# Pre-pump questions



## shiv (Sep 19, 2010)

Hi every

My 10 week pump trial starts TOMORROW! I'm excited/nervous/haven't really had time in my life to think about it properly. My DSN is slowly becoming more and more useless (I haven't heard from her since before I did the CGM trial 3 weeks ago I think it was? She didn't give me the results of the CGM), I get the feeling I will have to do all the chasing with her in regards to questions and problems I'll have when I get hooked up. I'm going to ask her all these questions, but I would love to hear your experiences.

First off:

- she hasn't given me any advice re: how much background insulin I should take on the day. Tom has advised me to take half my usual amount. Is this what everyone else has done? I had presumed to just not take my morning lantus.

- did everyone get put back onto 1u:10g carbs as a starting point? 

...there will be more!

I plan to basal test tomorrow night, and Tuesday afternoon - and then probably Wednesday morning. And then as often as I can, I haven't planned further than that yet!

Thanks

Shiv


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## bev (Sep 19, 2010)

Hi Shiv,

How exciting! Are you in Brighton or Birmingham?

Alex was on split levemir and so we just didnt give him his morning injection.
If your not on split - I would suggest giving half of what you normally do the night before.

Ratio's - we had ours worked out for us using the ones we were already on. I think (?) they took 25% off each ratio as you use less insulin when on a pump.

Basal testing. It is more important to get your night time levels right to begin with - so you will be doing a lot of that. We did 12 midnight, 3am, 6am, and 8am to begin with and obviously tested as normal throughout the day. We did this for about 2 weeks until we were happy with night time levels. If you dont get that right - then you wont get the day time levels right. And dont forget that if you need a change of basal at 3am - then you make the change on the pump at 1am so it has an effect.

You will have lots more questions and if I can help - do let me know. Dont forget that Hannah is in Brighton and wont be starting uni until 27th - so I am sure she will be happy to help and advise - she knows quite a lot! Good luck tomorrow and let us know how it goes - are you going live tomorrow?Bev


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## Freddie99 (Sep 19, 2010)

Hey Shiv,

I was put on a one unit to ten grammes of carbs when I started. As I was only on one dose of Levemir I was under orders to halve that. Basically go with what they say as I found that I need far less basal insulin and far less bolus now that I'm pumping. Something I've used and abused to the detriment of my waistline/beer gut. 

Now to return to some Judas Priest on youtube.

Tom


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## Ellie Jones (Sep 19, 2010)

When I started on my pump, I was also on spilt levimer, so didn't take my morning jab...

You will need to do something with your background insulin before you start the pump, if you split it's easy you just don't have drop the morning jab, but if you only have one at night, then this will need to be reduced so it only really covering the moring before going on the pump...  You will need to ask the DSN to find out by how much to reduce..

Even though you reduce the background insulin, it still can have an effect for several days on the BG before totally burning out the body, so don't be surpised if the first day or two every seems fine then on 3rd day you reall notice a lot of change..

Different clinics have slightly different proticals with the start off,

But all use the same formula to find out your starting point for basal, they will take the adverage of your last 3 days of TDD, calculate your starting basal, and a correction dose, some clinics with look at your BG data to help to determin a probably starting basal, others like my clinci will just split the basal dose evenly over 24 hours..  

As to carb-insulin ratio's I can exactly remember what I did about these, I either kept to the same as MDI or I may have gone back to 10g-1unit??

As Bev said it's important to pin the night time basal down early if you can, what I did with my was very similar to what Bev did, but I used to do change the testing time, so one night be 12, 3am and 6am the next I did 11, 1am then 4am, etc so I coverd all over several night..

Yep, you do have to remember to pull back and change the basal before you want the change to happen, again this can be a bit individual, 2 hours is a good starting point, but I've actually found that for myself I change about an hour before..


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## tracey w (Sep 19, 2010)

Hiya,

I was on one dose lantus so got told to talk half, but I think Bevs advice sounds good if you are on a split dose.

