I was just wondering, when your child switched from MDI to a pump, how long did it take to get all the settings down to see more stable numbers? We just started 10 days ago, and its such a roller coaster. We have (had) a great grasp on I:C ratios but seems like they just don't apply anymore. Hoping its gonna level out soon.
The toughest issue with switching to a pump is setting the basal rate accurately. I've pumped for 10 years and still have to adjust my basal rate occasionally. Keep that in mind anytime you child's numbers are off at the same time each day.
It's also important that the insulin sensitivity factor and insulin duration time are set accurately on the pump. Has your doctor/diabetes educator been helping you with these issues? If not, contact them and work with them daily to get the settings figured out.
If you haven't read it, you should get John Walsh's book "Pumping Insuln." It's a great resource I still find to be helpful.
There are also a number of things that can go wrong like an inset that doesn't work, a bloody site. If nothing helps I would change sites and the area you use.
We are 2 1/2 years out and don't have to adjust his basals that much unless we notice a growth spurt! Took probably a good year before we had it down to where we just watched for a growth spurt. He is 5 years old now.
Hi Jen
it's impossible to get anything right until the basals are close. If you can get him to fast even for part of one day for a few hours it can be a huge help. Mornings on the weekend are a good time to do this for us. We test him when he wakes up, then he goes off and reads or plays a game, then we test him before breakfast and that gives us a good idea if his morning basals are correct. The other strategy that I have found works is to make frequent small changes. When you observe highs consistently at a certain time of day then tweak the basals up. It can also be useful to let some numbers go uncorrected. For example our son went to bed last night at 180 with nothing active and we didn't bolus him so that we could get an accurate read on his overnight basal (he woke at 150, so it's pretty reasonable). There are also patterns of basals that are generally true although certainly don't work for everyone. High in the morning when insulin resistance is high, then lower in the early-to-mid-afternoon, then higher in the evening and low overnight (with a possible bump overnight for dawn effects, which our son doesn't seem to have).
The other thing to be aware of, which was awful for us, is the type of infusion set you are using. We started with the Mio and it would fail sporadically, usually sometimes early in the second day after we had changed his set. He would go from a reasonable number to the 400s and we would have to change him immediately. This was frequently (always?) at 3 in the morning, so it was really hard. We switched to the Sure-T which has the needle that stays in and it is much, much more reliable for us. We think it's because he's such a lean and active kid. Hardly any fat on him, so the plastic canula would bend and insulin delivery would stop. The Sure-T was intimidating at first, but having the needle stay in really hasn't been that big a deal.
The last thing I'll say, and this is more controversial (our nurse thinks I'm crazy), is that I like to have a *lot* of basals programmed into the pump, even if they are quite similar. There are two reasons for this. The first is that it doesn't seem reasonable to me that his basal would be from .65 in the morning to .45 in the afternoon from one second to the next, so I put in intermiedate basals to step him from one to the other. The other reason is that I find it allows me to make smaller changes to the basal since the change is for a specific window of time that only covers a few hours. Changing a basal for large chunks of the day, even tiny changes in our experience, has a huge effect, so limiting the time that each basal covers has made it easier to get to a good set of numbers (and less dangerous). It does seem counterintuitive that having more basals would make things easier, but in my experience it has.
Sorry for the long-winded reply. I hope it was helpful.
take care,
Bruce
Thanks, we are great now. We've been pumping over 5 months now.(My original post was in August, lol) The first 6 weeks were a bit rough but our last a1c was 7.0 and things are pretty stable... Well as much as they will ever be.
By chance are you on the Omnipod? We are looking at potentially starting my daughter on that model in the next 2 months. I have been reading some negatives on other sites about high failure rates and such. My real draw to the unit is because it is tube free. My daugher is 4 and this model just seems so perfect for her age. Hoping someone has had good experiences with this pump.
Kelly, my dtr is four and we use omnipod. We love it! Every pump with have its problems and I don’t think OP has any more than others. Since August we have had 3 pump fails but it alarms each time and only one was while it was attached. The other two failed to prime. OP customer service is awesome and has always replaced them. I would recommend the system for sure. Tubeless and waterproof was a no brainier for us. However, you should be aware that OP has a 0.05u for smallest dose whereas other pumps can deliver as small as 0.025u. It may make a difference in a small body and is something to consider when choosing. Let me know if you have any other questions.
Kelly-
Get a free sample from Omnipod's website. It doesn't use insulin and gives you a feel for what it's like to wear the pod.
I thought it was way too big and the adhesive bothered my skin. Everyone is different, so try a sample and see what your daughter thinks.
The tube of the Minimed hasn't bothered me but I'm an adult. In 10 years of using the pump I've never had a site failure. The pump itself has stopped working twice and I had to take shots for day until a new one could be overnighted to me.
-Jenna
Thank you so much! I am looking forward to her getting some better control and having a little more freedom, not having to be on the NPH clock all the time.
We actually did that, and she had no issues with it, she went around showing everyone, so I hope that is a sign it will go well.