Combating fat  One parent has learned the fineart of dosing for fat by using the Combination Bolus in her daughter's Cozmo pump.  She takes the number of carbs (46 g for example) and the number of grams of fat (say 25g).  Next she divides the number of grams of fat by the number of grams of carbs to get a ratio of fat to carbs (25/46=.54). You know have a percentage (54%). This is the amount that you bolus on the "back end"  You would do a combination bolus for 46g CHO with 45% up front and 55% extended over 2-2.5 hours.  The higher the back end number, the further the bolus is extended.

Please remember to consult with a physician before making changes to your insulin regimen.

Untethered Regimen by Dr. Steven Edeleman
Discusses the idea of using a basal insulin such as Lantus to compensate for extended periods of time when disconnected from the pump. 
http://www.childrenwithdiabetes.com/clinic/untethered.htm

The Super Bolus by John T. Walsh

The "Super bolus" borrows from the basal insulin effectively loading more of the insulin up front where you need it.  Add up the total of the basal that would be delivered before the food is gone, or for a couple of hours. You would then drop the basal rate to zero for a chosen period of time as that basal insulin was bolused as a single dose. This makes more insulin available right away, when needed most bringing the blood glucose level down sooner, thus taking care of the food that is hitting faster than the bolus normally would. It leaves the latter part of the meal bolus to act in the place of the basal insulin, since the Super bolus took care of the high from the food already and the bolus "tail" is no longer needed to deal with the meal. This works very well for high glycemic index meals.  See the links below for more detailed information. 

·          Do NOT correct high blood sugar in between meals (if it is extreme, suspend the test and treat, make adjustments, and retest another day)

·          Eat low fat foods with known carbohydrate count

·          If blood glucose levels are hypoglycemic at any point, treat the low, suspend the test, make appropriate adjustments to the regime, and then test again another day. 

Site Rotation We all know that site rotation is very important whether on MDI or on pump therapy. Recently we came across a "new" way of thinking about site rotation.  The idea is to say start on the left arm. Move each site over 1 inch until you have done all sites on that arm. Next move to the right arm and do the same.  This continues for all sites--bum, legs, belly.  The idea is that by intensively doing one area at a time, the other areas literally may end up with a month or more before being used again and seriously decreasing the risk of hypertrophy developing. 

Increasing and Decreasing Basal Rates:

Animas Pumpers Summer Tips
With all the activities that summer brings, it’s important to remember to take some precautions with your insulin and pump. For complete instructions for use for your Animas insulin pump, including all warnings, precautions and pump maintenance instructions refer to your Animas User Guide. Below are some reminders for the summer season.
- Unopened insulin vials should be stored in a refrigerator. Insulin can be kept at room temperature for up to a month. After one month, the insulin can degrade and become less effective.
- Do not expose your insulin to extreme temperatures, hot or cold. Do not leave your insulin in an un-insulated container in your car. Also be careful while packing your insulin in a cooler. Keep the insulin away from direct contact with a cold pack.
- Do not take your pump into hot tubs, as the extreme temperature can adversely affect insulin quality. If you spend an extended amount of time on the beach, keep your pump out of direct sunlight. Cover the pump and tubing with a heavy towel and keep them in the shade.
- If you are visiting an amusement park, be sure to remove your pump when riding “free-fall” types of rides and leave the pump with someone who will not be riding. Also disconnect when riding rollercoasters.
- Before you jump into the pool this summer, make sure that your pump is ready for the water. Like any waterproof device, it is important that you check your pump case for cracks. If the pump has been dropped or knocked against a hard surface, it is possible the case may have cracked. Also, make sure the grip pad, bumper pad and keypad are securely attached to your pump. If you have any questions, do not put the pump in water. Call Pump Support immediately at 877-767-7373 (US)
- Also check the o-ring. If the o-ring is torn, damaged or removed, you should replace it. Orings for the IR 1000 should be replaced every 6 weeks. The battery cap and o-ring for the IR 1200 and IR 1250 should be replaced every year or every six months if you work in a dusty environment or swim frequently. Also check the vent on your IR 1200 or IR 1250 battery cap. There is a tiny hole in the middle of your battery cap that keeps the pressure
equalized in your pump. If at any time you suspect the vent opening is clogged, replace the battery cap. Under no circumstances should you introduce any kind of sharp object into the vent opening to clean it. Doing so could compromise the pump’s waterproof capability. If you need additional battery caps or o-rings, call the Reorders Department at 877-937-7867 extension 1522. Refer to your User Guide for instructions on changing the o-ring and
battery cap. If you use the IR 1000, make sure the battery straps are under the batteries and completely inside the battery compartment. This will ensure that the o-ring seals the door properly.
- Some suntan lotions and skin creams contain glycerin which could cause a red flag at an airport screening. If you have handled glycerin containing products be sure to clean your pump as described in your User Guide.

June 2006

If you have tips to share with us, please send them along!