Now I know why people move on to insulin pumps

[Amity Island]

Insulin Pumps…….now I know why!

I know this may all be stating the obvious to many of you, but it’s been an eye opener for me. On my two week excursion with the Freestyle Libre, it became glaringly apparent that trying to mimic (with mdi) the body’s natural process of releasing insulin and glycogen is very tricky and requires a lot of testing. I’ve learnt so much (from first-hand experience - not books or opinion) about how multiple bolus insulin injections (plus basal) work with food digestion. It really has taken my understanding to a whole new level. The experience has left me in 2 mind sets and it is something I will now be giving serious consideration of in the future, not just for food but for the fact a pump will probably work better for exercise too.

1. Eat low fat, low sugar and small meat portions and bolus at meal times*. Put simply eat a healthy balanced meal.


OR


2. Eat more varied food types (various glycaemic indices) and use an insulin pump with varying degrees of insulin release times to suit.

*Although there are potential work arounds with m.d.i’s, although this gets complicated if done often as you’d always have overlapping insulins when splitting or delaying doses.

And as for “you should always take your insulin before your meal” how wrong can that advice be!

I’ve learnt already that more often than not, I need to take my bolus about 15 to 30mins after a meal for it to run smoothly.

What are your thoughts, experiences on my recent learnings and conclusion?

Thanks

 

[khskel]

Roughly the same as me. If I even have a sniff of insulin before my evening meal I'm guaranteed a hypo. Splitting bolus seems to be working fine so far.

Splitting basal on strength of findings from the libre means I get a pretty flat line overnight most of the time and during the day if fasting.

 

[Northerner]

The timing of my insulin injections varies through the day - in the morning I can inject an hour before eating, at lunch 45 mins, and immediately before evening meal Libre is brilliant though for really showing what's going on that a few finger pricks really doesn't make clear

 

[Robin]

I’ve learnt so much (from first-hand experience - not books or opinion) about how multiple bolus insulin injections (plus basal) work with food digestion. It really has taken my understanding to a whole new level. The experience has left me in 2 mind sets and it is something I will now be giving serious consideration of in the future, not just for food but for the fact a pump will probably work better for exercise too.

The problem is in our cases, we’ve studied, learnt, and adjusted so well, that we now don’t stand a cat in hell's chance of ever being prescribed a pump! I mean, why would they spend that much money when I’ve got a decent HbA1c without!
Like you, since using the Libre, I've changed basal to Levemir so I can split it to accommodate my night time dive, and then I bolster it with a couple of units of short acting in a morning, irrespective of what I'm going to eat, to counter the rise. When I’m out for a long walk, I keep an eye on the Libre (during and afterwards) and head off a hypo by eating something when the line starts to drop.
Maybe if I’d ignored it, continued to have night time and exercise hypos til I lost my awareness and ended up in hospital, I'd get a pump, but I wasn’t prepared to do that and dice with my health!

 

[Sprogladite]

The problem is in our cases, we’ve studied, learnt, and adjusted so well, that we now don’t stand a cat in hell's chance of ever being prescribed a pump! I mean, why would they spend that much money when I’ve got a decent HbA1c without!

Not necessarily Robin, my hba1c was 45 when I got my pump, and a large part of that was my libre showing absolutely that every basal insulin I tried just didn't work for me. I went through a period of about 6 months where I was getting up at 2am to eat to prevent the crash/spike cycle and getting up at 6am every day to bolus and it became clear pretty quickly it wasn't sustainable - I just needed a pump! It may be worth demonstrating the particular actions you are taking to ensure your results are as good as they are - diabetes in itself isn't meant to be a full time job (though it sure feels like one sometimes!!)

 

[Robin]

Not necessarily Robin, my hba1c was 45 when I got my pump, and a large part of that was my libre showing absolutely that every basal insulin I tried just didn't work for me. I went through a period of about 6 months where I was getting up at 2am to eat to prevent the crash/spike cycle and getting up at 6am every day to bolus and it became clear pretty quickly it wasn't sustainable - I just needed a pump! It may be worth demonstrating the particular actions you are taking to ensure your results are as good as they are - diabetes in itself isn't meant to be a full time job (though it sure feels like one sometimes!!)

An extra hurdle for me would be to get referred back to the hospital, at the moment I’m only seen in my GP surgery. Last time I mentioned I was using the Libre my GP snorted derisively! (If I thought it was definitely the right thing, I’d go into battle, but I feel like I’m rubbing along OK at the moment.)

