Saturday, January 07, 2006

We've reached a decision

Well, we have decided on a pump, the Cozmo. It's kind of been my favorite from the beginning and I've gotten the best response from their customer service reps. The pumping class went well, I guess. I really didn't learn anything I didn't already know. I did get to play with the pumps a bit, which was nice. But, she didn't have a battery in the Cozmo, so all I could do was look at it. But I have played with the virtual pump plenty and I just like the menu. The DE was really pushing the Animas for Riley because it gives the lowest dose possible. Michael and I decided we just don't like the Animas. No offense to you who use them, but there is too much scrolling to do through the menu. I like that the Cozmo is designed more like a cell phone (as far as the face goes). I'm thinking about the future with this one too. When Riley starts school it's important to me that he has a pump that is easy to use. He will be attending a private school, so no nurse to help with it.

Now, I have been reading "Pumping Insulin" and have figured out a rough estimate of what Riley's basal rate will be. When I first figured it, well, the Animas was really the only option (other than diluting insulin, which I'm not interested in either, since you can't dilute NovoLog and Riley would have to switch to Humalog. I've pretty much got his peaks and things figured out with the Novo and I really don't want to start figuring out how he responds to Humalog while starting the pump too.) Anyway, I don't think Riley's basals will be low for too long. You see, we've had some rough past few days. For those of you who may have read previous posts, you know that Riley had a "perfect" day on Jan. 2. No sugars out of range. Well, the bliss ended just as quickly as it began. Starting on Jan 3rd his sugars were just high, high, high. There were a few that were OK. (His range is 80-140 before breakfast and 100-225 the rest of the day.) Well, on the 3rd they were : 176, 143, 260, 372, 285,280,222,327, 321, and 316. Then, on the 4th and 5th, not a single sugar in range. Not one. So, I'm thinking his Lantus needs to be increased. I'm comfortable with adjusting the Novo but I've never adjusted the Lantus before. Well, I called the endo. and faxed his sugars late Wednesday afternoon. I had to leave a message. It wasn't really urgent since I wasn't supposed to give his Lantus again until the next morning. Well, on Thursday morning, his sugar was 224. ( It had been 299 at 3 AM) So, I took it upon myself to increase his Lantus to a full unit all on my own. A little while later his endo. called and said that was exactly what needed to be done. She also said from looking at his sugars that he may need as much as 2 units a day, but we're going to increase in 1/2 unit increments and see how it goes. So, after 3 days (today is day no. 3) if his sugars are still >140 in the AM, I'm to up it another 1/2 unit. Well, I think that is going to happen. Yesterdays AM sugar wasn't so bad (150), but this morning it was 206. He still pretty much doesn't have any sugars in range. He even has some trace ketones sometimes. He doesn't feel sick though. We haven't had anymore 300s since the Lantus increase. I've also noticed I've had to up his carb coverage a bit too. The endo said not to give any Novo after 7 PM unless necessary if his sugar is >300. Well, he doesn't have those nighttime lows anymore that she was trying to prevent. So, I gave him 1/2 unit Novo last night at 10:20 PM for a sugar of 287. I told my husband his little body just did not need to be out of range all the time. So, I got up every hour last night until his Novo wore off. The lowest his sugar got was 134. So, I'm glad I gave him the Novo. But, then it was 206 this AM, so in the morning we will probably increase to 1 1/2 units of Lantus.

So, I'm going to call Dr. Morris Monday morning and talk about getting a pump. I'm going to tell her we want the Cozmo and see what she says. I've done my own little math and decided that I would be OK with the Cozmo as long as he gets his Lantus up to 2 units. Now, this is just my opinion. I don't know what the endo. will say. Michael and I have discussed it and decided that if she says he can go with the Animas now or wait until a certain level before getting the Cozmo, we are going to wait. We don't want to use a pump we don't really like just because he might need those lower basal rates for a few months.


Unknown said...

That's how our first pump training went.I remeber now,Josh had his Humalog diluted. With the honeymoon stage,was probably a good idea for less Lantus.You'll begin to see days,weeks,even months where his BS will be in range, and just when you figure it out, with his growing things will be changing.
You're doing an incredible job,and another reason why the pump is great I don't feel so bad about giving him a correction bolus as I did a correction shot.Looking forward to more updates on future pump trainings.

Anonymous said...

Congrats on the pump picking - Cozmo wasn't an option for us because of insurance but I still think I would have gone with the Animas so I can give the lower basal. Also you can adjust the basal up or down in finer increments (as far as I know) with the Animas. This has been very important for William - otherwise we would definitely needed to use diluted humalog in his pump. I hardly wish to sound like a shill for Animas though! LOL! Perhaps it would help as well to find some other toddlers on Cozmo to check out their experiences. Both are great pumps.

I'll add that William was on diluted humalog for injections and we did not notice any difference between it and the novolog we now use in the pump. So this could always be an option if you run into issues. I hope the dr. will ok everything so you can start pumping - it really is wonderful compared to injections.

Shannon said...

Cozmo gives the option for tiny basal increments and diluted insulin would be unnecessary.

We originally had Brendon doing diluted insulin before he went on the pump because he was about your son's age and raising his dose a 1/4 unit was sometimes way too much.

It doesn't matter what regimen he's on now with Lantus. The basal rates on the pump are tiny enough to make up for what the Lantus is doing for him now.

Cozmo is great for toddlers which is why his CDE recommended it. It is actually one of the only pumps on the market that meets the small increments that toddlers need.

Anonymous said...

Of the 3 major pumps on the American market, the Cozmo pump and the Minimed has its lowest basal increment at .05 and the Animas is .025 (which is quite a bit smaller - half as much)! In other words the Cozmo's smallest basal is 1/20th of a unit whereas the Animas is 1/40th of a unit.

I just wanted to make this clear to anyone pump shopping - all 3 are excellent pumps but the Animas is the only one with the .025 basal increments - half as much as the other pumps. This could make a difference for some people in which pump they choose.

Penny Ratzlaff said...

Thank you all for your comments. I called the endo. today and left a message telling her I wanted to talk about choosing a pump. She hasn't called back yet, so I'll let you all know what she says when she does call back.

Shannon said...

Update on the Cozmo, it is now .01, not .05.

Anonymous said...

Not to beat a dead horse but do you have a link to more info on the Cozmo with the .01 basal increments? I based my comment on what it says on the Cozmo website at which is .05. Are they coming out with a new/different pump?

I'd really like to know if it does give you the ability of a .01 basal increment increase - this would be a HUGE difference in the lowest amount currently on the market and I'd be personally interested in knowing more about it for William.

Penny Ratzlaff said...

Carol, as far as I know, the lowest basal is still 0.025 and that's only with the Animas. I have Cozmo's newest brochure and just attended the pumping class and Cozmo's lowest is still 0.05.

Anonymous said...

Thanks Penny - I actually called Cozmo this morning to confirm that myself - the lowest basal increment is .05 for the Cozmo.

I rather feel bad pursuing the issue but it really made me curious! I didn't want you to think I am being critical of your choice for Cozmo - it is a great pump and whichever you get will change your life and your son's too I think. The first few weeks (or month or two) can be hard - rather like starting all over again with diabetes trying to get the basal and bolus right. In the end it makes managing the diabetes so much easier. I hope you get good news from the doctor.

Penny Ratzlaff said...

Carol, read my next couple of posts. You might be surprised.

Shannon said...

Sorry about that, they have increments of .01 for boluses.

I personally don't think you're beating a dead horse. If anyone reading this is thinking of putting their kid on the pump, it's important that they get accurate info :)