pump and level not steady

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Anna1

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Type 1
Hi
So I have been on the Medtronic 640G for 3 months now and am still fluctuating with my levels. I have been told being on the pump means I do not need to eat and my levels should stay level so to speak but I have problems with this. If I do not eat then my levels just keep dropping the longer I don't eat. When I went on holiday recently I only flew 1 1/2hrs and decided not to eat any carbs to stop having to take extra insulin and suddenly my levels started dropping without any extra insulin being present. I ended up suspending delivery for 1 hour and it still kept dropping and that was after reducing the background insulin from 0.60 to 0.30. It's as if my body eats all the glucose and my liver stops producing any!! It's very upsetting for me as I just want it to be level and not constantly changing. I also found whilst on holiday my insulin needs dropped considerably from what I need when I'm at home. I even ended up eating two digestives and my BG did go up but then started go down by itself again. I was hoping with a pump my levels would be easier to control but still really struggling and the flight where my levels kept dropping really knocked my confidence. It doesn't help that I have had to have two pumps replaced so far due to error 63 which is apparently a software error!! I should mention that I am peri-menopausal so I know my hormones are up and down so this could have an effect but don't think this should influence my levels when I'm flying or travelling. Hope anyone out there can give me some hope as feel I'm really struggling.
Thanks Anna
 
I should mention that I have done basal testing but when my levels keep dropping even at 0.30 then you do wonder what my base level actually is. Also when I do eat carbs my base level seems to be fine and a bit more stable in between meals.
 
Welcome Anna

If you are dropping with 0.30 then that is still too high. There are quite a few of us who are on very low doses, and that is the advantage of the pump. So keep doing the tests, adjusting your insulin until you get BG level.
When you eat it may be that your carb ratio is compensating for incorrect basal rates.

If you can sort the basal rates you can then adjust the carb ratios. It does take time and a lot of work at the start of pumping but it will be worth it.
 
It's quite common for your insulin needs to change when you are on holiday, that's one of the things temp basals are useful for!

Also, I agree with @SB2015, if you are dropping without eating anything then your basal is too high, even if you are already on a tiny dose. My daughter for a while was on 0.18 u/h for part of the day, the mind boggles at how tiny each individual dose is at that level, but if I changed it by as little as 0.02 u/h that would make all the difference between her going low or not going low! I've also heard of people having their basal set to 0.00 for part of the day, so anything goes really, just keep testing and adjusting until you find what works for you 🙂
 
Welcome Anna. Your DSN should be able to help, really good luck
 
Levels do change when on holiday, so ignore any basal testing for that period.
As you are still dropping with no food then obviously your basal is far to high.

So the simple solution is to cut your basal down even further with a temp basal and test again.
It can take up to six months for some people to get a reasonable basal level and still have to tweak on a regular bases.
Bottom line is the pump only delivers what you tell it 🙂

As a matter of interest how long before your blood sugar drop are you adjusting your pump?

Have you purchased the book pumping insulin by John Walsh? If you haven't then do so as it's known as the pumpers Bible and worth it's weight in gold.
 
thanks everyone - unfortunately not all DSN's are created equal - mine is great to talk to but has never once gone through my basal levels with me apart from when my pump was set up and then I told her what I think I should have - she is great at chatting but offers very little in the way of advice even when I tell her what I tell you guys. She just says switch it off for a while and then see how you go hence why I am on the forum so all your help is much appreciated
 
Pumper_Sue if I start to drop then I adjust the level an hour before. Thanks for the suggestion re the book
 
Anna1 said:
Pumper_Sue if I start to drop then I adjust the level an hour before. Thanks for the suggestion re the book
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Ah that's your problem I would suspect, try 2 hours before and see how you get on.
 
Anna1 said:
thanks everyone - unfortunately not all DSN's are created equal - mine is great to talk to but has never once gone through my basal levels with me apart from when my pump was set up and then I told her what I think I should have - she is great at chatting but offers very little in the way of advice even when I tell her what I tell you guys. She just says switch it off for a while and then see how you go hence why I am on the forum so all your help is much appreciated
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Do you down-load on the web to your DSN, Medtronic site does a great site that gets all your figures
 
Hi Hobie, no chance she never asks me to download or look at the figures. It's a very poor support service and I seem to know more then they do. All they are interested in is the HBA1C and that I attend ever six month apart from that I am left to my own devices and if something isn't working my DSN just says oh that's strange maybe put it down a level but she is not interested in what levels I have during the day, what I eat or anything like that. She also blames a lot of things on my hormones and says that's probably why it's so variable. I have had a look at the medtronic site but because I wear a CGM I pretty much know what is going on 24hrs so I can see when it's dropping and when its going up but still very hard to get the levels right and then get the carb ratio right on top of that as I seem to take 2-3hrs to digest things so sometimes I get a spike up after 2hrs so playing around with dual shots but again struggling to get everything right. Thanks Anna
 
@Anna1 you need to go right back to basics.
Stop messing around adjusting this that and the other.
No1 priority is to nail your basal.
So keep all meals simple ignore your CGM and do finger pokes for your basal adjustment. Adjust basal 2 hours before the low descended on you.
Unless you are using Fiasp then make sure you bolus 15 - 20 mins before you eat.

You will never get everything right everyday/week/month year. You have to remember you are human and not a machine so no way on earth are you or anyone else going to be perfect.

Basically what you are doing is trying to run before you can walk 🙂 So put the brakes on and concentrate on one section of the day once that is right move on to your next section and so on.
Leave carb ratio's well alone until the basal is sorted.
 
Anna1 said:
Hi Hobie, no chance she never asks me to download or look at the figures. It's a very poor support service and I seem to know more then they do. All they are interested in is the HBA1C and that I attend ever six month apart from that I am left to my own devices and if something isn't working my DSN just says oh that's strange maybe put it down a level but she is not interested in what levels I have during the day, what I eat or anything like that. She also blames a lot of things on my hormones and says that's probably why it's so variable. I have had a look at the medtronic site but because I wear a CGM I pretty much know what is going on 24hrs so I can see when it's dropping and when its going up but still very hard to get the levels right and then get the carb ratio right on top of that as I seem to take 2-3hrs to digest things so sometimes I get a spike up after 2hrs so playing around with dual shots but again struggling to get everything right. Thanks Anna
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I use duel every single time. T1 is a right pain at times but you should be on to your DSN about down-loading info from pump. Have a look on web to see what you can do. Really good luck 🙂
 
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