Who are pumps best for?

[SugarBuzz]

If you don't know how to carb count then it's no surprise that your BG is out of control. It's a fundamental process required for controlling BG - is there a reason why you don't know how to do this?

As for the 10-12 injections, I can imagine that the majority of those are correction doses? Correction doses from both incorrect amounts of bolus administered for meals (through incorrectly estimated carbs) and a lack of basal insulin; that's certainly my guess.


Have you ever adjusted your basal insulin dose by yourself, tested your duration of insulin action, calculated your I:C ratio, TDD, correction factor, etc?

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Carb counting has never ever been mentioned to me at all by any health professional - like ever. But I really need to sort that. As today I had a weird hypo at 3.1mmol and I ate 2 pieces of brown rye type bread with no added sugar blueberry jam and 1 hour later my blood was 11.3mmol. So quite an increase. Though that was quite a mild food treatment - as normally when I've gone hypo I've gone munchie crazy and reached for the crunchy nut cornflakes and snickers bars :-o

As for some of that other stuff I:C ration etc. I've never done any of it. I heard a rumour about some carb counting course - but as I spend part of the year out of the UK (in the sun) It's quite difficult to sort something out - especially when they seem so pie in the sky about appointments and simply refuse to use modern technology - i.e. - they could easily send me an email or text which I can pick up anywhere instead of a letter sent to an address I might not be at. Anyway, I have an appointment with an endocrinologist in May here in Spain (as my GP was concerned about my last blood test being 3 times the max recommended number)- so perhaps I'll spend the next month trying to learn some medical spanish and ask if there's any course around here that I can do. As I don't fancy a top temperature of 10c so much.

 

[Deleted Account]

There's a lot of information on the internet about carb counting. This website has some information (http://www.diabetes.co.uk/diet/carbohydrate-counting.html). However, unfortunately, it gives you no hint what to do once you have counted your carbs. Diabetes UK (https://www.diabetes.org.uk/Guide-t...and-diabetes/nuts-and-bolts-of-carb-counting/) gives you a little more of a hint regarding insulin to carb ratio (I:C). Calculating I:C is a bit of trial and error but, from what I have read, I think most people start at 1 unit of insulin to 10g carbohydrates and then adjust accordingly.
After 12 years of carb counting, I went on a course (it was a pre-requisite for a pump). Whilst the course was not a complete waste of time, I learnt nothing about carb counting: there was a lot of how to interpret packet labelling which is usually in carbs per 100g.
Quite a lot of people use Carbs and Cals (http://www.carbsandcals.com/) to help estimate carbohydrates. This is available as a book and an app. It was not for me but I can see how it will make life easier for many people with diabetes.
Good luck - hopefully, starting on this voyage of discovery, will help you get your diabetes under control. Don't be put off - it is a continuous voyage with a chance to stop off at some amazing ports along the way before you discover more and set off again.

 

[azure]

Carb counting has never ever been mentioned to me at all by any health professional - like ever. But I really need to sort that. As today I had a weird hypo at 3.1mmol and I ate 2 pieces of brown rye type bread with no added sugar blueberry jam and 1 hour later my blood was 11.3mmol. So quite an increase. Though that was quite a mild food treatment - as normally when I've gone hypo I've gone munchie crazy and reached for the crunchy nut cornflakes and snickers bars :-o

As for some of that other stuff I:C ration etc. I've never done any of it. I heard a rumour about some carb counting course - but as I spend part of the year out of the UK (in the sun) It's quite difficult to sort something out - especially when they seem so pie in the sky about appointments and simply refuse to use modern technology - i.e. - they could easily send me an email or text which I can pick up anywhere instead of a letter sent to an address I might not be at. Anyway, I have an appointment with an endocrinologist in May here in Spain (as my GP was concerned about my last blood test being 3 times the max recommended number)- so perhaps I'll spend the next month trying to learn some medical spanish and ask if there's any course around here that I can do. As I don't fancy a top temperature of 10c so much.

@SugarBuzz There's an online course here:

https://www.bertieonline.org.uk

That helps with carb counting, etc. I may have already recommended it to you, but if I haven't, I highly recommend the book Think Like A Pancreas. It's brilliant for Type 1s.

Carb counting is crucial for good control. If you don't carb count, it's like getting in a car with a blindfold on, no maps, no satnav, and trying to drive from London to Edinburgh.

