I'm glad I didn't waste my time, as you've not responded.

dave

On Tue, 24 Jan 2006 04:42:11 -0500, Vicki Beausoleil
<VBeausoleil@netscape.net> Huffed and Puffed the following into the
madness of usenet:

There is a teen in my endo's care who is going through puberty and
pumping.  He has damn near perfect control.  He only has a few spikes
and the occasional mild low.

Puberty is the worst time for a type 1 diabetic of either sex.  Before
and after that time, things are not as difficult as you think.

Ok, here we go:

We are only going to discuss ONE thing for now--getting the basal rates
settled down.

The first thing that you must understand is that the pumper will have to
skip a MINIMUM of one meal per day for any time frame that you wish to
nail down the appropriate basal rate, as well as having the pumper go
about the typical activities.  If the activities vary, than make a
mental note of the two extremes in activity level and be prepared to set
up two sets of basal profiles.

The skipped meal(s) allows the pumper to concentrate on getting the
basals set up to provide a constant bg level.  Even someone who has
volatile bg's such as myself can find a basal rate that keeps bg's in
the "normal" range of say, 80-120, indefinitely.  When you eat that
changes everything, so getting the basal rates adjustment means skipping
meals to see how, during a portion of the day, the basal is handling the
 "background" insulin needs of the pumper.  If the basal rate is too
low, adjust it in SMALL increments and test, test, test another day,
skipping the same meal.  Repeat this process for each meal period.
Frequent testing is important during this discovery phase.  Check the
bg's in the middle of the night, too.  It might take several weeks, or
even longer to skip the meals necessary to fine tune the settings.

When it's all dialed in, other factors can turn it all upside down.
Changes in activity.  Eating and bolusing incorrectly.  Illness.  Stress.

No matter what's going on with learning to pump, the most critical bit
of advice I can give is that you MUST GET THE BASAL RATES ADJUSTED
before moving on to fine tune the bolus ratios (carb-to-insulin ratio).
 For example, my ratio is 10:1, meaning for every 10 carbs, I take one
unit of insulin.  Many pumpers will have a lower ratio at breakfast than
the rest of the day due to DP.

That's enough to digest for now.  Please ask for clarifications if you
wish.  Get the Walsh book.  Work with the endo or trainer.

The other issue for pumpers is figuring out a correction bolus, which is
the amount of insulin to take to bring a high bg under control.  That's
expressed as a whole number, like 40.  that would indicate 1 unit would
drop your bg's by 40.  The trick is to realize that it takes upwards of
3 hours for the drop to occur.  don't expect bg's to return to the
desired level in an hour.  If you do, then you'll (the pumper) get hypo
later.  My wife's correction value is around 60 and mine is 38, except
in the middle of the night when it drops to 25, because of the DP.

Enough for now.

dave