Catch Up

[ElkBond]

Hello All.

I have been quite absent due to busy schedule (I occasionally pop on to have a look through the odd post so not totally absent) and just thought I would say hi again and give you my recent news and updates with Christmas coming up.

Best news is all the courses done, i's dotted and t's crossed and Omnipod will be ordered soon and I am looking at mid to late Jan for starting it. Looking forward to joining to omnipodders here! I am sure I will pick some of your brains later on

My HBA1C was a bit too low again despite lowering all my insulins (come on honeymoon period level out!) still trying to keep in the 5s. It still seems that I either have too much or two little. 4s or 6s, rarely stable 5s

I got moved to echo pens for the .5 units which helped with the bolus for sure. Carb counting is still erratic as ever, for example I had a lazy day today due to being away yesterday with not one but too pre made meals! one pasta (49g carbs) and half a M & S pizza (50g). Lunch was perfect, straight as a dime, the 1:20 ratio working perfect. Pizza (which I know is notorious for being tricky) was a disaster. I gave myself a little more upfront (4 units which should cover me for 80 carbs) and followed up with 2.5 units after an hour. This goes against the rules of a split bolus (half up front followed by the rest an hour later) but I heard pizza was tricky (friends over which is why pizza was chosen - it was a nice one, wood fired peppers and mozzarella or something) so I would rather have too much and tail off with a sip or two of coke when i see it start to fall than embarrass myself by freaking out because I'm in the high numbers. First hour went ok not even an 8 (which I allowed myself as its pizza), in the next hour...10, next hour 9.4. three extra jabs on top of my two previously of 2, 2 and 4 finally brought me down to 6.3. O and perfect timing for the Dexcom sensor to fail on the last large jab after 4 weeks..impeccable timing as usual.

So my question is why? I get that pizza is tricky but if my carb ratio that I use everyday is used why does it require so many correction (enough for well over 200g carbs altogether) to bring it back down? Is this just the erratic nature of the honeymoon period? I consumed around 50 carbs, bolused way above that so where are the extra carbs/ sugar coming from (pizza was on its own no other food aside from salad and just a water). Once I ate there was no hypo from the extra pizza so there couldn't have been a liver dump. Confused. I bet if I had it tomorrow it would be too much.

This is why I prefer to low carb when possible, and to be honest 5 to 6 days a week I can run bolus only or one bolus meal. But with Christmas coming on and friends over you can't starve yourself!



How is everyone else? Ready for Christmas? Anyone got any interesting developments of their own to share?

Thanks for reading the essay, I seem to have developed a knack for making what I thought would be short posts into essays...apologies!

 

[GrantGam]

I hope you get on well with the Omnipod, it seems like such a cool piece of kit! I'm sure @noblehead will be able to keep you right with any issues you may encounter

Funnily enough, I booked-marked this from a post of @noblehead's I'd read a while back - it seems to describe the exact issues you've had with the "pizza effect". I've stolen a few handy links from him over the last year, he doesn't seem to mind... too much:

http://www.mendosa.com/The-Fat-of-the-Matter-How-Dietary-Fat-Effects-Blood-Glucose.htm

Ready for Xmas haha - still waiting on parcels to be delivered for presents for the Mrs, so starting to sweat a bit... Also still waiting for a consult with the lead pump Dr wrt my eligibility for one. Exciting times

 

[Robkww]

I hope you get on well with the Omnipod, it seems like such a cool piece of kit! I'm sure @noblehead will be able to keep you right with any issues you may encounter

Funnily enough, I booked-marked this from a post of @noblehead's I'd read a while back - it seems to describe the exact issues you've had with the "pizza effect". I've stolen a few handy links from him over the last year, he doesn't seem to mind... too much:

http://www.mendosa.com/The-Fat-of-the-Matter-How-Dietary-Fat-Effects-Blood-Glucose.htm

Ready for Xmas haha - still waiting on parcels to be delivered for presents for the Mrs, so starting to sweat a bit... Also still waiting for a consult with the lead pump Dr wrt my eligibility for one. Exciting times

Good luck with the pump and the parcels!

 

[noblehead]

Best news is all the courses done, i's dotted and t's crossed and Omnipod will be ordered soon and I am looking at mid to late Jan for starting it. Looking forward to joining to omnipodders here! I am sure I will pick some of your brains later on

''Omnipodders''...................I like that

What you'll find when you start on a pump is dealing with difficult meals like those that are high in fat will be less problematic, you can use a feature on pumps called a Dual Wave bolus that delivers some insulin upfront and the rest over several hours if need be, but you'll likely learn all this on you pump training days.

Keep us updated on your progress and good luck @ElkBond

 

[Kristin251]

I always eat high fat low carb meals. For me, it would be all the dairy and saturated fat that takenonger to come in and keep me higher for much longer. Long after the original bolus runs out. I wouldn't eat the crust as I'm grain free but I think it would effect the timing the carbs come in.

If on the extremely odd occasion I eat pizza ( LOVE IT, but gave that up too ) I just eat the toppings off one or two pieces and don't struggle with it. I would struggle more worrying about dosing. Foods just not always worth it to me anymore. It's always a fight and D always wins

 

[ElkBond]

Thank you all for the replies.

