Minimed and changing bolus ratios

[Juicyj]

Hi all,

I have been on the minimed for 2 weeks now, am happy with it and very comfortable - had an issue last week with the infusion set but changed it and issue went, ongoing issue I have is that I still cannot get my levels down. I met my DSN last week to change my bolus ratios and increase my morning and evening bolus but there's been no change even though we adjusted by 30%, she is away this week and i'm feeling quite run down with running above 12 morning and night, it's only during the day I get below 8 and that only lasts till around 3pm when I start rising again. I cannot get in touch with DSN as she is away this week and cannot get in touch with the hospital as they are on answer phone so am considering adjusting myself, I know I should do this eventually but just feeling a bit nervous about making changes myself - any advice or should I contact medtronic direct and see if we can do this on the phone as they should be able to access carelink where I download all my info (at least I hope they can!) Thanks.

- Extra note, I did another infusion set change this morning and all day my BG has been rising so now at 15.1, when I should normally be under 8, looks like another dud on the set change..

 

[himtoo]

ouch juicy !! levels that high are no fun when used to running lower.

i know when I started on the pump my BG's were high for the first couple of weeks generally because the DSN had put me on a flat basal profile for the full 24 hours and we did the tweaks in twice a week phone calls.

are you sure it is your bolus ratio that is the issue -- could it be that your background basal rates need looking at first ?

my DSN and I spent about 3 weeks getting my NIGHT TIME basals right first and then moved on to daytime

I would say that in total it took about 6-8 weeks before most of my settings were ""so called perfect""

 

[Juicyj]

ouch juicy !! levels that high are no fun when used to running lower.

i know when I started on the pump my BG's were high for the first couple of weeks generally because the DSN had put me on a flat basal profile for the full 24 hours and we did the tweaks in twice a week phone calls.

are you sure it is your bolus ratio that is the issue -- could it be that your background basal rates need looking at first ?

my DSN and I spent about 3 weeks getting my NIGHT TIME basals right first and then moved on to daytime

I would say that in total it took about 6-8 weeks before most of my settings were ""so called perfect""

Thanks @himtoo we did make an adjustment on both basal and bolus ratios, at the time with my limited knowledge of ratios I wasn't sure what we did was correct though, so came out of our meeting and just thought i'd better keep a watchful eye on it which I have, I have learn't that it's only the medical team who can give advice about insulin changes so am going to keep calling the hospital team until someone picks the phone up !

I know it will take time but as today they have been rising gradually since this morning it's become one of those 'I must get this sorted today' things !

 

[Snapsy]

Hope it all works out @Juicyj. I'm in the middle of some testing and basal tweaking at the moment as I keep waking up way low - funny, as I though my basal rates were working well!

Hope you manage to get it sorted - persistent highs and lows are so frustrating! Am sure you'll get there.

 

[himtoo]

@Juicyj -- to be honest I felt so rubbish the first 3-4 days i was ready to throw it away and go back to MDI-- but it was also a control thing as I didn't feel as though I was in control anymore.

I didn't make any changes to pump settings the first couple of weeks without first speaking to my DSN.

as time has gone on I have gained confidence and now I am just catching up with her every 4 weeks ( been pumping for 4 1/2 months ) and I do all my own adjustments

I think it is the usual advice really -- just slow down take things 1 day at a time -- try your best not to worry -- it is sort of like starting all over from diagnosis because everything treatment wise is brand new.

 

[Juicyj]

Thank you @himtoo that was like having a big hug and a 'it will be ok' moment. I haven't doubted having it since I got it as I worked so hard to get it but seeing the same pattern each day is wearing me out as i'm so keen to change it myself - it would have to happen whilst my DSN takes her week off !! Have left another message for the hospital team to call me back so hopefully someone will today.

Thanks also @Snapsy I just need to learn some patience !!

 

[Mrsass]

@Juicyj what infusion sets are you using? I had problems with plastic cannula's when I got my pump and changed over to steel ones as the plastic weren't sitting in my skin properly and I was forever getting high readings after changing my set X

 

[Snapsy]

@himtoo I know exactly what you mean about starting all over from diagnosis! I felt that I was losing 29 and a half years of diabetes education when I started pumping in October, and starting from scratch. But sticking with it with determination (and sometimes tears) has made it the thing I most want to keep in the world.

 

[noblehead]

@Juicyj, all points to your basal rates being out IMHO. Why don't you start on a afternoon when your bg is in range and do a basal check and see what happens in the absence of food and bolus insulin, if your bg shoots up then your basal rate needs adjusting.

As @himtoo says it can take weeks to fine-tune the basal rates when starting on a pump.

 

[tim2000s]

Out of interest, how many basal injections were you on beforehand, and how good was your blood glucose management on that?

 

[Juicyj]

Hiya all, finally got a lovely nurse in the phone earlier from the hospital, we've bumped up the basal 20% so will try this overnight and talk in the morning, also slightly increased correction doses too as i haven't come down all day, however it might be that I'm coming down with a bug as feeling knackered and a bit achey. My pump settings were based on my previous insulin requirements so we tried to mirror that as my starting point, I was running high before so we knew it would take some tweaking, I think I was fairly disappointed as last Weds was my first tweak and my results previously weren't great but were ok as was in range in the daytime, so I was expecting even better things after the tweak. I have had 2 issues with the set change (plastic), so both days ran high so might be the tubing is kinking or not flowing ok, I am speaking to the nurse in the morning so will ask about this then.

I was on 1 injection of Tresiba before which kept my pretty level @tim2000s

 

[Juicyj]

@noblehead yes that's a very good idea, will wait 2-3 days for new basal ratios to set in and then check them, thanks