 

[Bronco Billy]

My children love their pumps as it allows so much more flexibility than MDI. They have several basal rates throughout the day to cope with then fluctuations.

 

[trophywench]

On MDI - sorry!! - you don't learn anything about how much insulin your body needs and when it needs it. I was utterly gobsmacked when I started pumping 'fast acting' as basal insulin - totally different needs to what using 'long acting' had fooled me into believing - and I was very unsure about making the changes I needed to start off with. However because my BG was more all over the place than it had ever been for the previous 30-odd years - I knew I'd have to make changes if I was going to stay alive and well so I had to try it.

During the day I have lots of different rates - some as high as 0.58u/hr and the lowest 0.21u/hr, and they range back and forth during the 24 hrs.

Using 'long acting' is merely as means to an end, but much in the way of a sledgehammer to crack a nut, frankly.

 

[Sally71]

LOL @trophywench - my daughter's lowest basal at the moment is higher than your highest! Her lowest is 0.68 u/hr and her highest is 2.60! We really are all different!
(Although I'm told that it's common for insulin requirements to at least double during puberty and that once she stops growing it should settle down a bit )

 

[trophywench]

Well I'd know I was in trouble if my hourly rate shot up to 10x what it now is - the same as your daughter would if her's suddenly plummeted to mine! My TDD basal is just about 10u - and that's a lot less than the finely adjusted 14 + 4u of Levemir I was on prior to pumping.

It really doesn't matter how much we need - it is what it is and that's that, so don't argue with it!

 

[everydayupsanddowns]

And as for “you should always take your insulin before your meal” how wrong can that advice be!

I’ve learnt already that more often than not, I need to take my bolus about 15 to 30mins after a meal for it to run smoothly.

What are your thoughts, experiences on my recent learnings and conclusion?

Thanks

Great that you are finding out so much information from Libre.

Have you come across the EDEC Libre Quiz - an Edinburgh Dr Fraser Gibbs, put together a series of very helpful scenarios and suggestions for interpreting Libre data.

http://www.edinburghdiabetes.com/librequiz/

Very interesting that you have found that you need to dose after a meal. This is quite unusual in my experience. Have you tried fasting between meals to check your daytime basal is not overreaching? Alternatively a split dose - some (half?) before eating and the rest an hour or two later might help match food and insulin action while avoiding any initial spike.

 

[Amity Island]

Great that you are finding out so much information from Libre.

Have you come across the EDEC Libre Quiz - an Edinburgh Dr Fraser Gibbs, put together a series of very helpful scenarios and suggestions for interpreting Libre data.

http://www.edinburghdiabetes.com/librequiz/

Very interesting that you have found that you need to dose after a meal. This is quite unusual in my experience. Have you tried fasting between meals to check your daytime basal is not overreaching? Alternatively a split dose - some (half?) before eating and the rest an hour or two later might help match food and insulin action while avoiding any initial spike.

Hi Mike, Thanks very much for your reply, I really appreciate it. I'm having a look right now on the libre guide, i'm still learning and already in that guide I've spotted a problem I was encountering each breakfast!

 

[Amity Island]

Great that you are finding out so much information from Libre.

Have you come across the EDEC Libre Quiz - an Edinburgh Dr Fraser Gibbs, put together a series of very helpful scenarios and suggestions for interpreting Libre data.

http://www.edinburghdiabetes.com/librequiz/

Very interesting that you have found that you need to dose after a meal. This is quite unusual in my experience. Have you tried fasting between meals to check your daytime basal is not overreaching? Alternatively a split dose - some (half?) before eating and the rest an hour or two later might help match food and insulin action while avoiding any initial spike.

Hi Mike. I've read the guide, all really good information. thanks again. We could do with another category on the forum for links to documents and guides, this could go in it! brilliant....

 

[SB2015]

Great that you are finding out so much information from Libre.

Have you come across the EDEC Libre Quiz - an Edinburgh Dr Fraser Gibbs, put together a series of very helpful scenarios and suggestions for interpreting Libre data.

http://www.edinburghdiabetes.com/librequiz/

Very interesting that you have found that you need to dose after a meal. This is quite unusual in my experience. Have you tried fasting between meals to check your daytime basal is not overreaching? Alternatively a split dose - some (half?) before eating and the rest an hour or two later might help match food and insulin action while avoiding any initial spike.

Thanks Mike

A very useful quiz.
Covers a lot of info that can enhance use of the Libre.