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will a pump solve my problems?

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
H

heasandford

Well-Known Member
Relationship to Diabetes
Type 1
Well, met the new DSN with the new T1 team I have finally been allocated to, and she spent ages with me discussing my results. That's the good bit! Oh, and the fact that my HbA1c is 7.1, barely up from 6 months ago when a similar 7.0 was lower than I've ever had.

My current worry is the range of results I get, too many highs and lows (SD always over 4), and they don't seem to follow any predictable pattern. In usual pattern, they really just want to get rid of the lows, so I am reducing my Lantus and setting the magic meter (Expert) on a higher range to see what happens. I said what I really want is a Continuous Glucose Monitor, but she immediately said that won't solve the problem, but a pump might. I now keep thinking about this, but I'm not convinced it can do any more than the MDI system if I can't tell when I'm high or low. What does anyone else think?
 
Are your mealtimes and other routines following any sort of pattern ?

And are you eating fairly predictable sort of meals ?

Just trying to eliminate some of the obvious things that can upset MDI and pumping.🙂

Rob
 
heasandford said:
Well, met the new DSN with the new T1 team I have finally been allocated to, and she spent ages with me discussing my results. That's the good bit! Oh, and the fact that my HbA1c is 7.1, barely up from 6 months ago when a similar 7.0 was lower than I've ever had.

My current worry is the range of results I get, too many highs and lows (SD always over 4), and they don't seem to follow any predictable pattern. In usual pattern, they really just want to get rid of the lows, so I am reducing my Lantus and setting the magic meter (Expert) on a higher range to see what happens. I said what I really want is a Continuous Glucose Monitor, but she immediately said that won't solve the problem, but a pump might. I now keep thinking about this, but I'm not convinced it can do any more than the MDI system if I can't tell when I'm high or low. What does anyone else think?
Click to expand...

A cgm would be a great help for a week so you could at least see what is happening.
Yes a pump would be a great help for problem basals. If you can use and understand the expert then pumping wouldn't be to difficult to get the hang of.
Have you actually tested your basal ? If not that might be a good starting point for you.
 
No, I do not have a very routine life, although it is better these days! Don't work any more, so days vary depending on which bit of voluntary work I'm doing or not. My meals vary a lot too, but I think I am quite good at carb counting (qualified as a Food Scientist in a previous existance) I have tha same breakfast every day, and sometimes the same lunch for 3 or 4 days and STILL there is a massive range of readings
 
Sorry 2 replies at the same time!
I have tried basal testing a bit before, and was reasonably happy that it was OK in the morning, although I did fell it ran out/wasn't as effective about 3-4 hours before injecting again
I need to print all my questions and answers out so I remember them when going back next time!
 
heasandford said:
No, I do not have a very routine life, although it is better these days! Don't work any more, so days vary depending on which bit of voluntary work I'm doing or not. My meals vary a lot too, but I think I am quite good at carb counting (qualified as a Food Scientist in a previous existance) I have tha same breakfast every day, and sometimes the same lunch for 3 or 4 days and STILL there is a massive range of readings
Click to expand...

It does sound like hard job for MDI to adjust to. So a pump would presumably be more flexible.

But the basal sounds like it could be running short and may improve from a split or boost as it more accurately is.🙂

Rob
 
She didn't seem keen on me splitting the Lantus as there is too much overlap, but is asking the doctor about Levemir. Currently I'm just trying to get rid of the hypos, spread anywhere over the waking hours interestingly. I only get them overnight if I drink wine in the evening, sometimes almost regardless of BG level.
I suppose I still don't see how a pump could help - it is my own fault having irregular hours and the pump doesn't affect bolus doses? oh, I hadn't thought, presumably you can reduce the basal if you are eating too close together?
 
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No you'd never reduce your basal on account of eating anything! (on MDI or a pump)

What you would do though is test your BG, input it into the Bolus calculator on the pump and then tell it how many carbs you were going to eat 'now' and then it will take the 'insulin already on board' into account when telling you how much to bolus for this new lot of carbs.

Just like your 'Expert' meter should be doing now on MDI.

Going back to MDI - I found 2 jabs of Levemir instead of 1 jab of Lantus sorted quite a lot of my high/hypo probs out for me. I did have to fiddle about with doses and timings quite a bit though - nothing on either MDI or pump can be sorted out without quite a lot of input and understanding from the User. You do have to be prepared to put the 'work' in, to get the best out of whatever it is! When did you last do the fasting tests to make sure your Lantus is correct? (as correct as it can be for you anyway)

re your comment about not knowing whether you are high or low - have you lost hypo warnings?
 
