Pumping - some questions

[Monkey]

I'm not, but I'm interested to hear experiences, if that's ok?

I've had T1 for 20yrs, MDI using lantus and humalog, have done DAFNE. Lasat hba1c was 7%, one prior to that was 6.8%. (They were only a month apart, and I had a stomach bug between the two plus a weird week of insulin sensitivity afterwards, so I suspect the former is a better indication of how things generally are.)

My son is 2y 7m, and we're now TTC number 2. Towards the end of my first pregnancy, my consultant mentioned a pump and said we could discuss after the birth. She was keen for me to seriously think about it, particularly if we wanted to have a 2nd.

Said consultant has now left. I'm under the pre-conception team, so seeing the DSN team rather than a consultant - I don't know any of the others, so no particular relationship.

Is it worth me re-igniting the pump discussion, and if so, with the DSN in the first instance? I'm finding things okish at the moment, altho am getting frustrated at some of the things I'm doing to get my post-meal readings ok - lots of snacking between meals (which I had to do a lot in pregnancy, but would rather not now!) and having to run a bit higher than I'd like when driving etc.

Thoughts, please? All very welcome.

 

[novorapidboi26]

If not to help with the hypos, definitely to help with getting numbers more stable for conceiving...........

How often are you having lows, is dose reduction helping any?

 

[Monkey]

If not to help with the hypos, definitely to help with getting numbers more stable for conceiving...........

How often are you having lows, is dose reduction helping any?

Lows are general explainable - 6 or 7 a week maybe? I can't escape a late morn hypo, without eating mid morning (or having a high post-breakfast reading) so don't count those that I prevent in that way.

I think I'm going to email my DSN and see what she thinks. I don't know her that well, but got to be worth a shot!

 

[Monkey]

If not to help with the hypos, definitely to help with getting numbers more stable for conceiving...........

How often are you having lows, is dose reduction helping any?

And sorry - thanks for the reply! Pressed enter too soon.

Dose reduction tends to be a bit hit and miss - more often than not, reducing a ratio at mealtimes might mean I'm fine at 3 or 4 hours, but high straight after I eat.

I'm usually quite upbeat about it all, just a bit meh today.

 

[novorapidboi26]

And sorry - thanks for the reply! Pressed enter too soon.

Dose reduction tends to be a bit hit and miss - more often than not, reducing a ratio at mealtimes might mean I'm fine at 3 or 4 hours, but high straight after I eat.

I'm usually quite upbeat about it all, just a bit meh today.

The late morning hypo could maybe be tackled with an adjustment of background, or if not already, a split dose, which is possible with Lantus, but more suited to Levemir........your overnight needs may be significantly different to that of your daytime needs you see.....

The ratio is only right if after your food and insulin has gone [4-5 hours], you are on target before the next meal............

the spike you experience immediately after you eat can be tackled by injecting 15 or more minutes before actually eating, you would need to experiment with different meal combinations to get a suited time......

Dose adjustment for the most part can be done without much difficulty, as long as your background needs are being met, which for you, might not be the case.....

But if you can get a pump for the pregnancy, I would definitely take it.....🙂

 

[Monkey]

The late morning hypo could maybe be tackled with an adjustment of background, or if not already, a split dose, which is possible with Lantus, but more suited to Levemir........your overnight needs may be significantly different to that of your daytime needs you see.....

The ratio is only right if after your food and insulin has gone [4-5 hours], you are on target before the next meal............

the spike you experience immediately after you eat can be tackled by injecting 15 or more minutes before actually eating, you would need to experiment with different meal combinations to get a suited time......

Dose adjustment for the most part can be done without much difficulty, as long as your background needs are being met, which for you, might not be the case.....

But if you can get a pump for the pregnancy, I would definitely take it.....🙂

Yup - I already split dose lantus, with a great weighter to the overnight dose, inject pre-breakfast by about 20mins. I've tried tweaking (on completely separate occassions!) both the evening and morning background, and neither up nor down seems to make significant difference. (Sorry I sound like I'm dismissing everything you say - I'm not, just reassuring myself that I'm in the right direction!)

I guess I probably need to try a fasting test of my background to see if that's completely right.

Thank you - it's helpful to chat it all thro with someone!

