Tuesday, April 5, 2011

Pump Adjustments - Part 3 (Correction Factors)

I am writing this a few days late.  I have taken the pump off today but here is what I did over the week-end.

Now it is time to fine tune my correction bolus. So to refer back to Dr Conway and Colleagues,  The Professionals Guide to Insulin Pump Therapy  as quoted below:        

          Adjusting the Correction Bolus:

The goal is for the blood glucose to return to within 1.7 mmol/L of the target blood glucose within 4 hours of giving the correction blous.The correction bolus is based on the insulin sensitivity factor: the mmol/L one unit of insulin will lower the blood glucose.

Raise or lower the mmol/L on unit of insulin should drop the blood glucose.  Make small adjustements: .3 - .6 mmol/L for each adjustment. 

For example, if the insulin sensitivity factor is 1 unit for every 2.8 mmol/L above the target and the blood glucose 4 hours later after giving the correction blous is ?? mmol/L lower than target, adjust the insulin sensitivity factor to 1 unit for every 3.1 - 3.4 mmol/L.

If you recall I have set my pump correction factors according to the chart. So for 1 unit of insulin it is theoretically suppose to drop me by 1.5 mmol/L. 

This seemed a little high, or low depending on which way you look at it. I know I normally need 1 unit for 3 mmol/L.  Sure enough, I have changed my pump settings since I was reunited 5 days ago. I have set my Correction Factors as follows.

0000 = 1 unit for 6 mmol
0400 = 1 unit for 1.5 mmol
2300 = 1 unit for 6 mmol

I have used the correction for breakfast --- it worked
I have used the correction factor for lunch --- Needed to change it to 1 unit for 2 mmol
I have also change my dinner CF as I was dropping way to low.  Trial and error.

Now they are:

0000 = 1 for 5
0400 = 1 for 1.5
1100 = 1 for 2
1600 = 1 for 3
2200 = 1 for  5

Now you are probably asking yourself why I took the pump off? 

One - I am impatient and my fasting is really sucking lately. I tweak, I test, I trend and change.  But I, at this point in my life, have limited time and energy to do what`s needed to fix my basals.  I don`t want to wake up every three hours to test right now. 

Two - Money, thats right, we have coverage, but we need to purchase up front, and once again, Rowan is priority.

Three - MDI works for me when I let it, meaning, when I behave in the food department.

She is the priority
My plan:

 Wait until I can take a vacation to focus, trend correctly, and have the resources to buy some glucose sensors to really get the settings correct.

So, back to MDI, Levemir, and Apidra.


 (I had a comment to take into consideration, that is when adjusting basals make the change 2 hrs before hand, which makes a lot of sense)