New to pumping, finding it a pain!

[iHs]

What times during the night does DP usually start Chris?

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[ChrisWoodward]

4am usually, my basal is set at 0.7u p/h from 1-2, 2-3, 3-4 and 4-5 which is an increase on the normal 0.4 p/h for most of the day up until 6pm when it runs at 0.5 until the increase.

 

[iHs]

My DP is also about the same time as yrself but I also tend to have very low bg levels from midnight to about 3am so on injections I always eat a snack b4 bed to try to stop me going into hypoland but there were times when my DP caused me to have higher than usual bg levels so I coped by injecting more background Lantus to deal with the DP but also eat a bit more snack to deal with the times in the night when bg went low. In many ways, I was lucky that my low bg levels were more or less at the same time frame and carb sorted it.
Since being on a pump, although my bg levels still change at times, ive sorted them to a target level of 6mmol and then the changes in bg wont cause me to go so hypo that my OH wakes up cos I am baking hot and sweating. On a pump, the lowest I may go is about 2.5mmol due to bg changing direction, but on that level I am able to sort myself out with 2-3 jellybabies and OH stays fast asleep.

Once youve got yr basal rates sorted with bg testing, try to set them to different target levels in the night like 6mmol for times when bg stays the sameish but at 5mmol to copr with the DP surge and then hopefully yr bg will behave and even if the DP changes, the lowest youll go on waking will be 2-3mmol with any luck and a cup of lukewarm tea with 1 or 2 tsp sugar in it will have you ok to eat breakfast and do csrb bolus.

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[ChrisWoodward]

Well ive just changed my basal to do this (on the advice of my DSN):

00:00 0.6 units
01:00 0.6 units
02:00 0.6 units
03:00 0.8 units
04:00 0.8 units
05:00 0.8 units
06:00 0.8 units
07:00 0.7 units

So hopefully that will help stem the increase but it shouldnt be too much to send me into lows if it doesnt happen, Ill test this for a few days and see where I am.

I also got it wrong on what I said it was before, its was this before:

00:00 0.4 units
01:00 0.5 units
02:00 0.5 units
03:00 0.5 units
04:00 0.5 units
05:00 0.5 units
06:00 0.6 units
07:00 0.7 units

 

[iHs]

Good luck Chris....youll get there slow but sure. A pump is only an insulin delivering device so changes in bg will still happen but at least a pump is able to fine tune the changes.

Roll on....the artificial pancreas. I hope that I will be able to use it within the next 5 or so years.

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[ChrisWoodward]

Yeah tell me about it! Also keen to see if this is a go or not.

http://www.gluco-wise.com/

Says they expect to take pre orders late 2016 but as we all know most never get off the ground.

 

[kt78]

Hi there, just thought I'd chip in and ask what sort of carbs you're eating? If I have regular pasta I have to run a temp basal of +50% 3 hours after eating for 4 hours, if it's wholewheat then for 6 hours. High fat meals over about 30g are similarly annoying... Good luck and you might want to try Pumping Insulin by John Walsh - Brilliantly helpful with this sort of thing!

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[ChrisWoodward]

Ok thank you for the advice. I do eat a really varied diet so could be the culprit although I dont generally eat high carbs,

Ill take a look at that book.

 

[kt78]

It's trial and error sadly Chris! The odd short-lasting high won't kill you and it's clear you're monitoring closely. In the end the benefits of a pump will change your life - honest! If you can see if your clinic will lend you a cgm again and try different food types to see what happens, it isn't as simple as pasta: good, sweets: bad, unfortunately! You can download that book too, it's better than any hospital course thingy I've ever done, and I've done loads!

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[Spiker]

I'm doubtful as to whether this is a problem of a long acting evening meal, as Chris has used a CGM and seen the rise start around 4am. With a slow delivery evening meal you would expect a slow rise all through the night.


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[donnellysdogs]

At the end of the day everybody whether on pump or not has days of up's n downs with levels.

I personally have huge variances in days from working bloody hard physically, to days when all I do is sit in front of a computer...

A pump needs basal testing initially especially at nights... You could be doing things in the proceeding 24 hours that can alter your your night readings... It just needs extra thought...

For example.. I have a lovely friend whose daughter is on a pump. Her Bg's fluctuate from weekdays at school to weekends to school hols, to swimming on Fridays etc...

A pump allows you to recognise and adjust basals to better fine tuning.... For these occurences....

It may well be that you do something say every Tues and Thursday that could well impact on Weds nFri bgs in mornings.

If you feel better management on mdi, then go back to mdi... HOWEVER.... I really think personally that you should look closer at your patterns... No day is going to be the same... Thats impossible.... But do look to see what causes affect your bg levels..