I did not change my ratios as they were sorted once Id done dafne and continued with those. The dsn should work out your initial basal dose. they use a calculation dependent upon your usual total daily dose.

They start you off lower than your usual, as on a pump you tend to need less, as has been said. And you will work (usually upwards), from there.

Good luck with everything hope you love pumping!


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## tracey w (Sep 19, 2010)

Also, no real point basal testing right away as you will still have levemir in your system. As in the first day or two.

You will however, probably be told to do 2 hourly testing , and throughtout the night at first, this will give you a good indication on how you will need to alter your basals during the first week or so.


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## bigpurpleduck (Sep 19, 2010)

Hi Shiv,

Excellent news! Best of luck with it.

The basal depends on whether you split your dose or not. Mine wasn't split and I was taking it in the morning, so I just skipped the Lantus on the start day.

My starting carb ratio was 1:15 but I'm now 1:12. I guess everyone's different. If you start on 1:10 and find you're having lots of hypos it's easy to change it.

Let us know how you get on!


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## Rainbow (Sep 19, 2010)

Hi Shiv, exciting isn't it?

I was on split Levemir pre pump, my DSN advised me to take half my evening dose the night before and no Levemir on the day. Just to add that even with a reduced dose it hung around for days and made things tricky for well over a week. She said it was unusual but not unheard of so go steady at the beginning.  I really wouldn't worry too much about basal testing until you're sure it's all out of your system. That doesn't mean to say that you shouldn't test like a lunatic though!! Just go steady on the adjustments til you have a clear pattern. 

I started on 1u:10g but now my basal rates are sorted they have changed.

Please enter this with an open mind, lots of patience and try not to expect too much too soon. We're all here to help and keen to follow your journey. 

Wishing you all the best tomorrow
Sue x


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## rossoneri (Sep 19, 2010)

Shiv,

I was on a split Lantus dose before pumping, I think I was told to have half at night and none in the morning but I don't think it mattered too much, in fact I turned up with my BG a little high, which turned out to be good because they could demo the correction dose working straight away!

My Basal rate was initially set to be constant throughout the day based on the formula they have, my initial bolus ratios were set based on what I already had in place for MDI.  After a few days settling in I started the Basal fasts and both these settings soon started to be adjusted.

Best wishes for tomorrow and your forthcoming adventure into the world of pumping.


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## shiv (Sep 19, 2010)

Thanks everyone. 

I realised today that it's going to take a couple of days to get the Lantus out my system, so whilst I will do some mild basal testing, I won't start properly knuckling down with it for another couple of days.

As I normally take my Lantus injection around 11am (split dose), and my appointment is at 1pm, I think I will just not take it.

If she wants to know total daily doses she's going to have to be patient whilst I work it out as she hasn't asked me to bring anything with me - as I say, she is going down in my ranks.


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## shiv (Sep 20, 2010)

I've posted this in the main forum but wanted to make sure everyone saw it (without sounding big headed!! you know what I mean):

Hi everyone, I am all hooked up. It's a purple (!!!!!!) Paradigm 512, Medtronic. The Paradigm 512 is an older model but the only one the hospital had available for trialling - although to be fair, there are only a few differences between it and the new Veos.

Have been told that my DSN doesn't want to flap around with a 3 month trial as she said the trial is only to check I am okay with using the pump and I'm happy with it. So, the official trial is for 2 weeks, at which point she will ask the consultant to apply for funding. She went around the houses a bit but from what I understand, I will basically get to keep the trial pump until we get a positive answer from the PCT (unless of course it takes a ridiculous amount of time).

I did manage to hypo as I left the hospital, mainly due to the heat I think, but am now back up to 10.7. I think my initial basal is set wayyyy too low, but she wants me to email her every 2 days so we can make adjustments.


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## tracey w (Sep 20, 2010)

Good luck with it all!


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