Excited...first step to pump

[rebrascora]

"I know people say...go to bed on a higher level, but I just find it goes down of its own accord if i do that.
And i can be nice and level, but then dip around 3am. Or 4am. Still, thank heavens for cgm!"

@Tdm Have you considered that your body might be releasing it's own insulin to bring you down to those low levels at 3am because that is where it wants to be. You are on such tiny doses and It is not unusual for non diabetic people to dip below 4 at that time of night. Maybe eating something at bedtime to push your levels up is triggering your own insulin response to bring it down and perhaps, if you didn't have a CGM you wouldn't be aware of it happening and maybe what you are worrying about is maybe a perfectly normal response. If this is the case then a pump may not resolve it because it can't suspend your own insulin.

 

[everydayupsanddowns]

At my review this week, we talked about the OmniPod HCL. Apparently, it has one of the “gentler” algorithms which would raise my HbA1C.

Better to think of that as ‘reducing your exposure to hypoglycaemia’ surely?

I wasn’t involved in the HCL evidence sifting, and haven’t really had time to unpick what lies behind the guidance by reading the full document, but I do get a bit frustrated by the emphasis on HbA1c ‘cut offs’.

It happened with pump therapy too, despite the guidance explicitly stating that what pumps were really good at was reducing hypos. On average their capacity for HbA1c reduction was actually relatively modest.

And HCL can be absolutely brilliant at reducing risk of hypoglycaemia (depending on how the particular algorithm works with an individual).

If they are complaining at you for ‘too many hypos’, in my mind that really should be a vote for HCL. Incidentally what do your TIR stats say about your time below 4.0? How do they compare to the recommendations?

 

[everydayupsanddowns]

Congrats on your nod for pump / HCL @Tdm

Any idea which options / brands are available to you?

 

[CliffH]

No idea what this and other posts you have made tonight are on about ie Freda's glasses?? But just thought you should know that 194/4=48.5 not 48.75 so you could round it up or down.

I'm currently trying to explain to a teenager in my extended family that the convention is always to round up when the final digit is 5: it's not a choice 😱

 

[helli]

I'm currently trying to explain to a teenager in my extended family that the convention is always to round up when the final digit is 5: it's not a choice 😱

I would say "it depends upon the situation".
With carb counting and insulin dose calculation, I always round down when the final digit is .5.
Better to have too little insulin and add more later if it not enough than risk a hypo because you gave yourself too much.

 

[CliffH]

I would say "it depends upon the situation".
With carb counting and insulin dose calculation, I always round down when the final digit is .5.
Better to have too little insulin and add more later if it not enough than risk a hypo because you gave yourself too much.

Good point - but please don't tell my young relative, who already tries to argue with the Maths teacher!

 

[Tdm]

Congrats on your nod for pump / HCL @Tdm

Any idea which options / brands are available to you?

So far i have the list thats on the 'decision support tool' whuch has 5

NHS England » Decision support tool: making a decision about managing type 1 diabetes

NHS England » Decision support tool: making a decision about managing type 1 diabetes

www.england.nhs.uk

I don't know which ones they do, but to my mind i'd be interested in ypsopump or dana-i as they use dex g6 and wjithin those that use g6 are the only 2 that allow you to set a target below 6.1 which is a bit higher than what i already get from mdi. If thats not available, omnipod so i can see if it works for me without tie in.
Medtronic could be ok but not sure about their sensors, and changing sensor and pump at the same time may be a bit much.
What do people think between dana and ypsopump? Medtronic sensors any good/better than g6?

 

[Tdm]

Though i am still waiting the result ftom a follow up c-peptide, so if that shows i still have a quite bit of my own insulin that may affect things....i've looked on nhs app but nothing in results on there...would hospital results show on there?

 

[grovesy]

Though i am still waiting the result ftom a follow up c-peptide, so if that shows i still have a quite bit of my own insulin that may affect things....i've looked on nhs app but nothing in results on there...would hospital results show on there?

It depends on the area whether hospital results are on the NHS app. My area have recently announced it is looking into making them available on the app.

 

[Lucyr]

i've looked on nhs app but nothing in results on there...would hospital results show on there?

The NHS app just shows GP requested blood results

 

[Tdm]

The NHS app just shows GP requested blood results

Thanks

 

[Tdm]

It depends on the area whether hospital results are on the NHS app. My area have recently announced it is looking into making them available on the app.

Thanks...my consultants letters aren't there so i guess not available. I suppose i should just wait for letter

 

[Inka]

So far i have the list thats on the 'decision support tool' whuch has 5

NHS England » Decision support tool: making a decision about managing type 1 diabetes

NHS England » Decision support tool: making a decision about managing type 1 diabetes

www.england.nhs.uk

I don't know which ones they do, but to my mind i'd be interested in ypsopump or dana-i as they use dex g6 and wjithin those that use g6 are the only 2 that allow you to set a target below 6.1 which is a bit higher than what i already get from mdi. If thats not available, omnipod so i can see if it works for me without tie in.
Medtronic could be ok but not sure about their sensors, and changing sensor and pump at the same time may be a bit much.
What do people think between dana and ypsopump? Medtronic sensors any good/better than g6?

I have the Dana i but don’t loop with it. It’s a fantastic pump though and I rate it extremely highly. A quick Google turned up the document below which has graphs of its accuracy in basal and bolus compared with other pumps. Open the document, have a read about MARD and look at the graphs:

https://www.drwf.org.uk/media/id0fc1ja/dana-i-camaps-drwf-2023.pdf

.

 

[everydayupsanddowns]

What do people think between dana and ypsopump? Medtronic sensors any good/better than g6?

No idea how applicable my experience will be to anyone else’s body chemistry, but…

I had great correlation between G6 and fingersticks in the whole, but I did find it very ‘laggy’. Certainly the full 10 mins behind. And only updating data points every 5 mins was frustrating, if my BG was set to start rising or falling at 11ish minutes, and the first two 5 min data points showed steady levels, but by the next 5 mins later things had risen (or dropped) dramatically. My traces were often fairly trapezoid in shape on G6, flat sections, with rapid diagonal rises and falls.

I haven’t tried Medtronic G4 (the G3 wasn’t great for me) but have been pleasantly surprised by the Simplera. It generally tracks well, certainly ‘in range’, and feels a little more responsive than Dex G6. It’s really simple to insert and use. Several sensors seem to have had a tendency to slightly under-read higher levels, and over-read lower levels, so my TIR is sometimes artificially inflated (eg fingerstick might have me at 10.5ish, but Simplera will reassuringly suggest I’ve levelled out at 9.8.

Keeping hydrated is important with both. Gotta keep that interstitial fluid moving!

The Medtronic MM780G algorithm suits my metabolism better than Tandem tSlim’s Control IQ, so my time below 4.0 has significantly dropped, down to about 0-1% from 2-4%.

 

[PhoebeC]

My new DSN (mine is retiring) said last week during the DAFNE course that mental load is a consideration of HCL as is quality of life.
And that they look at HB1AC, TIR and number of hypos and hypers to see how someone is actually doing, they do not rely on HB1AC ever on its own and TIR is getting more important.
From what he said results are one element and the persons life is the other. My TIR overall is good, but around my cycle it goes nuts twice a month, that’s how I was put forward for the pump. The data showing my cycle and the impact, and now it’s why I get HCL tomorrow even though my HB1AC is 52 and my TIR 65%. My overnight patterns due to menstrual cycles still join the party and the changes I have to make when I am due on a HCL could be quicker than me