Can't cope with constant highs

[MushyPeaBrain]

I have been on the insulin pump almost 2 weeks now and feel so, so , so ill. My diabetes is out of control and my DSN team don't seem to understand the panic this is causing me. When I started I expected some fluctuations but my average BG is now 16 and I am regularly reaching sugars of 23 ish. Is this normal?

I asked about revising my carb ratio, which was 2 to 10g before pump. They said it needs to be smaller on a pump and dropped it to 1 to 10g. When I questioned this I was told even 1:10 is a huge dose and it's not good to be on a pump with a big ratio :?

They said they wanted to look at my basal but they will only increase it by a tiny amount at a time. It started on 0.6 flat rate. Then I argued and got it changed to 0.75 flat rate. I noticed I spike in the morning so they set it to 0.9 between 8am and 12pm. I have myself increased this to 1u and started from 7am in a vain attempt to curb the highs.

Take last night. BG was 14.4 at 8pm (after several bolus during afternoon to try and lower it to that). Took another bolus to reduce further. Ate dinner of lasagne so measured amount. Took bolus for dinner. BG 10 at midnight. Woke up with 15.9 :shock:

I don't know what to do, how to start, and I can't keep up this crazy rollercoaster of BG :cry: :cry:

 

[hanadr]

Either you go ahead and alter your ratios yourself or you sit on the clinic doorstep and throw a tantrum.
that's what it takes to get throuh to some medics
Hana

 

[iHs]

I have been on the insulin pump almost 2 weeks now and feel so, so , so ill. My diabetes is out of control and my DSN team don't seem to understand the panic this is causing me. When I started I expected some fluctuations but my average BG is now 16 and I am regularly reaching sugars of 23 ish. Is this normal?

No this is not normal. An insulin pump is meant to improve people's quality of life giving them less worry about bg levels, not make it worse :evil:

I asked about revising my carb ratio, which was 2 to 10g before pump. They said it needs to be smaller on a pump and dropped it to 1 to 10g. When I questioned this I was told even 1:10 is a huge dose and it's not good to be on a pump with a big ratio :?

I'm not sure about this. :? When I first started pumping my basal rate was started off at 0.50u/hr and insulin to carb ratio was 1u to 20g carb. I knew that this probably was not going to be correct so when I got home I told the pump that I was going to eat 20g so that it would give me 1u bolus but only eat 10g carb just to see what my bg levels were 2hrs later. Because they were a lot higher I then knew that I would need to start reading the training manual and try to remember what the pump rep showed me when he adjusted the settings on the pump. Using trial and error and doing loads of bg tests I then started to adjust my basal rate bit by bit and then my carb ratios. My carb ratios are now similar to what they were on MDI but just fine tuned a touch. Like you, by carb ratios on MDI were 1:4 br, l:7 lunch, 1:4 eve meal. Now they are 1:7br, 1:8 lunch, 1:4 eve meal. My basal rate starts off being low in the morning but then increases from 2pm onwards.

They said they wanted to look at my basal but they will only increase it by a tiny amount at a time. It started on 0.6 flat rate. Then I argued and got it changed to 0.75 flat rate. I noticed I spike in the morning so they set it to 0.9 between 8am and 12pm. I have myself increased this to 1u and started from 7am in a vain attempt to curb the highs.

Everyone's need for insulin is different so just because you or I don't fit in with what is written in text books that doesn't make it that pumps will be no good for us.

Take last night. BG was 14.4 at 8pm (after several bolus during afternoon to try and lower it to that). Took another bolus to reduce further. Ate dinner of lasagne so measured amount. Took bolus for dinner. BG 10 at midnight. Woke up with 15.9 :shock:

I don't know what to do, how to start, and I can't keep up this crazy rollercoaster of BG :cry: :cry:

If you know how to adjust your basal rates and insulin to carb ratios yourself then do your own thing. As long as you can test frequently you should be ok. Even if you go very low with a hypo you'll be able to sort yourself out by eating some glucose stuff and then alter the basal rate by just 0.1 on the 2hrs before the hypo started to see what happens the next day :wink:

Remember - it's YOUR pump, YOUR diabetes. Life using a pump should not be based around doing everything as a dsn advises you and finding yourself in grave difficulty :evil:

 

[jopar]

Firstly, Hana as you don't know anything about insulin pump therapy, you be wise not to make any comments..
_____________________________

Mushypea

Don't worry it's only your first week on the pump, it does get better

You need to do some basa testing to find out what going on... Basal testing is basically fasting with taking a BG every hour to track what is happening to your basal profile... Here a link which explaines how to do them..

http://www.diatribe.us/issues/13/learning-curve.php while you there have a look around you find it very interesting..

Gary Schiener is the authour of Insulin pump therapy dismisified There is another one called Pumping Insulin by John Walsh I would reccomend either one of these books as a must for using a pump..

Back to basal testing..

You need to sort this out before having a look at your ratio's as these are likely to change, don't forget that part of the carb ratio under MDI could have been helping to correct the basal slightly..