Just as an aside - I noticed your rye bread comment above. I love rye bread and eat it most days, but it's not a good hypo treatment. Something like glucose tablets, full sugar Coke or some sweets is best, then follow that up with some longer acting carbs.

 

[SugarBuzz]

@SugarBuzz There's an online course here:

https://www.bertieonline.org.uk

That helps with carb counting, etc. I may have already recommended it to you, but if I haven't, I highly recommend the book Think Like A Pancreas. It's brilliant for Type 1s.

Carb counting is crucial for good control. If you don't carb count, it's like getting in a car with a blindfold on, no maps, no satnav, and trying to drive from London to Edinburgh.

Just as an aside - I noticed your rye bread comment above. I love rye bread and eat it most days, but it's not a good hypo treatment. Something like glucose tablets, full sugar Coke or some sweets is best, then follow that up with some longer acting carbs.

Yeah I have some of those dextrose energy tablets - I can't find them here in Spain which is weird. I often stock up on them when I go back to the UK.
I guess the rye bread I had is not the 'typical German stuff' - the rectangular stuff that you normally buy in those tight plastic packets - though I do eat that. It was kind of stuff that looks like normal bread. It seemed to do the trick with blueberry jam - though not sure if it works quick enough (like the energy tabs would) and that could have been a reason for the wild tingling continuing for over 30 mins. Though who knows - I have 'other stuff' going on as mentioned in a previous thread.

Anyway, whilst I'm here I'm going to get the thread back on track and throw this statement out about pumps.

IF I EXERCISE EVERY DAY. IS A PUMP A BAD IDEA?

Basically I'm coming from the angle that if I keep having to take off and reattach a pump that it's probably not worth the hassle in that respect.

 

[noblehead]

IF I EXERCISE EVERY DAY. IS A PUMP A BAD IDEA?

Quite the opposite in fact, you'll find the TBR (temporary basal rate) is a marvellous function on a pump.

Basically I'm coming from the angle that if I keep having to take off and reattach a pump that it's probably not worth the hassle in that respect.

You don't need to disconnect for exercise.

 

[azure]

@SugarBuzz Normal bread isn't the fastest either, but back on track - you don't need to take off your pump for exercise. The only exercise I remove it for is ice skating, but that's because I skate fast but not very well : D My pump is very robust but I wouldn't want to bash it falling over. Also, I don't need the insulin when skating.

For normal exercise, I leave my pump on and set a TBR as above.

 

[GrantGam]

Carb counting has never ever been mentioned to me at all by any health professional - like ever. But I really need to sort that. As today I had a weird hypo at 3.1mmol and I ate 2 pieces of brown rye type bread with no added sugar blueberry jam and 1 hour later my blood was 11.3mmol. So quite an increase. Though that was quite a mild food treatment - as normally when I've gone hypo I've gone munchie crazy and reached for the crunchy nut cornflakes and snickers bars :-o

As for some of that other stuff I:C ration etc. I've never done any of it. I heard a rumour about some carb counting course - but as I spend part of the year out of the UK (in the sun) It's quite difficult to sort something out - especially when they seem so pie in the sky about appointments and simply refuse to use modern technology - i.e. - they could easily send me an email or text which I can pick up anywhere instead of a letter sent to an address I might not be at. Anyway, I have an appointment with an endocrinologist in May here in Spain (as my GP was concerned about my last blood test being 3 times the max recommended number)- so perhaps I'll spend the next month trying to learn some medical spanish and ask if there's any course around here that I can do. As I don't fancy a top temperature of 10c so much.

That's a shame, because it really is vital for managing T1. The sooner you become more educated regarding diet, carbohydrate counting and general T1 management - the less you'll need to worry about having concerning blood test results...

Carbohydrate counting courses (certainly where I am in Scotland) tend to run a couple of times a year and are usually one day a week for four weeks. So 4 days in total. My Clinic always send me letters advising of the dates well over 6 months in advance and I'm quietly confident that you'll have the same opportunities wherever you are in the UK.

As @azure has already said, your choice of hypo treatments aren't great. It's advisable to treat hypos with simple carbs rather than complex ones. The fat content of your Snickers bars can delay the rate at which your BG rises - which for obvious reasons can prove troublesome when in a hypoglycemic state. The same effects can be seen with the fibre content in the rye bread.

 

[catapillar]

I read that link but I don't really get what the aim of the test is.

The aim of the test is to see if your basal insulin is doing its job, that is it should be keeping you steady when you aren't eating or bolusing.