@GrantGam1337 thanks for the link, Ive known about including the fats in a carb count but never knew why... sounds exactly what you suggested, fat makes the liver a bit more docile! That would perfectly explain the rising despite giving way too much insulin.

@noblehead I have been reading pumping insulin way back and translated a few pump things such as microbolusing (.5 is my smallest amount currently) and thats helped. My only real concern with moving to a pump is that safety but restrictive basal is gone, so if you have a pod failure your on your own. So my question is worst case scenario, all the spare pods I carry are also duds how quickly does Tresiba start working once injected, or should I retain my lantus pen for a backup basal (the issues I had with lantus would be minimal to no basal of course).

I am not getting cold feet to a pump, I just want to get all ground covered! I actually cant wait tbh!

@Kristin251 I don't follow a lchf diet, but I kind of limit carbs as much as possible most meals, and allow myself some wiggle room. I have never had two carby meals a day, its probably a 50+ meal a few times a week max. Also this was my first piece of pizza since feb... will not be returning for a while! I had more success with a full Indian takeaway!

And to top it all off, managed to pic up a cold a few days before Christmas! Typical! Any tips for that? Paracetamol os off the list due to dexcom sensor so it rules out everything!

Hope you all have a nice relaxing Christmas!

 

[noblehead]

@noblehead I have been reading pumping insulin way back and translated a few pump things such as microbolusing (.5 is my smallest amount currently) and thats helped. My only real concern with moving to a pump is that safety but restrictive basal is gone, so if you have a pod failure your on your own. So my question is worst case scenario, all the spare pods I carry are also duds how quickly does Tresiba start working once injected, or should I retain my lantus pen for a backup basal (the issues I had with lantus would be minimal to no basal of course).

Not sure what you mean by ''restrictive basal is gone'', but if a Pod does fail you just change it, it would be highly unlikely that the spares would fail too @ElkBond

You always keep insulin pens as back-up, so they stay on your repeat prescription.

 

[ElkBond]

@noblehead sorry I mean that currently I have a fixed basal that takes two days to accept any changes, so if I am more active one day I end up munching glucotabs to keep me afloat. I am on a measly 4 units of tresiba a day, sometimes I take that to 3.5 which is mostly too little so I end up moving back to 4. So temperamental.

 

[himtoo]

Hey @ElkBond
a warm future welcome to you an an omnipodder

we're a happy crew and ( in my opinion) get on very well with our pods

your concern about "no back up" was my first sort of frightening experience with pumping ( it happened sitting with my DSN going through "what to do in an emergency" )
fortunately I have not really had an emergency yet ( 15 months pumping )
but as long as you have pen back up in the fridge you always have the fall back solution should a need arise

 

[iHs]

Out of a choice of 2 basals, I would lean towards using Lantus as the backup because it works a bit quicker than Tresiba and the need for using a backup basal is probably no more than 3 days before using a pump again.

 

[himtoo]

@noblehead sorry I mean that currently I have a fixed basal that takes two days to accept any changes, so if I am more active one day I end up munching glucotabs to keep me afloat. I am on a measly 4 units of tresiba a day, sometimes I take that to 3.5 which is mostly too little so I end up moving back to 4. So temperamental.

with a pump your basal rates can be set to be adjusted on a 1/2 hourly basis ( hard to understand until you see how it works ) --- but trust me -- taking a few ( 4-8 weeks ) weeks to get settings correct for your individual basal needs and you will be smiling

 

[noblehead]

@noblehead sorry I mean that currently I have a fixed basal that takes two days to accept any changes, so if I am more active one day I end up munching glucotabs to keep me afloat. I am on a measly 4 units of tresiba a day, sometimes I take that to 3.5 which is mostly too little so I end up moving back to 4. So temperamental.

This is where a pump comes in handy, if your more active on a particular day you can use a different basal programme on the pump or use what they call a TBR (temporary basal rate), this feature reduces or increases the basal delivery.

 

[ElkBond]

@noblehead thats one of the reasons I cant wait for a pump.

And on that note! My pump day is last week of Jan! So any tips for the switch are welcome!
Should I not take my Tresiba the night before as it takes 48hours to wear off or just stay the course?

The pre-pump nerves are kicking in now!

 

[noblehead]

@noblehead thats one of the reasons I cant wait for a pump.

And on that note! My pump day is last week of Jan! So any tips for the switch are welcome!
Should I not take my Tresiba the night before as it takes 48hours to wear off or just stay the course?

The pre-pump nerves are kicking in now!

Not long to wait then

The only tip I would give is keep in close contact with your pump DSN for the first few weeks until your confident at using the pump and adjusting your own basal rates, if you get the chance to go on any post-pump training days take up the offer as you'll be surprised at what you can learn.

Regarding your Tresiba, it's best that you speak with your DSN before your start date as they'll advise you what to do about your injection, I was using lantus and was told to take half the dose the night before but see what your DSN says.

btw try not to be too nervous as all will go well, I had some pre-nerves but they soon disappeared once I was up and running with the pump, good luck @ElkBond