Ypsomed driving me mad

[Lauren]

I was changed from the Medtronic 780g on Tuesday to the Ypsomed/Libre 3 system. Overnight the basal rate has been working beautifully but whenever I eat my BG has gone up to between 17 and 20 for over 5 hours at a time even with the boost function being used. The first few days I figured maybe I was stressed or ill but the last two days it's continued and I've realised it's only been after food. I am panicking as I'm 7 weeks pregnant and my time in range has dropped from 88% to 50% and I feel so unwell with almost constant high sugars during the day.

So I spoke to one of the DSNs today and we changed my insulin to carb ratio and correction ratio which hopefully will be very helpful. But she did say that the Ypsomed doesn't react to high BGs with corrections like the Medtronic does - does anyone know if this is right? She said rather than responding to highs at the time it will remember for the next day. I'm baffled by this, what a silly system if that's true?!
I wasn't keen to change pumps during pregnancy anyway, although I understand the target range can be set on the Ypsomed to slightly lower, I was achieving this with my Medtronic. The nurse at one point suggested I go back on my Medtronic again until I can attend the clinic on Monday but after I pointed out that my Medtronic has been switched off without a battery for most of the week and will have lost its algorithm, she advised me to stick to the Ypsomed as I will have high bloods and feel ill regardless of which pump I use until it 'learns' me. I am unhappy and irked and wondering what damage I'm doing

 

[Inka]

Can you use the Ypsomed in manual mode @Lauren ? That’s what I’d do.

 

[Lauren]

Can you use the Ypsomed in manual mode @Lauren ? That’s what I’d do

Ypsomed have advised me not to. Also it's set with basal rates which may not be very accurate as my nurse had to calculate them according to my total daily dose rather than having a set basal profile, as I'd come from having a hybrid closed loop previously. Although honestly I'm thinking it would give me better control.

 

[Inka]

To be blunt, it’s not their pregnancy. You should do what you think best. With such a drop in your TIR, I’d think you can improve that yourself x

 

[Lauren]

To be blunt, it’s not their pregnancy. You should do what you think best. With such a drop in your TIR, I’d think you can improve that yourself x

Fair comment! Thank you. I will see how the rest of today goes with these changes first. Not happy though especially as I said to them several times, including during the pump training, that I didn't want to change my pump and I especially didn't want to if there was any risk of high BGs while the new pump got used to me!

 

[nonethewiser]

No nowt being male about pregnancy hormones & such, but what about preempting rise after food by giving a extra bolus if pump in automated mode is slow to react.

Sometimes do this on my Omnipod 5/Dex6 as pump still takes into consideration any extra bolus doses given, should be same with your pump @Lauren but do check first.

Just ignore above if unsure.

 

[Lauren]

No nowt being male about pregnancy hormones & such, but what about preempting rise after food by giving a extra bolus if pump in automated mode is slow to react.

Sometimes do this on my Omnipod 5/Dex6 as pump still takes into consideration any extra bolus doses given, should be same with your pump @Lauren but do check first.

Just ignore above if unsure.

I am soo tempted to do this but they have told me not while it's learning in the first week or so.
However I did do a pen correction earlier because my BG had been 17 for several hours and I was so fed up. If it continues like this I will probably go back to my Medtronic. I've realised I can see my previous basal rates from the Medtronic software so could use this to set it back up. But I'll see if these changes work first.

 

[Inka]

See, this is what I don’t get. It takes that time to learn - fair enough - but things change so often in pregnancy. Surely it’s always going to be on the back foot?

 

[Lauren]

See, this is what I don’t get. It takes that time to learn - fair enough - but things change so often in pregnancy. Surely it’s always going to be on the back foot?

Completely agree with you. I'm so sad I went through with it and changed.

 

[Lauren]

My BG is now 3.8 with a red down arrow after bolusing for dinner 🙄

 

[Saoirse]

Hi Lauren, I don’t have ypsopump, but do have some experience with camAPS which I assume is the system your using?

My understanding is that the loop does normally attempt to correct a high at the time, unless it thinks you have sufficient IOB to deal with it, AND it should also learn from what happened. If it’s of help I’ve attached my graph from earlier today below to see it in different points of the day. The solid blue line is the rate of insulin infusion. Around 6 am blood sugar is falling, so you can see the loop shuts off almost completely (there’s a little pulse of insulin, but the system does that to avoid occlusions). Later in the day (blue circle) my blood sugar is getting towards 10 so you can see the infusion rate goes up. I was about to cycle somewhere which usually drops me fast, so I took 15g as ‘hypo’ treatment to tell it not to bolus for those carbs, and you can see the infusion rate drops to zero, befor then settling to my baseline (which is the blue dotted line). Apologies if this is all redundant information, but I hope it is helpful.

I’m really sorry the system is being so frustrating for you, especially during pregnancy. Have they discussed the boost functions or using a split bolus with you yet?

 

[Lauren]

Hi Lauren, I don’t have ypsopump, but do have some experience with camAPS which I assume is the system your using?

My understanding is that the loop does normally attempt to correct a high at the time, unless it thinks you have sufficient IOB to deal with it, AND it should also learn from what happened. If it’s of help I’ve attached my graph from earlier today below to see it in different points of the day. The solid blue line is the rate of insulin infusion. Around 6 am blood sugar is falling, so you can see the loop shuts off almost completely (there’s a little pulse of insulin, but the system does that to avoid occlusions). Later in the day (blue circle) my blood sugar is getting towards 10 so you can see the infusion rate goes up. I was about to cycle somewhere which usually drops me fast, so I took 15g as ‘hypo’ treatment to tell it not to bolus for those carbs, and you can see the infusion rate drops to zero, befor then settling to my baseline (which is the blue dotted line). Apologies if this is all redundant information, but I hope it is helpful.

I’m really sorry the system is being so frustrating for you, especially during pregnancy. Have they discussed the boost functions or using a split bolus with you yet?

This is helpful, thanks. It's good to know it does actually correct!
Yes I've been using boost and split bolus, although they initially said not to use boost while the pump works out the algorithm, I've found it helps a little.

An hour after food my BG is now 5.8 so I feel that my carb and correction ratios must have been way off. I'm so thankful it seems to be working as there's elements of this system I'm quite optimistic about (such as ease of accessing data). These last few days have absolutely thrown me and then the nurse confused me so much with what she was saying about corrections!

 

[Saoirse]

This is helpful, thanks. It's good to know it does actually correct!
Yes I've been using boost and split bolus, although they initially said not to use boost while the pump works out the algorithm I've found it helps a little.

An hour after food my BG is 5.8 so I feel that my carb and correction ratios must have been way off. I'm so thankful it seems to be working as there's elements of this system I'm quite optimistic about (such as ease of accessing data). These last few days have absolutely thrown me and then the nurse confused me so much with what she was saying about corrections!

Yes, they do recommend avoiding boost in the first two weeks, because the system doesn’t learn when this or ease off are used. Inka is right too and do keep at the dsn, make them give you all the support. I’ll keep my fingers crossed that things settle down asap.

 

[everydayupsanddowns]

So pleased things are gradually improving for you @Lauren

It must have been so stressful changing systems with the pressure of the pregnancy targets hanging over you