probably try the doctor's recommendation first, then after testing at the 2 hour or 2.5 hour mark and correcting and seeing where you are at 1-2 hours after the correction you will find if the setting is correct.
I would probably try the doctor's recommendation first, then after testing at the 2 hour or 2.5 hour mark and correcting and seeing where you are at 1-2 hours after the correction you will find if the setting is correct.
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I agree Jonathan -- you can also do a more "conservative" correction if you do it earlier (like half of what you normally would do) as you start to experiment with what works for you. Don't worry -- you'll eventually be the expert on your own care, and your endos, etc, will just be people you just check in with for advice and b/c they can write you prescriptions! (: I don't think my endo has changed a dose for me in 2+ years (not since I was pregnant and needed tons of help) because I've already done it myself, or can explain why I'm doing what I'm doing.
For me personally, if I'm high at 2-3 hours, I NEVER go down by 4 (or not enough to be in range). But, I can't correct at 1 1/2 or I will go low...
Thanks everyone, especially for the encouragement and assurance that I'll become more independent in making my treatment choices.
I actually "get" IOB. The disconnect for me is that I was essentially my own IOB governor with the pens, and 2.5 or 3 hours was the guide I was given. I don't get how the pump would require different IOB rules than pens containing the same insulin, and today's CDE couldn't give me a valid answer to that question. I really think it was that my endo just made sure nothing on the orders looked bizarre before signing off on it. (The way the "orders" were written up was that a CDE from Animas called me for all of my info, because my usual CDE was out of town, and I told her all of my usual doses. Then she wrote it out, faxed it to my endo to sign, and the endo faxed the "orders" to my CDE. My endo may have technically "given the order," but she didn't create the orders.)
I do get why they want me to not correct for now, and that's fine, I'll follow it. And if I get to the point that I think it's a problem (I don't think it is, so far), I'll call her before I make any changes. I'm complaining a lot because I really dislike that I'm sort of having to loosen my good control temporarily, but I'm actually pretty compliant and get called "dream patient" a lot. :p
Even with the IOB issue, I'll probably mention it to my usual CDE before actually changing it to three hours. I'm the lamest rebel ever!
I expected Humalog to work for 3 hours for me. My CDE suggested I start with 4 hours - since then, I've raised it to 4.5. Like Sarah said, if i'm high at two hours, i need to correct (usually with a little more than the pump suggests), but if i'm high at 1.5 hours and correct, i can expect a nasty low.
It really is so much trial and correction and retrying. It's frustrating that you can't trust CDEs/endos to make the calls, but you can't always make the calls without them either.
Also, the point of the IOB is to tell you how much insulin is active in your body so you can (in theory) correct earlier without going low. So even though my IOB number is 4.5 hours, I correct two hours after eating. All the numbers will vary, but I just wanted to make sure you didn't think that they wanted you to wait until all the insulin was out of your system before correcting (although that may be what they want you to do to start.)
Also, the point of the IOB is to tell you how much insulin is active in your body so you can (in theory) correct earlier without going low. So even though my IOB number is 4.5 hours, I correct two hours after eating. All the numbers will vary, but I just wanted to make sure you didn't think that they wanted you to wait until all the insulin was out of your system before correcting (although that may be what they want you to do to start.)
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OK, I retract most of my complaints about the four-hour IOB setting. Before, when I was "practicing" with the pump (unhooked and with a cartridge of water), I thought that it looked like the IOB subtracted all of the previous bolus from the suggested dose until the four-hour mark! This made me go back and look another look three hours in, and I was wrong. It isn't subtracting all of my lunchtime bolus. Four hours doesn't sound unreasonable, now that I know that.
Duh, sorry. Maybe I was looking at that adjusted "correction" much too close to the bolus time, when I practiced. I was thinking, man, you'd think such a smart little machine could at least ESTIMATE how much insulin is out of my system before the IOB is up. :p
I hate when I get all worked up over something and then it turns out I was mistaken about it in the first place. :p