 

[Monkey]

Well - emailed my DSN to ask in theory if it was an option last night, and she's going to talk to the pump team next week. Didn't say much more than that, but I'm assuming that the fact she's willing to discuss it means she doesn't think it's a nuts idea.

Wonder if this ought to be moved to the pumping subsection - can I do that, or does it need an admin?

 

[everydayupsanddowns]

Hi Monkey

I've been on a pump for almost 6 months so my experience is a little limited, but what I have seen is that the precision of dose adjustment and flexibility of basal patterns on a pump can make the fine tuning that you seem to be looking for possible - at least in theory!

My levels since November have been a whole heap more stable, with far fewer high highs and low lows (anything below 3 or over 12 is very rare these days). I spent 2 years working intensively on my MDI and could never get it this good. My ongoing project is to keep the averages down while further reducing any readings below 4. On a pump this kind of micromanagement seems a distinct possibility.


Good luck with funding if you decide to go for a pump 🙂

 

[Monkey]

Hi Monkey

I've been on a pump for almost 6 months so my experience is a little limited, but what I have seen is that the precision of dose adjustment and flexibility of basal patterns on a pump can make the fine tuning that you seem to be looking for possible - at least in theory!

My levels since November have been a whole heap more stable, with far fewer high highs and low lows (anything below 3 or over 12 is very rare these days). I spent 2 years working intensively on my MDI and could never get it this good. My ongoing project is to keep the averages down while further reducing any readings below 4. On a pump this kind of micromanagement seems a distinct possibility.


Good luck with funding if you decide to go for a pump 🙂

That's really helpful too, thank you. I think you've hit the nail on the head with the fine tuning comment too!

 

[RuthieG]

Hi Monkey

I went on a pump in early Feb at 3(ish) months pregnant. They were really keen for me to try it because although my HbA1cs were great (6.3, 6.1, 5.3 I think) I was having post breakfast highs followed my late morning major lows. I am not sure how but the pump has really stabilised that. It is not perfect ad the late morning low is still there but apparently that is the baby not the insulin/food.

Anyway the pump is not perfect but it has stabilised things incredibly (any highs are not that high and same with lows) and I feel alot more in control because you can make tiny tweaks throughout the day to suit your body and its weird ways.

I think if I could turn back time I would go onto a pump pre-conception. I went through my cpnsultant and pump nurse but my other non pergnancy consultant had also mentioned it. The DSNs are all very helpful about it too.

All the best 🙂

 

[Monkey]

Hi Monkey

I went on a pump in early Feb at 3(ish) months pregnant. They were really keen for me to try it because although my HbA1cs were great (6.3, 6.1, 5.3 I think) I was having post breakfast highs followed my late morning major lows. I am not sure how but the pump has really stabilised that. It is not perfect ad the late morning low is still there but apparently that is the baby not the insulin/food.

Anyway the pump is not perfect but it has stabilised things incredibly (any highs are not that high and same with lows) and I feel alot more in control because you can make tiny tweaks throughout the day to suit your body and its weird ways.

I think if I could turn back time I would go onto a pump pre-conception. I went through my cpnsultant and pump nurse but my other non pergnancy consultant had also mentioned it. The DSNs are all very helpful about it too.

All the best 🙂

Thank you - that's really helpful, and the bit in bold is something I struggle with already, so interesting to hear the pump's been of help.

My DSN has chatted to the pump team and suggested she refers me after my next pre-conception appointment at the start of May, so feeling quite encouraged by that. I assume they'd have not suggested a referral if they thought it was a complete no-go!

 

[RuthieG]

That sounds good. I must say that in my area (Manchester) they were really keen to push the pump so I feel lucky.

I am currently up and have been all night because following dinner last night I had major high (18!!!!!) which seems to be due to my canula becoming dislodged somehow and i have no fully got it down all night - no idea why. I am in single figures now )still at 8.9 and am usully in 4s on waking) but struggled all night. Not sure whether the pump becoming dislodged is only reason as I have an upset tummy and headache so prhaps a bit ill, but I hate it. I have sat and worried about the baby all night (well and I have slept a little bit).

Anyway having said all that this is rare (but has happened once before) and overall he pump is a good thing for me.

All the best