Getting a pump at last.

[Julian_Hands]

My hospital did exactly the same @Julian_Hands
They sent me the follow up prompt letter with the consultant before I'd actually started! I phoned up and went through a right old rigmarole!
Me:' I've received a letter asking me to make an appointment within 7 days.
Receptionist: I can't book an appointment for you, you're not due until July 2017, it's too far in advance.
Me: that's the follow up appointment, I haven't actually started pump therapy yet nor had an appointment
Receptionist: I can't book you your pump appointment.
Me: that's ok, but the letter says I'll be removed from the list if I don't make an appointment.
Receptionist ' I guarantee that won't happen

7 days later: 'you have not responded to our letter asking you to be booked in to see your consultant, we presume you no longer want to access our services and have removed you from our list.'

Me'

It all came good in the end as you know from my other thread, I started yesterday. Whether I'm still in the system for a consultant follow up in July, who knows? But I have my pump

That's pretty much what happened to me, I received the appointment in November and phoned the hospital to advise that I was hoping to get on a pump before Xmas but the receptionist advised this was the earliest I could see the doctor. I was a bit disheartened and when I saw the doctor she told me I should of phoned her receptionist.
I did advise that I thought I had phoned the receptionist and haven't any other number to contact so could only take what I was told as gospel.
All resolved now though and a week today we make the change.

 

[Claire007]

Oh well, at least we both got there in the end!
Good luck for next week! I'ts all worth it, I'm loving my pump, the one injection I'm really glad to see the back of is the final background at night, I used to really resent that injection
(Only had diabetes two years so I really ought to get a grip, I know, but I've found it hard adjusting to this way of life)

All the best for go live

 

[Julian_Hands]

I've been reading a few posts in the Forum and watching a few You Tube videos. I'm now curios when I go to the hospital on Monday that I should also ask for Ketone Testing strips as I haven't done any ketone testing in years and was wondering if this is something everyone is still doing?

 

[tim2000s]

Yes, you should. You shouldn't need them, but you should always have some.

 

[Lorraine1973]

I usually check my ketones when i'm ill. You don't get many in a pot x

 

[endocrinegremlin]

Having a way to test ketones is always important but even more vital on a pump as one set gone wrong can throw you into keto within hours. Sometimes your bg can be ok but you still get ketones due to lack of insulin in the system. I always like to keep either pee sticks or trips that test on a kit near me. I do understand the NHS making sure diabetics know how to carb count before we get our shiny pumps. I've known a few to claim they know how to do it and then actually have no idea and the pump is useless. The NHS has many box ticking moments but that is one I'm willing to hop threw.

 

[Julian_Hands]

Got my pump yesterday along with a ketone testing meter and strips.
An interesting start as I reduced my Lantus on Sunday night by 50% and managed my BG levels via bolus during Monday morning. When I got to the hospital my BG was 8.2 and training via the Roche rep was superb.
My nurse put 5 basal profiles into the pump which gives the flexibility of -20%, -10%, 0, +10% & +20%.
When I left the hospital my BG was 7.3 and when I got home it was 4.9. Due to this drop I changed my basal profile to -10% and maintained 4.9 to my evening meal. After the evening meal it rose to 7.7 so I returned the basal profile to 0 where again it then reduced to 4.3 so I changed back to -10%.
The problem you have when first changing is the remaining Lantus that you have to work around and closely monitor.
I was a little worried about my BG dropping overnight so left my basal profile on -10% which did allow a rise and at 2:30am my BG was at 11.8 so took a bolus to compensate and woke this morning with a BG of 8.5.
Overall for the first few hours I'm happy with what's happening and there is logic to what is going on.
Where this pump therapy is a revelation to MDI therapy is the speed in which you can respond to your circumstances, which also allows far tighter control. This has always been my annoyance with Lantus therapy as once you have that dose inside you, you can't do any more activity than you planned for that day without resulting in hypo situations.
I'm convinced this is the best treatment I have ever had in my 42 years of type 1 diabetes and so grateful to Prince Phillip hospital, Llanelli for giving me this opportunity.
If anyone is struggling with Lantus and gets this chance, grab it with both hands, it truly is life changing.

 

[Julian_Hands]

Due to the Lantus, my results were dropping to begin, now the Lantus is out of my system (48hours on), last night I did a BG every 2 hours and have lowered slightly my bolus and sensitivity ratios, which has this morning provided the most magical results staying between 5.2 and 6.3.
Yes you have to work on a pump to get control but boy it pays off if you think about every step and try to think around the 4 hour life cycles of any bolus insulin in your system.
Absolutely loving my Insight.

