Basel and bolus increments - HELP


(Matthews Dad) #1

I am trying to compare the Omnipod to the Ping and wondered if you could help.

I took out the bells and whistles (battery power, waterproofing, ease of use etc) to get down to the basics (delivery of insulin.)

All the companies talk about smallest basal increment and (I know the smaller basal increment, the more precise the dose can be).

The also talk about the Smallest bolus increment (More precise bolus dosing helps match insulin with food intake and blood glucose readings).

I guess I am not thinking about how the pump functions in that respect. I see my son get insulin injections based on my calculations based on carbs.

He does 30 carbs and he gets 2 units etc. which would  be no problem if the number always came out right and I could  determine the exact dose on insulin but its just a close estimate now.

Now they are talking are .025 vs .05 . I guess I am just a bit confused.

 

Wondered if you all could help


(Sarah_0776) #2

I have a Ping. I know that the smallest basal increment it can deliver is .025u/hr. And the smallest bolus increment it can deliver is .05u.

With the Omnipod, the smallest basal increment is .05u/hr. and the smallest bolus increment is also .05u.

If you would like to compare both pumps, you can go here.


(Matthews Dad) #3

Hi

Thanks for the help.

Would you happen to know WHY .025u/hr is better than .05u. I think that is the part I don't understand. 


(Sarah_0776) #4

It just makes it so that you can even more tightly control your blood sugars. Some people are very sensitive to insulin, so being able to adjust their basals by such a small amount can make a huge difference. I personally am not that extremely sensitive to insulin (my basal rates are 1.3 and 1.7), but for some people having that tiny increment available is wonderful. I know some people are so sensitive that they barely need any at certain times of the day, so being able to set the rate at .025u/hr. works really well, whereas if it were at 0u/hr. it'd be too little, and .05u/hr. would be too much.


(joe) #5

[quote user="Keith"]

Hi

Thanks for the help.

Would you happen to know WHY .025u/hr is better than .05u. I think that is the part I don't understand. 

[/quote]

who said it's better?  it's just more precise, and it being "better" only depends on what that precision does for you.    okay, my pump delivers bolus in 0.1 unit increments, meaining I can take fractions of a unit for example 5.6 units as opposed to 5.5  ---  for ME, (12 grams of carbs per unit of insulin) it doesn't mean very much when I am eating.  if I am trying to correct a blood sugar - it helps a little more because 1 unit of insulin brings me down 32 mg/dl.  so I can easily bring down a 154 to a 99 in one correction bolus of 1.7 units.

as far as basal rates, 0.05 units per hour resolution is the right precision for my needs.  My basal adjustments are in the range of 5-10% and my lowest rate is 0.55 so I can bump it to 0.50 or 0.60.  I don't have much of a need for 0.57, but that's just me.

cheers


(Matthews Dad) #6

It is getting clear but it still seems to be we are trying to use an exact measurement on an in exact science.

For example, you are in a restaurant and you order a pasta, or a pizza or rolls are served. Now you can use the book to get an idea to determine approximately how much pasta etc  is there but you can only get close.  Pizza even at fast food places can vary by the person making it - ie they add more sugar to the sauce or put more pasta on the plate etc. So you calculate approximately what the carbs are. Yesterday I ordered pizza and the book said 30 carbs per slice and the website of the same company said 39. Multiply this by 3 slices sometimes four and your off by almost 40 carbs. The same is true if you go over to someones house and they made an appetizer or something. 

Right now my son takes one unit for every 15 carbs. If you estimate incorrectly the carbs your 2 or 3 units off right at the start.

So for a pump how would you adjust something like that.

I can see the importance for maybe a small child or a baby. 


(joe) #7

[quote user="Keith"]

It is getting clear but it still seems to be we are trying to use an exact measurement on an in exact science.

[/quote]

exactly.  welcome to the jungle.  ALL pumps on the market today have AN ORDER OF MAGNITUDE more precision than "necessary"

now to really "get" the situation consider this, our crummy blood sugar meters have an average accuracy of +/- 20%.    So you test and get a 199.  What's your blood sugar?  ANSWER: BETWEEN 239 and 159.  so now tell me why is it so important to deliver 0.05 units in a bolus?    The reality of the situation is that it is not all that important.    Most bolus and corrections are "Best Guess" based on experience. if anybody tellys you different then they do not have diabetes.