Like surely if I eat something even before the fast slots that's going to effect my numbers right? Like slow release carbs or something?

Yes, that's why the guide on how to do the test says your last meal should be at least four hours ago and with not too much fat or protein in it.

IF I EXERCISE EVERY DAY. IS A PUMP A BAD IDEA?

Basically I'm coming from the angle that if I keep having to take off and reattach a pump that it's probably not worth the hassle in that respect.

I exercise pretty much everyday. I've never taken my pump off for exercise. Temporary basal rates are useful for exercise.

 

[Vwhite1980]

I don't mean to deviate from this thread but when I read the responses - the first thought that crossed my mind - how do you afford it/pay for it? The last time I was inquiring about a pump, where I live, amounted to thousands of dollars and I just didn't think it was worthwhile considering the price and my diabetes control wasn't that bad. Interesting thing - I live in Canada - the land of universal healthcare - but it's a bit of misnomer as the average person with diabetes in Canada who is living from pay check to pay check can barely afford the test strips let alone a pump. Interesting article about Pumps and Strips where I live - http://www.cbc.ca/news/canada/princ...tes-budget-insulin-pump-test-strips-1.4066368 - Fortunately my own private health plan covers the cost of strips but only partly reimburses me for a pump. What about people in the UK - is the pump and test strips affordable to most people or does it require creative accounting and good health plans?

Type 1 diabetics receive free prescriptions so it is not a worry. I did have to fight with my doctor to get enough test strips as the NHS allows an average of about 40 sticks per patients per month. Lots of people however don't bother testing, especially type 2 diabetics. I personally get 250 test strips per month and my doctor was happy with this as it helps me to keep my diabetes under control and therefore means I am less likely to need funding for diabetic complications later in life, which are far more costly.

 

[AndBreathe]

Type 1 diabetics receive free prescriptions so it is not a worry. I did have to fight with my doctor to get enough test strips as the NHS allows an average of about 40 sticks per patients per month. Lots of people however don't bother testing, especially type 2 diabetics. I personally get 250 test strips per month and my doctor was happy with this as it helps me to keep my diabetes under control and therefore means I am less likely to need funding for diabetic complications later in life, which are far more costly.

Hi VWhite - Just one comment on your post really. When you say, ".... Lots of people however don't bother testing, especially type 2 diabetics....", to be fair, most T2s are instructed not to test their bloods, and even if we want to, the NHS will not prescribe testing strips for us at all. Some are luckier, but I would suggest the majority of T2s are not supported to test.

I appreciate T1s are different, but just clarifying.

Nice to see you posting.

 

[Vwhite1980]

Hi VWhite - Just one comment on your post really. When you say, ".... Lots of people however don't bother testing, especially type 2 diabetics....", to be fair, most T2s are instructed not to test their bloods, and even if we want to, the NHS will not prescribe testing strips for us at all. Some are luckier, but I would suggest the majority of T2s are not supported to test.

I appreciate T1s are different, but just clarifying.

Nice to see you posting.

Yes I see your point, Doctors are given this advice to keep costs down I believe. A friend of mine is type 2 (Late onset) and he tests his blood sugar around twice a day. If people want test strips including type 2s they just have to ask their doctor. Another friend of mine who has type 2 has been given a blood testing machine but rarely uses it cos she cant be bothered. Each to ones own I suppose. Funny because before she was diagnosed she kept asking me to check her blood sugar levels on my machine when she was feeling really poorly. My point is test sticks are available in the UK if you ask for them, some doctors may be more "tight" with their budget (Obviously they have targets to meet as well!) and you may have to fight for it, but I have found that just asking normally results in you getting what you need, even if you have to see a different doctor!

 

[AndBreathe]

Yes I see your point, Doctors are given this advice to keep costs down I believe. A friend of mine is type 2 (Late onset) and he tests his blood sugar around twice a day. If people want test strips including type 2s they just have to ask their doctor. Another friend of mine who has type 2 has been given a blood testing machine but rarely uses it cos she cant be bothered. Each to ones own I suppose. Funny because before she was diagnosed she kept asking me to check her blood sugar levels on my machine when she was feeling really poorly. My point is test sticks are available in the UK if you ask for them, some doctors may be more "tight" with their budget (Obviously they have targets to meet as well!) and you may have to fight for it, but I have found that just asking normally results in you getting what you need, even if you have to see a different doctor!