Work on one sector at a time and only make one adjustment at a time say you increase 1 or several hourly rates, then mnitor over a couple of days to see how it pans, then review if this sector is sorted move to the next sector.. Chances in one sector can have a knock on effect on another hence the need to sort one out at a time, and not too many adjustments otherwise you won't know what or didn't work..

Once you've the basal is settled it's time to sort out your carb ratio's.. you may find that you've adjust these slightly in one sector that's been sorted this is fine, but never assume that they will stay the same..

It's a lot to do when starting out, but take the time to work out and sort out your basal, then you find it easier to work out the rest out...

When to make an adjustment, well some say 4 hours before, other say less time really depends on what insulin you are using and how it reacts for you, I tend to make my adjustments an hour before for me this works best...

 

[hanadr]

I may not know a great deal about pump therapy, but I didn't say anything about it. I do know a LOT about dealing with medics and that is what I wrote about.
Hana

 

[jopar]

Hana

You don't know anything about insulin pumps,

As to dealing with the medic's as you call them, I don't actually consider being rude to them as it seems you are if your continue criticisum is anything to go by...

Stamping your feet and making demands at the pump nurse is probably the quickest way to have your pump funding removed from you..

But hay what do I know about dealing with the medical profesion, I fought for my pump for 3 years, oh and I spent 15 years working within the medical profession,,,

 

[hanadr]

I bow to the fact that you know it all
Hana

 

[sugarless sue]

Hana and Jopar,

While you are point scoring off each other there is a member who needs an answer
. Please use the PM system if you want to continue your disagreement.


Sugarless Sue.
Forum Monitor.

 

[jopar]

Hana and Jopar,

While you are point scoring off each other there is a member who needs an answer
. Please use the PM system if you want to continue your disagreement.


Sugarless Sue.
Forum Monitor.

no point scoring invovled I said what I wanted to say end of

 

[josie38]

Hi mushypea,

I was very confused when i started on my pump in aug. My bs were a bit high as well and it was explained that to get it right takes time. You haven't metioned what pump you are using.

I am using a spirit combo which comes with a blood monitor which acts as a bolus advisor. I would suggest that you try phoning the pump nurse and ask her advice. During my first three weeks i had to go and see mine 4 times for hi sugars and eventually she changed my insulin which has worked wonders and now it is manageable. My basal rate was set at 0.7u at first but now im on 0.9ubetween 3-9am and 0.8u rest of the day. Maybe you are changing to much at once and not giving it time to settle down. Like jopar said try changing one thing at a time.

hope it all goes well

josie

 

[iHs]

Hi again Mpb

'Take last night. BG was 14.4 at 8pm (after several bolus during afternoon to try and lower it to that). Took another bolus to reduce further. Ate dinner of lasagne so measured amount. Took bolus for dinner. BG 10 at midnight. Woke up with 15.9'



Sometime during the night yr bg level changes. The only way to find out when the change happens will be by testing 2am, 4am and 6am and then carefully alter the basal rate. I would think you are affected by DP which happens on a pump (usually from 3am onwards but everyone is different). Once your morning bg level starts to be more in the normal range, then all you've got to do is sort out your daytime basals.

I'm wondering if you can alter your insulin correction factor on the Animas. This can be found out by using the 100 rule. I would think that your's has altered from when you first started off with the pump. If your's is 1u will make yr bg drop by 5mmol then it will take a long time for a correction dose to make yr bg drop back to a target of 6 or 7. Have a look at the TDD of insulin that you are currently using including yr corrections then divide that into 100 to work out your correction dose.

 

[jopar]

Hiya Josie

What insulin did you start with, and what are you using now may I ask...

I'm using the original spirit pump with humalog..

I started off on a flat rate basal, can't remeber but think I started with about 0.4 units per hour.. Changed a bit from the early days, I now have a profile ranging from 0.1-0.6 throughout the day..

Some of the biggest problems with newbies to pumping is, trying to change too much at one go, and not taking the time to do fasting tests to see whats happening and what needs changing, some get away with it they think at the begining but tends to end up at some point bitting them on the bottum..

Seen it happen quite a few times now, sadly clinics don't help when they discourage the fasting tests of things still got there mind set, insulin=carbs need to eat regularly at times...

iHs

What about the hours between 2am, 4am and 6am?

The lowest ebb for hormone and the lowest point for blood glucose is around 3am in the morning!

Once you've got enough testing over night done, you be surprise what sort of changes there can be over night..

Much better to get all the information, so you know what the basal is actually doing, could always split over 2 nights though so not quite so much disruption to sleep

 

[MushyPeaBrain]

Thank you so much for your kind answers. I have this week off work so will be able to start some fasting to hopefully pinpoint some of the problems.

I think high sugar levels freak me out as I am already blind in one eye (due to NHS blunder during retinopathy treatment) and am very scared of losing the sight in my other eye.