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[ElyDave]

To be fair, this did come across as talking down to someone (and like you've ignored the point completely).

I can totally understand the frustrations as I have issues of massively fluctuating blood glucose which no amount of basal testing and recording of what feels like bloody everything seems to be able to solve (food, carbs, insulin, activity, amount of sleep etc etc). Unfortunately though the chances are the pump is the best way to control the problem because there's very little injections can do about dawn phenomenon (unless you inject as and when it happens, but even that would be easier with pump).
It sounds like the best thing you could do is see if you can get more CGM monitoring, maybe for a month, make sure the food (incl fat and protein details) and activity is logged perfectly for that time period, and if there are still no patterns I'd agree with Spiker and say make a case for keeping the CGM- that way you can adjust your basal rates for the majority of the time and the CGM will protect you from the odd nights where you don't have DP.



Type One Diabetes since 2001, Coeliac Disease since 2003 ish, IBS, and on and off depression and diabulimia.

Current HbA1c 11.7%

not from where I'm sitting it didn't.

It came across as quite tongue in cheek to be honest.

But if you are posting here requesting help, then you need to be open to all the advice that is posted, evaluate the advice, not the giver and then decide whether it will help you or not.

It seemed to me that the OP had an agenda to start with - Help me justify going back to MDI.

But opinions are like ar$eholes - everyone has one.

 

[ChrisWoodward]

To be honest yes you are entitled to your opinion but you are wrong. I don't need anyone here's say so to go back on MDI, if that's what I wanted to do then I would do it.

I came to ask here because there are plenty of people that have been through what I am experiencing now and may offer me an insight into these issues that I hadn't been aware of or hadn't thought of.

Instantly assuming someone has an agenda because of the questions they are asking about their illness and treatment on the relevant forums strikes me as odd and rather cynical.

 

[Spiker]

Well come on let's not argue. We're all on the same side and it's all just about sharing advice. All the advice is offered in a well meaning way, sometimes a bit gruffly, and of course all of it is "take it or leave it". Let's just stick to the diabetes info and see if we can help each other out. That's what the site is for.

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[lilyfleur]

ElyDave-
The "tuff talk" just came across as if speaking to a child- the whole tone felt very "get off your **** and do something about it" which would really annoy me if I'd been the OP. He wasn't saying he expected it to be easy, he was just saying is it worth sticking with if his control was better without (a perfectly valid question- pumps aren't for everyone).
In terms of the actual advice, I've done plenty of days of basal testing which seemed to show everything was perfect but I still have a lot of issues of unpredictable highs and lows, with no apparent cause (and similarly some days have a rise at 4am, but not always).
I just think we can answer questions kindly without having to resort to the tough love approach. Hopefully basal testing will help in this case!



Type One Diabetes since 2001, Coeliac Disease since 2003 ish, IBS, and on and off depression and diabulimia.

Current HbA1c 11.7%

 

[ChrisWoodward]

Just about managed to get my fasting done at the weekend, basal seems fine apart from at 12 noon and 10pm where it rises quite sharply but seem to have got this under control by increasing basal at 9-10am and 7-8pm.

Annoyingly the night time one still is a bit hit and miss 3 am this morning was 15.3 but took some corrective and was 6.2 when I woke up so all good and it seems to have stayed there too but the annoying part is I am now having hypo symptoms continuously, I guess this is because of the raised BG since having the pump so im hoping it goes away quickly!

 

[lilyfleur]

If the hypo symptoms continue, try setting your target ranges a little higher (so if your current target is 5-8, try 6-9) and then once you're consistently in that range, you can drop it to where you want to be. Often the hypo symptoms are just a result of dropping your levels too sharply, so a gradual improvement will feel better.
I'm glad you've had some improvement after your basal testing, and I hope you manage to work the rest of it out soon


Type One Diabetes since 2001, Coeliac Disease since 2003 ish, IBS, and on and off depression and diabulimia.

Current HbA1c 11.7%

 

[ChrisWoodward]

Thank you very much, I'm hoping with time that things will level out because its making me have the weirdest mood swings

 

[Type1Jim]

Stay motivated and things should settle down after a while. Ratios and sensitivity can be frustrating!

 

[kkkk]

Don't know whether you have come across this, but I find it really useful when dosing at night....'cos of the change in hormones that happen when you sleep - most people (not all...yep all different ) need less insulin to correct a high at night when they are about to sleep...for me I have to reduce the dose by about 50% e.g. if the pump said 1 unit I would change it to just 0.5....so it's like I'm twice as sensitive to insulin when I am asleep. It just might help you reduce the lows if you do wake up and correct at night...but it is something you will need to play with and work out for yourself.