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Have had low blood sugar and pump rate was lowering. Doesn't know how to regulate insulin pump. Suggest?

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Practicing since : 2001
Answered : 1663 Questions
My son's blood sugar went down to 33 today and he had to go to the hospital as we could not get it to go up. He is 27 years old. His pump XXXXXXX rate was 12am 1.60 units/hour 7am 1.80 units/hour 10pm 1.60 units/hour. Today after the low blood sugar he is lowering the 1.60 to 1.40 and the 1.80 to 1.60 do you feel this is a correct change, none of his doctors know how to regulate an insulin pump.
Posted Sat, 10 Aug 2013 in Diabetes
Answered by Dr. Shehzad Topiwala 22 minutes later
See if you can find an endocrinologist locally

When you locate an office, call them before hand to check if the endocrinologists' practice manages insulin pumps frequently. In particular, ask if they have an RD/RN/CDE/CPT (Certified Pump Trainer). Prefer to see one who has these resources.

For now, when I see someone in the situation you are describing, I first significantly lower the pump basal and bolus rates , to first cause the low sugar reactions to go away. It might even mean running a tad high for a few days, then I control it through appropriate adjustments
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Follow-up: Have had low blood sugar and pump rate was lowering. Doesn't know how to regulate insulin pump. Suggest? 12 minutes later
I will have Robby look at the web-site, as far as we know there is no one in our area. Humboldt County, CA. He used to go to UC XXXXXXX when he was 21 years and younger and was covered by CCS. But that is a 6-7 hour drive from us. XXXXXXX XXXXXXX 4 hours and San Francisco is about 5 1/2-6 hours from us and those are the closest that we know of. But is insurance is CMSP now and not all of them take his insurance (just a bit of info to help know why we have not been taking him to one in the last few years) My biggest question is what should he change it to. Someone I know in the medical field who is not a doctor, said she would lower it to 1.0 units through the night and then go up if its too high and go from there. Also is exercising everyday for 2 hours ok in your book? We are very glad he is doing so well with diet and exercise so I do not want to discourage him, but safety is first. Thank you, XXXXX
Answered by Dr. Shehzad Topiwala 16 hours later
Yes in general, that is the strategy I employ when major low's are occurring : Lower the pump rates significantly and then see if the sugars rise and only then gradually raise the rates to bring the glucoses down
Exercise is always encouraged. Checking sugars before , during and after exercise is key. Also, there is a temporary basal rate feature in the pump. I typically advise my pump patients to halve the rate for the duration of exercise (and often an hour prior and for an hour after too)
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