I am on the animas 2020 pump with Novorapid and have been told am not allowed to use any advanced features until given training next week. My normal DSN is on annual leave but she did show me how to change my basals so I am ok with that.

I didn't realise that the carb ratio could vary as the DSN seems to want me on a single ratio. It would make much more sense to be able to vary it slightly but I'll leave it alone for now and take everyone's advice to focus on the basal.

Off to read that link Jopar

 

[sugar2]

Hi Mushypeabrain ( I like you sign on by the way!)

Hope things improve...I had a similar exprience when new on the pump, with the medical team (understandable) very concenred that we all make ourselves hypo,(I got my pump at the same time as 5 other people) so basically cut down our basal rates from what we were on when doing injections. They were also under the mistaken impression that we were all "getting a pump" because we had really bad HbA1c, and didn't want us to drop from a HbA1c of say 9, to 6 in 3 weeks, and do damage to our eyes.

For me, this wasn't true...I needed the pump because my insulin needs vary so much throughout the day...so I went home after getting the pump, and experimented, raising the basal rate until I was happy with it...although, to be fair, 6 months later, I am still tweaking it) The reason they want to sort out your basal first, before looking at your bolus (I think anyway) is because, without getting this straight, they can't really see the wood for the treses with your bolus rate. This is fine, if you sit at say 10, for a week or so, but no one thinks it is fine to stay at say 14+ for any time at all.

Hanas advice does ring true...if you are happy to alter you own rates, then do it, ultimately, we have to manage our own care. If you aren't, and need the professional to guide you, the all you can do is ask then (nicely but firmly!!) to do so. Accept, that for the first few weeks, your control may get worse, before it gets better, but at the same time, it shouldn't get so bad as to make you ill. Other pump users are a fantastic wealth of knowledge, and I can honestly say that I have learnt far more from Jopar, IHs and others on thsi board, than I have from my medical team...whom I have spoken to once since getting the pump in february. Hope it goes well!

 

[jopar]

The basal is the kingpin to all control, if this is incorrect then everything will be out!

The basal is our baseline glucose level, all our insulin needs are based on this one profile, we adjust our background insulin to create a flat as possible base line to work from..

The actual profile of a baseline is waved, so with MDI we attempt to match insulin in such as manner that we tighten the glucose range of the peaks and troughs as much as possible so ideal we have a gental wave to contend with, it will never be flat...

As we can't creat a flat basal line, we need to put a saftey measure in to ensure that our BG don't become to high at the top of a peak or when at the bottom of a trough we are hypo.. Hence the +/- 2mmol/l fasting test!

How does our bolus and carb-insulin ratio fit into this little malarky..

Well most people will say, that the carb-insulin ratio changes at different times of the day, purely due to insulin resisdence, this isn't strickly true only partly true..

Some of the carb-insulin ratio, will be compenstating to where on the wave you are eating, if you are eating at the start of rising peak, you may have to increase the ratio as with the food and whats coming of the liver insulin fulls too short to prevent you going to high..

If you are eating on the the downward slope then you may need to reduce the insulin as the combination of quick and background lowers the glucose too much to prevent a hypo....

I find that my carb-insulin ration is pretty constant, the only residence change I make is in the morning, otherwise the only other residence issue I get is based on current BG reading...

Hence the need to sort out the basal first..

Correction dose also changes, There is a forumla using your TDD to get your correction factor, I know that when they did mine, they were very concerned as 1 unit of insulin drops me by about 8mmol/l (and they wondered why I needed a pump!)

 

[Debloubed]

Hi ya, my tuppence worth (only been pumping since Feb so not as experienced as some!) but I do know that your basal and bolus ratio's could be subject to change, even once you have sorted them out! the more experienced you get the easier you will find it to adjust when you need to. If you don't know what the cause is, you can always go back to basics and do some fasting tests to confirm your basal is where it needs to be. As Jopar said, basal is the key!

Good luck, stick with it, it's definitely worth the effort

 

[anniemai]

Hana

You don't know anything about insulin pumps,

As to dealing with the medic's as you call them, I don't actually consider being rude to them as it seems you are if your continue criticisum is anything to go by...

Stamping your feet and making demands at the pump nurse is probably the quickest way to have your pump funding removed from you..

But hay what do I know about dealing with the medical profesion, I fought for my pump for 3 years, oh and I spent 15 years working within the medical profession,,,

I find your attitude just awful. I work in the health service and have since I was 18 - i'm now 39 .
I have had Type 1 iddm since I was 11 - 28 years
However that makes me NO expert on diabetes, one can only use their own experiences to try and HELP other people who are experiencing a difficult time.
Just because one person finds something a relatively easy it does not mean another person will.

 

[jopar]

anniemai

Excuse me, but I am helping with actual comments that are worth giving...

Not comments made on a subject that I don't know anything about nor encouraging somebody to take action that would actually put the person in danger of having funding withdrawn!!!

It seems that you aren't taking your own advice either... Err what help is your post to the origianl poster????