getting tighter control

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Akasha

Akasha

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Relationship to Diabetes
Type 1
Hey.
I have been on the pump for 3 months now. Bloods have been fairly constant between 7 and 10.
DSN has said now i've got to grips with the pump, Set the target to the pregnancy range which is 4 - 6.
My levels for the past week have been below 7. however i'm seeming to have more hypos. as in below 3.5.
Is this normal?
 
Is there a pattern to the hypos? It may be your basal rates that need adjusting (but I'm no pumper so I'll stop right there! 😉)
 
4-6 is quite tight and doesn't give much room for error (though I know some pumpers who seem to manage it).

If it were me I'd set the target range as 5-6, or even 5.5-6 so that a tiny adjustment will be made to any meal dose where your BGs are below that (knocking fractions of a unit off the calculated meal bolus).

Other than that I guess it's just be a case of setting a TBR for the slightest activity since at 4-5 you have almost no 'slack' before you dip into a hypo.

I've only just started on a pump myself - hopefully a more experienced pump veteran will come along soon to share their wisdom!

I might move this into 'Pumping' to make sure it gets spotted.
 
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I put it here because of the pregnancy eliment to it aswell.

I had a basal rate of 0.550 from midnight to 7am. Woke up most mornings hypo (3.5-4) so i dropped it to 0.525.
DSN now said cause of the pregnancy targets up it to 0.575. Which I have.
I have then been told that i can go as low as 3.5 before being classed hypo.

I feel uncomfortable sitting that low to the line. I'm a driver and DVLA states that you cannot drive below 5.

Just soo much conflicting advise!! :confused:
 
Have you tested your basal rate(s) overnight recently to see what is happening between midnight and 7am?
 
I was going to ask the same question, re overnight testing.

I don't know what to suggest about driving - as clearly you just cannot drive if you are under 5.5.

What did other preg ladies do?
 
Might be worth clarifying what the targets are supposed to mean. Cos there's no way I can stay within 2mmol/L after every meal. Some I do, but not all of them.

Is the 4-6 supposed to be pre-meal only? What meal-rise are you being allowed?
 
I see that you've only been using the pump for 3 months and by the looks of it, you seem to have sorted out your main control well... So how to tighten up a little further?

Firstly checked that your basal is actually correct, it needs to be floating between 4mmol/l and 6mmol/l and should ideally stay in the main in the top 4's lower 5's...

I wouldn't set your target ranges for any lower than 4.mmol/l as you do need some lee way, I have mine set 4.5-6.5mmol/l this means that any bolus I set will via the wizard the corrections will pitch it towards 5mmol/l

Once you've know that your basal is sorted and correct...

You need to double check your carb ratio's if your carb/insulin ratio is correct then you follow with working on ensuring that you've using the right bolus...

You need to learn which bolus to use to best effect, when to use a square wave or the multi-wave on the latter the split of the dose and how long to deliver the second wave so that you match the carb adsorption rate..

As it's pretty easy when running a tight range that you deliver your bolus too quickly an cause an hypo..

so it's a case of notebook and pen, a noting what carbs you eating, are they high fat high protein etc and what bolus you use, how long did you do the square wave and what split and how long to you deliver the second wave..

As to your DSN suggesting that 3.5mmol/l I feel is rather dodgy to say the least, running a tight range near to normal, will predispose you to losing your hypo warning, and you need time to react to an on coming hypo..

I am lucky to have a very tight and well controlled range, but because I'm aware of the possibility of hypo unawareness, I do a regular day or two running my levels slightly higher where I don't drop under 5 mmol/l this keeps the all important hypo awareness that I need to keep my driving licence..

Askaha it isn't illegal to drive or start your journey with a bg under 5mmol/l the only time you become illegal is when your bg is under 4 mmol/l but common sense should tell you if your level are below 5mmol/l that you need to weight up, how far you'll going to be travelling, the time the distance will take to cover, when was your last intake of carbs and how much insulin you've got on board... If I'm driving locally and I'm 4.6mmol/l and haven't just eaten, I generally have 2 or 3 jelly babies to ensure that my BG doesn't drop..
 
Well, it's the targets in pregnancy and there you are. Narrow yes, but they've got like that because problems have been noted at ligher levels. It ain't for life, it's for 9 months.

I will say that what others have done in pregnancy is to have enough fast acting to not have a spike, and also have it well in advance of eating. They then snack at 2 hours and after if required to avoid hypos.

It sure goes against all the rules. But it appears THE most important thing for baby is to avoid big spikes - hypos don't apparently bother it. Now whether mum can cope with it or not - is a different matter!

I thought it was 5.5 too Ellie - but it doesn't say that anywhere on the DVLA website!
 
Hi Akasha,
Lots of good info has been said already. As far as your lows go, my guess is high basal. It might not be much, but enough to tip you over the edge into hypo-land. The 3.5 threshold does seem low, my endo wants to know about any excursion below 70 (3.9).

In my experience, on days where I don't feel well, even with good numbers and suspecting high basal, a few percent cut (7'ish) in basal makes the difference on feeling better & avoiding lows. Takes about 2 hrs for change to start taking effect. % reduction has been higher following times where I added muscle.

While clarifying targets, it might be worth asking what A1c range they're expecting. This way, you can cross-reference the doc's intentions. As added benefit may also allow you to gauge your next A1c based on EAG estimated average glucose readings - where I approximate ~125 mg/dl = 6.9 mmol/l = 6% = 42 new money.

With tighter control (and lower BG's) you may want to study TDD, Basal/Bolus % and how they relate to tight control.
 
Targets are much lower in pregnancy Brian - A1c not to exceed 6.3, I think?
 
I fully intended to check basal rates last night. and didn't.
At half past 8, (2 hours post meal) I was 7.5. I had a packet of crisps and insulin to go with. Forgot to test before bed.
Slept through the half past 1 alarm and wok up at 3.10, 20 min before my next alarm.
Tested blood. 4.7. Was 4.2 upon waking this morning.

I fully intend to aim to be around the 5 mark. My DSN wants my HBa1c down to below 7.
 
trophywench said:
Targets are much lower in pregnancy Brian - A1c not to exceed 6.3, I think?
Click to expand...

Thx TW......I see the prego targets are strict w/focus especially on first trimester? Have also read some have tested every two hours and sometimes hourly.
 
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