Frustrated...

Maryam_Alam · Dec 1, 2016

Hey everyone, I need advices to better manage my sugars and overcome all the frustration and depression

I switched to medtronic's pump for more than a month now and had dka twice on the pump. No matter what I do my sugar wont come under control. For a day a basal is perfectly fine the next day my bgs are nowhere near normal as high as 390s. I correct the sugars too but not everytime I am able to do so. I feared using the pump after dka episodes but continued again. How often you people correct your high bgs? how do you guys set your ICR? For me the doses are good for one day and the next day highs again. For a 2 3 nights my sugar goes high after 3am when I adjust the basal after consulting my doctor its fine for a day or two then hypos occur. My after meals bgs are very high after 2 hrs by lowering icr hypos occur after 3 hrs. Sorry for such a long post but I am perplexed with this pump therapy. I feel like a loser and am depressed all the time now I will appreciate your help and advices. Thanks in advance.

azure · Dec 1, 2016

@Maryam_Alam If your basal is working one day and not the next that suggests to me there may be a possible issue with the sets - that is, either the wrong set/cannula, wrong insertion, or poor absorption.

Have you done a basal test or are you adjusting your basal without doing one? If you haven't done a basal test, then it would be best to do one as otherwise your boluses can give a false impression of how your basal is working.

For your highs two hours after meals, do you bolus in advance? Bolusing in advance can stop or reduce the spikes a huge amount. Eg for me I was always 11+ two hours after breakfast but with bolusing 30 mins in advance I stopped that high and my two hour result came down to approx 6.5. You may find you need to bolus different times in advance for different times of the day. Many people find breakfast needs the furthest in advance bolus.

A final thought - are you under stress or do you have any additional conditions that might be affecting your blood sugars? And could you have a hormonal imbalance? Those things can all cause erratic sugars.

Maryam_Alam · Dec 1, 2016

azure said:
@Maryam_Alam If your basal is working one day and not the next that suggests to me there may be a possible issue with the sets - that is, either the wrong set/cannula, wrong insertion, or poor absorption.

Have you done a basal test or are you adjusting your basal without doing one? If you haven't done a basal test, then it would be best to do one as otherwise your boluses can give a false impression of how your basal is working.

For your highs two hours after meals, do you bolus in advance? Bolusing in advance can stop or reduce the spikes a huge amount. Eg for me I was always 11+ two hours after breakfast but with bolusing 30 mins in advance I stopped that high and my two hour result came down to approx 6.5. You may find you need to bolus different times in advance for different times of the day. Many people find breakfast needs the furthest in advance bolus.

A final thought - are you under stress or do you have any additional conditions that might be affecting your blood sugars? And could you have a hormonal imbalance? Those things can all cause erratic sugars.

@azure I have done fasting basal profile and have set my basal accordingly. I am setting my ICR too but nothing seems to work. I am not stressed of anything except my bloodsugars these days. Quick sets are the only ones available I do insertion with a serter and regularly rotate sites too. Have no signs of infection too. They say these last 3 day but the second day my insulin turns purple and I change the set then.

Maryam_Alam · Dec 1, 2016

azure said:
@Maryam_Alam If your basal is working one day and not the next that suggests to me there may be a possible issue with the sets - that is, either the wrong set/cannula, wrong insertion, or poor absorption.

Have you done a basal test or are you adjusting your basal without doing one? If you haven't done a basal test, then it would be best to do one as otherwise your boluses can give a false impression of how your basal is working.

For your highs two hours after meals, do you bolus in advance? Bolusing in advance can stop or reduce the spikes a huge amount. Eg for me I was always 11+ two hours after breakfast but with bolusing 30 mins in advance I stopped that high and my two hour result came down to approx 6.5. You may find you need to bolus different times in advance for different times of the day. Many people find breakfast needs the furthest in advance bolus.

A final thought - are you under stress or do you have any additional conditions that might be affecting your blood sugars? And could you have a hormonal imbalance? Those things can all cause erratic sugars.

@azure I bolus only 10 15 mins in advance. My sugar spikes till 300 but comes back to 160 or 170 after 4 hrs. I had gastritis that might be to blame.

azure · Dec 1, 2016

Maryam_Alam said:
@azure I bolus only 10 15 mins in advance. My sugar spikes till 300 but comes back to 160 or 170 after 4 hrs. I had gastritis that might be to blame.

Then you could think about possibly bolusing a little more in advance perhaps? If you do try this, do one meal at a time and move your bolus forward 5 minutes at a time, testing lots. It could be that an earlier bolus may help.

Gastritis can mess your sugars up and your digestion too. Perhaps take,it easy and see how things go over the next couple of weeks, and then try to few changes if necessary.

Maryam_Alam · Dec 1, 2016

azure said:
Then you could think about possibly bolusing a little more in advance perhaps? If you do try this, do one meal at a time and move your bolus forward 5 minutes at a time, testing lots. It could be that an earlier bolus may help.

Gastritis can mess your sugars up and your digestion too. Perhaps take,it easy and see how things go over the next couple of weeks, and then try to few changes if necessary.

@azure yeah I will try doing this from now on. Thanks loads

Annamay · Dec 11, 2016

Maryam_Alam said:
@azure I have done fasting basal profile and have set my basal accordingly. I am setting my ICR too but nothing seems to work. I am not stressed of anything except my bloodsugars these days. Quick sets are the only ones available I do insertion with a serter and regularly rotate sites too. Have no signs of infection too. They say these last 3 day but the second day my insulin turns purple and I change the set then.

Hi Maryam_Alam - worth talking to your nurse as sounds surprising your insulin is turning purple! Have you checked the expiry date of the insulin and tried using a new pot of insulin? Axx

richyb · Dec 11, 2016

hi Maryam
I agree with bolusing before a meal . I used to do this on MDI but find the insulin works faster on a pump so only do it about 8 or 10 mins before. obviously do it gradually and see what happens. I also have only been on a pump for a month. My basal ALSO changes from day to day I seem to go from + 20 to - 20 % Within a couple of day's. I would find it difficult to manage without a Libre sensor fitted.
Still prefer the pump though. When I was on MDI it also varied a lot but did have times when it was stable. Because I keep monitoring and changing my temp basal, my overall levels are good.

iHs · Dec 11, 2016

Hi

If the insulin looks to be purple, this is probably blood coming up the quick set cannula and into the tubing.
If this is what's happening, then make sure that the set is being fired into the body correctly and also try to clean around the inside funnel of the insertion device with an alcohol swab to make sure that none of the circular adhesive is sticking a bit to the sides of the funnel. This was a problem many years ago with the quick sets but whether or not it has been addressed, I'm not sure.

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