January 23, 2006
Insulin, Insulin Pumps
Question from Powder Springs, Georgia, USA:
My four year old daughter was diagnosed 14 months ago. We have recently changed doctors, but, before we changed doctors, we were in the process of getting her on the pump (the pump was ordered but we had not received it yet). We told the doctor that the pump was on its way and we looked forward to start. He advised us that she was not on a large enough long lasting insulin dose per day and that the pump would be more work for us then anything else. My daughter is currently on three units of Lantus at night and anywhere between seven to ten units of Humalog throughout the day. Her ratios are 1:10 in the morning, and lunch and supper of 1:25. Her correction formula is: blood sugar-250 divide by 200. We have the Cozmo pump and we read that it could be set at a 0 basal rate, but the doctor has advised us that if we give 0 basal rate, the insulin would crystallize and we would end up changing her site more often rather then every two to three days. Everyone we know who is on the pump says it is the best thing. Is what the doctor telling us true?
Answer:
In my opinion, you should be fine with those sorts of total daily doses to use the Cozmo pump now. The basal rates on that pump can run as low as 0.05 units per hour. If you started with that around the clock, you’d have 1.2 units of basal per day, which is fine and should be enough to keep the tubing patent. Most kids your daughter’s age will need between 40 to 60% of their total daily dose as basal on a pump, which means that it is likely that at least some of her daytime basal rates on the pump will be more than 0.05 units per hour.
Some diabetes centers also dilute insulin to facilitate even lower basal rates. We have not done that at our center (haven’t needed to), but it’s also something to consider, if needed.
LAD
