Comments on: New Tricks for Tweaking Dosing Formulas for Your Insulin Pump

By: Interesting – Tweaks for Insulin Pumps | LADA Life

Interesting – Tweaks for Insulin Pumps | LADA Life — Sat, 12 Sep 2009 15:17:17 +0000

[...] New Tricks for Tweaking Dosing Formulas for Your Insulin Pump I’m giving it serious thought. Share and Enjoy: [...]

By: Well, it works… « Plastic Pancreas

Well, it works… « Plastic Pancreas — Thu, 03 Sep 2009 15:19:02 +0000

[...] 50%. Pumping Insulin also has recommendations for basal % TDD to be around 40%. Additionally, some studies have shown that the people with the least variability have basal % TDDs of around 40%. So, [...]

By: landileigh

landileigh — Thu, 27 Aug 2009 18:46:38 +0000

i tried this, and I have been amazed at the drop in insulin I’ve had to take every day. the correction levels were totally adjusted for me, and I haven’t been above 160 since doing this! Thanks Kelly!

By: Diabetes – Prevention And Cure part 3 | Alternative Medicine

Diabetes – Prevention And Cure part 3 | Alternative Medicine — Mon, 24 Aug 2009 10:56:26 +0000

[...] New Tricks for Tweaking Dosing Formulas for Your Insulin Pump (diabetesmine.com) [...]

By: Cathy

Cathy — Mon, 24 Aug 2009 02:28:55 +0000

I am the Mom of a 12 year old Type 1 girl and puberty is very difficult and not consistent at all. SOME if the CDE’s get caught into the formulas too much, although each family is different in their level of involvement and care.

By: T1 D

T1 D — Sun, 23 Aug 2009 22:54:02 +0000

Yes, Jan, these are definitely BALLPARK FIGURES FOR ADULTS. THAT’S WHAT THEY ARE SUPPOSED TO BE!. AND Anon no, Anon, NOT everyone is supposed to eat 180 carbs everyday (no corrections in an ideal world !!!! ???? !!!! ARE YOU CRAZY ?????????? ).
I eat 24 grm of carbs every day, not every meal BUT EVERY DAY and the correction NEW numbers are about right FOR ME.

By: kelly close

kelly close — Sun, 23 Aug 2009 05:52:01 +0000

yes, it is DEFINITELY true everyone’s mileage varies on this! I found the changes really helpful though – even though my A1c has been under 7 for a long time, it wasn’t without a lot of hypoglycemia, so I think I’m nearly a much “higher quality” A1c, which isn’t really a term we hear a lot about. But wow to be at 5.6 Elizabeth – that is amazing! I wouldn’t change a thing either if I had few lows! And Lloyd that’s exactly what the educator said about my numbers – we had to change the basal first, which I hadn’t really realized, so I had long been “tweaking” the other formulas without getting the right basals. Thankfully I’m there now. That’s fascinating, Jen, about the 180 carbs – I think mine varies a ton, but usually around 160, so not too far off. Jan, if I implied anything BUT these are starting points, I’m so sorry. I think their point is the new formulas may be better starting points. I’ve also heard from a lot of diabetic friends that their current settings are the SAME as when they began pumping – probably many people could use tweaks, but the HCP teams don’t always spend time on it. As for a pump vs injections – I don’t think I could ever go back! I know all the math sounds insane, but you really only do it once and then tweak (but I hadn’t tweaked enough, that’s for sure!) And last, even though the reason my insurance pays for pumps and CGM is because I am in much better health with them, one of the nice bonuses about pumps and CGM is also that it is fewer pokes! Thanks Amy for the chance to guest post!

By: Jan

Jan — Fri, 21 Aug 2009 17:09:09 +0000

As the caretaker of a child with Type 1 (diagnosed at 8 and now 12 years of age), I find all formulas to be quite dangerous. Formulas can only be used as a general, ball park check. For first two years prior to puberty, my niece used 36 percent basal, the rest bolus. Now, in puberty, she is using 60 percent basal, 40 percent bolus. She is 85 pounds. Her Insulin Sensitivity Factor is 75 days, 110 midnight to 6am. This has been checked time and time again and verified by her Endo. I have John Walsh’s charts as a very loose reference (mostly to check basal per hour) and they are way off. Her lowest basal is .95. Her highest basal (which can go higher due to growth spurts), anywhere from 1.75 to 2.7 during the 6pm thru midnight hours. We get night basals almost every night and she wears the Dexcom 7 Plus cgms. Current Insulin to carb ratios are 1 to 7 breakfast, 1 to 13 lunch and dinner. All have been checked time and time again and are verified. We do fasting basals and skip meals to check basals all the time. The one thing you can check with absolute certainty are basal patterns. Unfortunately in teens these change very frequently. Very. Each person should do their own basal testing to determine basal need. Then they can figure out the rest. Forumulas such as these do not and cannot work for each person. Each person is an individual and needs may vary tremendously.

By: Anon

Anon — Fri, 21 Aug 2009 13:43:46 +0000

These ratios work out to suggest that, on a perfect day without correction insulin, everyone — regardless of weight — eats 180 grams of carbs.

We start with:
———–
TDD = 0.2 * weight
Basal = TDD * 0.4
————

Since TDD – basal = non-basal insulin (no corrections in an ideal world), we get

non-basal insulin
= TDD – basal
= (0.2 * weight) – (TDD * 0.4)
= (0.2 * weight) – (0.2 * weight * 0.4)
= (0.2 * weight) – (0.08 * weight)
= weight * (0.2 – 0.08)
= weight * 0.12

So, let’s get the carb factor:

300 / TDD
= 300 / (weight * 0.2)
= 1500 / weight

So, if all of our non-basal insulin is going to carbs, it means that:

carb intake
= carb ratio * carb insulin
= carb ratio * non-basal insulin (ideally speaking)
= (1500 / weight) * (weight * 0.12)
= 1500 * 0.12
= 180

Therefore, everyone eats 180 grams of carbs no matter what they weigh.

Heh. Math.

By: Lloyd

Lloyd — Fri, 21 Aug 2009 07:38:08 +0000

I’m an insulin dependent T2, producing very little insulin. C-peptide of 0.5. Here is how I adjust my pump:
Adjust the basal so that the numbers are in line with my goals, and do not drift if I skip a meal. Insulin/carb and correction factors found by trial and error.
30 day stats:
Ave 94
Standard Deviation 12
26% bolus
2% correction
71% basal
The above numbers are low on bolus, due to my eating a very moderate amount of carbs.
I don’t see how anything derived from a formula can be anything but your first day’s settings, beyond that its all tweaking, basal first.

Having your glucose remain as constant as possible when a meal is missed or delayed is a very useful thing. Combine that with good carb counting skills, and a food scale, and you can be very successful.

-Lloyd