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I find that using Humalin I (medium acting insulin), two injections per day, gives me lots of flexibility to adjust basal, which is important, as my activity levels vary greatly depending on work - mixture of country park ranger duties, organising children's activity parties, meetings, early morning & bedtime care work, comouter work at home, cycling to all work (except at home, obviously), plus running, orienteering etc (although haven't been able to do any since accident over 4 months ago and still waiting for knee MRI & surgery.
 
trophywench said:
Just like your 'Expert' meter should be doing now on MDI.
Click to expand...

I'm not sure how active insulin works on the Combo TW, but that's not what happens on the Expert. The Expert only counts and tracks correction doses in 'Active Insulin'. It always assumes meal boluses and carbs eaten will have matched and only advises correction based on the set acting time and permitted meal rise (giving a permissible/non correctable BG even above target). As far as I know the active insulin figure is always ignored on the Expert in calculating meal or correction boluses - though it is displayed so you can see whether to take it into account with a subsequent bolus. It's the meal rise and acting time that the Expert seems to use to prevent stacking.

I had occasions where two tests in quick succession showed blah units of active insulin (correction) and the next test recommended the same correction again! To be honest I found active insulin on the Expert next to useless.

As for whether pumping would help? I would suggest that it might, if you were able to establish the triggers and circumstances for your highs. Ive only been pumping for a few weeks, but I can already see that it is a LOT more responsive than MDI. The ability to set temp basals for a few hours to cover a bit of activity, and to use different bolus delivery patterns to delay/spread insulin action are very powerful new addition to the toolbox.

I just need to work out how to use them properly!
 
Thanks everybody - I am prepared to put in the effort, but currently find it difficult to see any consistant trends.
I am interested in the amount of testing you had to do when you changed to Levemir, TW, do have any record of what you did on here that I could look at? Or has anyone else, with the reasoning behind the changes. I do get horribly bogged down with the sheer quantity of variables, especially when it is something I did yesterday!
 
I successfully split lantus in case you did want to try it.

Did it under DSN advice but it went fairly smoothly really.

Rob
 
Weren't they worried about the overlap, as there is still activity up to 20 or so hours? ie 2 lots will have around 16 hours overlapping, admittedly at lower amounts, or was that the point, to have more at a certain time of the day?
 
I'm not entirely sure how it all hangs together but it seems to.

I do my main lot of 15u about 8am and then the 2nd lot of 5-6u at about 6pm.

It gives me good premeal, bedtime and fasting levels. And any adjustments show pretty much straight away, so maybe I'm a bit 'special' but before splitting, it was definitely running short.

Rob
 
With that pattern I would expect a phased overlap - so the onset/activity/fade of the higher dose interacts with the onset/activity/fade of the lower dose but (since the total insulin injected is the same) their total action would not exceed the peak of the full dose as a single injection.

At least that's what I see in my head!
 
everydayupsanddowns said:
With that pattern I would expect a phased overlap - so the onset/activity/fade of the higher dose interacts with the onset/activity/fade of the lower dose but (since the total insulin injected is the same) their total action would not exceed the peak of the full dose as a single injection.

At least that's what I see in my head!
Click to expand...

I would have thought it would work better if I did the 2nd one before bed but it does the job.

It's very sensitive to daytime activity. If I have a busy day I have to reduce the 2nd by a unit or eat some supper. It's set up for an average day at the mo but with all the rain we're getting I can see it going up again.🙂

Rob
 
It doesn't always last 20 hours plus. It depends ..... :D



Oooh, PS. It also doesn't actually release itself evenly either, it does have a peak though it isn't huge but you do have to factor it in, esp if you tend to go low in the early hours.
 
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We did a swap from bedtime jab to morning jab to establish if it was runnign out. Instead of high evening BGs, I got high waking BGs, so she told me to do it at the set times and it worked after a bit of tweaking of doses.

She assured me she'd done it before. I was a bit reluctant. 🙄

But I trust her a bit more now. 🙂

Rob
 
The change in daytime activity was always a bit of a juggling act with Lantus for me. Though it was never responsive enough to make changes on the day I needed them to happen. (always took more like 48 hours+ for the dose to settle in). But on weeks where I wasn't going to the gym I'd deffo need to tweak basal.

I think my failure when I tried splitting Lantus was perhaps partly down to not having approx 12 hours between the doses. Uneven doses and uneven timing didn't play nicely together so I went back to morning injecting which worked pretty well on the whole anyway.
 
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everydayupsanddowns said:
The change in daytime activity was always a bit of a juggling act with Lantus for me. Though it was never responsive enough to make changes on the day I needed them to happen. (always took more like 48 hours+ for the dose to settle in). But on weeks where I wasn't going to the gym I'd deffo need to tweak basal.

I think my failure when I tried splitting Lantus was perhaps partly down to not having approx 12 hours between the doses. Uneven doses and uneven timing didn't play nicely together so I went back to morning injecting which worked pretty well on the whole anyway.
Click to expand...


How are you getting on with the pump Mike - I know it's early days but are you getting to grips with the technicalities of pumping
 
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