With respect, I think you will find many, many T2s do ask for blood testing equipment to find their requests repeatedly refused - even when they can prove they are able to utilise it to good effect.

I'd agree many of those refusals are cost based, but unfortunately, there isn't always great candour around that.

Anyway, I didn't post to derail the thread, so I'd best stop now, or I'll have to worn myself.

 

[catapillar]

enough test strips as the NHS allows an average of about 40 sticks per patients per month.

I'm not sure where this comes from, but I don't think that's correct. The NICE guidelines for type 1 diabetes - https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendations#blood-glucose-management-2 - provide that people with type 1 diabetes should be advised to test blood sugar at least 4 times a day, before meals and before bed, and people with type 1 should be supported (i.e. prescribed sufficient test strips) to test up to 10 times a day, or more when certain conditions like hypo unawareness or lots of exercise/driving, apply. A GP who wasn't complying with these guidelines and prescribing at least 130 test strips a month to a type 1 patient would need seriously good clinical reasons for contravening the guidelines and there simply aren't any clinical reasons that could justify it.

 

[Vwhite1980]

I'm not sure where this comes from, but I don't think that's correct. The NICE guidelines for type 1 diabetes - https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendations#blood-glucose-management-2 - provide that people with type 1 diabetes should be advised to test blood sugar at least 4 times a day, before meals and before bed, and people with type 1 should be supported (i.e. prescribed sufficient test strips) to test up to 10 times a day, or more when certain conditions like hypo unawareness or lots of exercise/driving, apply. A GP who wasn't complying with these guidelines and prescribing at least 130 test strips a month to a type 1 patient would need seriously good clinical reasons for contravening the guidelines and there simply aren't any clinical reasons that could justify it.

what are the NICE recommendations for type 2 Diabetics....as this is what I was reffering to?

 

[catapillar]

what are the NICE recommendations for type 2 Diabetics....as this is what I was reffering to?

Sorry that's a bit unclear from your post:-

Type 1 diabetics receive free prescriptions so it is not a worry. I did have to fight with my doctor to get enough test strips as the NHS allows an average of about 40 sticks per patients per month.

The NICE guidelines for type 2 don't mention anything about a number of test strips or frequency of testing, the do however quite clearly instruct not to routinely offer self monitoring of blood glucose to adults with type 2 unless they are on insulin, suffering with hypos, on meds that might cause hypos or pregnant - https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#self-monitoring-of-blood-glucose - that is a much harsher restriction than 40 strips a month.

 

[Karenchq]

What does MDI stand for? I am from another country and don't recognize this.

 

[Karenchq]

Never mind, I think that I figured it out - Multi daily injections

 

[SugarBuzz]

I may as well tag this onto this same thread rather than starting another similar.

Pumps again - once you have a pump would you be able to go back to pen injections? Or can you kind of do the 2 concurrently if and when needed? I do understand that to get any funding for a pump they want you to be 100% committed all the time so just for clarity the exact situation I'm thinking about (at some pie in the sky date in the not too distant future) is:

If I was on a pump for a while and then needed to go back on insulin injections just for a short while (i.e. - to do a one-off special event where a pump probably wouldn't be suitable - for example a mountaineering trip in possible sub zero temperatures). If that makes sense.

 

[catapillar]

I may as well tag this onto this same thread rather than starting another similar.

Pumps again - once you have a pump would you be able to go back to pen injections? Or can you kind of do the 2 concurrently if and when needed? I do understand that to get any funding for a pump they want you to be 100% committed all the time so just for clarity the exact situation I'm thinking about (at some pie in the sky date in the not too distant future) is:

If I was on a pump for a while and then needed to go back on insulin injections just for a short while (i.e. - to do a one-off special event where a pump probably wouldn't be suitable - for example a mountaineering trip in possible sub zero temperatures). If that makes sense.

I mean yes it would be possible to switch back if you wanted to, if you had a good grasp on your basal dosages and making the conversion between pump and pen. While obviously you can top up pumping with ad hoc pen boluses, doing the two concurrently doesn't really make sense and suggests you might not understand how pumping works?

I'm not sure that mountaineering in possible sub zero temperatures necassarily makes puming unsuitable, ask roddy riddle - https://roddyriddle.com/living-with-diabetes/exercising-with-t1d/

 

[Deleted Account]

I agree with catapilar. And to support this, a common recommendation is to retain your pens and some spare insulin cartridges as a backup in case there are problems with your pump.