The best thing about the pump is that you can program a variable basal rate, to match your body's variable basal requirements.  Most folks who have a wide variation in basal requirements are miserable on Lantus (or equivalent all-day insulin).  The pump can be programmed to make that miserable "under or overdosing" go away.  Furthermore, if you decide you want to exercise - you can turn your basal down within 45 minutes (try THAT on Lantus!)   everything else is FOO FOO marketing.  the basal motor program (in the pump) also delivers your bolus, so in the engineering specifications they list the smallest incremental bolus, but it doesn't really matter all that much - so don't get humg up on basal/bolus increments in pump marketing brochures - choose a pump you like, even if it's the color you like, because the basal matching can make all the difference in the world for overall control and comfort for when you are running the marathon or spend the day watching cartoons.

 


(Matthews Dad) #8

Thanks for the help

This will sound like a stupid question but do you still take Lantus at night if you have a pump.?

Also, from what I get from you is what I had originally thought - it becomes ease of use - based on your lifestyle.  Find a pump that your comfortable with -

As for the Omni pod vs Ping I next have to figure which of the two has the least of failure rate. I now the rep will slant those numbers and endo probably meets with the reps and trust their opinions. So I have to relay on this site.

Thank you for your help - it was great


(smat1234) #9

No, you don't take Lantus.


(joe) #10

Tracey and Keith.

The simple answer is no,  you don't need to take lantrus too,  but some people DO use Lantus with the pump, and you CAN use a hybrid therapy system.  Here's why and how you do it.

Say you are using a pump and you need to disconnect for a very long time because you are [filll in the blank] participating at a wrestling tournament, on a whitewater adventure, scuba diving to 300 feet, etc.

if yout total basal is 12 units, your average basal rate is 0.5 units per hour.  Most people during very high activity use about 20-30% of their basal rate, you program your pump to back down normally but for this special day/reason you want the pump off for hours and you don't want to chance DKA.    in the morning you would shoot 4 units of lantus (this is a all day basal rate of 0.17 units per hour) of and set your pump to a temporary basal rate that is about 0.2 units per hour less than normal. this is easier with a pump that can calculate percent of basal.

now when it's your turn to dive to 300 feet, you take your pump off, your basal rate is automatically reduced because, with the pump off you are relying on the lantus you shot in the morning, you dive for as long as you want and never worry about DKA.

some people get into DKA very easily.  A pump makes you MORE liable to suffer from DKA because there is typically only fast acting insulin in the pump.  if there is a delivery problem you could be in real trouble in 2-3 hours.  for THESE people, it is a good idea to mix their humalog (novolog etc) with REGULAR insulin in the pump reservior.  Because regular can  last 6 hours - you are way less liabel to get into trouble if you had an infusion set failure.

about 5% of pumpers mix their fast acting insulin with a medium acting insulin (insulinpumpers(dot)org)   becasue of DKA.    I don't,  I use humalog only.  I have never been in DKA in 31 years so maybe i am lucky.

regarding failure rates - people will tell you that pod failures are not uncommon (I said it that way on purpose).  If you get a bad one, you rip it off and slap a new one on.  you can't compare that failure rate with say the breakdown of a Ping - if you did the Ping would be way ahead.  instead you would have to look at the Ping PLUS the infusion system versus the omnipod.  if you compared that set you would probably find that the failure rates are similar.  You get a bad infusion set or site - you rip it off and put in a new one.  same same! =)

get samples and try them.  sleep with the ping, sleep with a pod stuck to you.  wear it around for a little while.  Play with the interface thinggy.  Make the sales people demonstrate how you set them up, fill the reserviors, etc.  IMO that's the best way to test which one you like.

cheers and good luck. 


(smat1234) #11

Joe, you are correct about the lantus if you are going to be off the pump.  I thought Keith meant on a normal day-to-day basis do you take lantus while using a pump.  I don't know anyone who mixes fast acting with medium acting.