From Sage, Arkansas, USA:
How do you know when you need to change carb/insulin ratio and your correction bolus? Do you go by weight? I have looked and looked and can't find information that has been helpful.
In order to figure out when to change carb/insulin ratios, corrective doses (or basal rate) you need to look at the overall pattern of blood sugars just like you would on shots. There are formulas based on total daily insulin dose that are used to estimate carb/insulin ratios and corrective doses when one starts using these techniques rather than fixed carb intake and a sliding scale, but these are less helpful once this type of dosing is already underway.
To figure out if the carb/insulin ratio is sufficient, checking a blood sugar two to three hours after eating is best (usually prior to the next snack or meal). If this number is consistently high, then the ratio at that meal may need to be increased. If it is low, then the ratio may be too high. Consultation with a dietitian can be helpful if certain foods (high fat foods, for example) seem to have differential effects on postprandial blood sugars.
To figure out if the corrective dose is sufficient, one needs to look at the pattern of the blood sugars after a corrective dose has been given. If the corrective dose is sufficient, the next blood sugar should usually be "in range". If it is too high, then the next sugars will be low, and if it is too low, the next sugars will tend to be high.
Basal rate adjustments may be necessary if there is a tendency to rise or fall at times of day (or across the board) despite adequate carb/insulin and corrective dose coverage.
I'd recommend looking at your children's blood sugar patterns and then contacting your diabetes team, giving them your suggestions for changes, and getting feedback on what changes you've developed so you can learn the techniques. Just like adjusting on shots, learning to adjust pump insulin takes time and practice (parental feedback is important since care givers always can explain their children's patterns better than anyone supplied with a set of numbers without a context).
[Editor's comment: Pumping Insulin by John Walsh, P.A., C.D.E., and Ruth Roberts, M.A. is "the bible of pumping". in my opinion. It is extremely comprehensive, it explains these concepts in great detail, and it provides worksheets to help you calculate various numbers for pumping, such as the insulin/carb ratio. Many tables and charts are used to illustrate each topic, helping readers to grasp what are sometimes complex subjects.
Original posting 17 Mar 2002
Posted to Insulin Pumps
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Last Updated: Tuesday April 06, 2010 15:09:32
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