 

[Lorraine1973]

Great results, chuffed for you. I've been on my pump (omnipod) since last year. Managing my BG is so much easier now.

 

[Claire007]

Glad it's going well, my first 4 days were pretty much spot on but I've had to do some further basal testing again after it went a bit haywire. Unfortunately my basal needs seem to vary week on week so it's actually driving me a bit bonkers trying to get it right. Pesky Hormones.
I'm back to see my DSN tomorrow to download the weeks data, so I'll see what she thinks.
Still loving it though.

Ooh! Does your 'notes' screen work? I can't save any notes. The icon on the top right should 'save' (I think!) but it doesn't, it just deletes the characters

 

[Julian_Hands]

Glad it's going well, my first 4 days were pretty much spot on but I've had to do some further basal testing again after it went a bit haywire. Unfortunately my basal needs seem to vary week on week so it's actually driving me a bit bonkers trying to get it right. Pesky Hormones.
I'm back to see my DSN tomorrow to download the weeks data, so I'll see what she thinks.
Still loving it though.

Ooh! Does your 'notes' screen work? I can't save any notes. The icon on the top right should 'save' (I think!) but it doesn't, it just deletes the characters

Hi @Claire007,
My notes are working with the Insight handset and I press the top right tick when finished.
I had trouble with the 360 software and it took a while for Accu Check IT to call back but the configurator now works, just need them to send me an update, as the pump came with old software.
My basal rates have been fine whilst doing limited activity but last night I reduced my basal by 20% and went out for a 2 hour dog walk and it dropped rapidly, I think I needed to reduce the basal rate say 1 hour before doing such an event?
All in all though it's great to be able to bring my control back into range within minutes, unlike Lantus that leaves you fighting all day.
I've also noticed that my insulin total daily dosage has reduced by almost 20% from around 50 units per day to around 40 units.

I in myself feel allot better, healthier and happier with this treatment as I was getting so frustrated before with the MDI.

My evening basal rate needs tweaking as it does seem to trending to rise over night, will bring this up next Tuesday with my DSN.

All in all though I'm very happy.

 

[ElkBond]

@Julian_Hands so glad you are enjoying it I have had mine since feb and difference is unbelievable. I never got on well with MDI (only been a t1 since feb 2016 though). Do you have a dynamic basal or do you manually change the +/- ?

If you can, pair with a CGM because the duo is a powerhouse in the fight on numbers

Yes adjustments need to be made an hour in advanced.

 

[Julian_Hands]

Hi @ElkBond,

I'm currently on Dynamic and using a Freestyle Libre for a short period to help get a good picture with the induction to the pump.

The biggest changes I've found so far are with the reduction in my boluses and insulin sensitivity ratios for the time-blocks, all initially setup based on the MDI treatment.

From the trends I've been witnessing are based around the 4 hour periods after taking a Bolus and when taking a bolus with correction.

Slowly Im reducing these Bolus and sensitivity ratios and starting to get where I want to be, I've just checked and currently 5.3, so really happy with the results I'm now achieving but also have to get a little better educated on the Extended Bolus features.

Last Night I screwed up big time which also has had a big knock on with my overnight BG levels, I was in a rush to get out and had my evening meal which was Chilli Con Carne with Brown Rice equating to 52g Carbs. Problem occurred when I just administered a standard Bolus and consequently then nose dived an hour later, corrected with Lucozade and consequently then started to climb all night due to the Rice taking effect, I had to take corrective bolus at 2:30am but still woke with a BG of 11.8.

Is there any data anywhere that provides guide lines for the amount of time we need to accommodate for the extended Bolus with these low GI foods. Brown rice seems to release so slowly in me and seems to be active for over 4 hours in my system, or am I wrong and something else must be a contributing factor?

The pump has allot of tools we can use, just needs the brain to engage and use them with a bit of education/experience on how best to accommodate the tools properly.

Huge learning curve but definitely see the benefits once correctly administered.

 

[ElkBond]

@Julian_Hands

I have this images saved to give me a rough guideline.

I also have a table from 'think like a pancreas' on the GI but I can't remember where I saved it.

 

[Julian_Hands]

@Julian_Hands

I have this images saved to give me a rough guideline.

I also have a table from 'think like a pancreas' on the GI but I can't remember where I saved it.

Thank You @ElkBond.

I've started to pickup again 'Think like a Pancreas' a bit more and could do with re-reading it, as I initially read it whilst on MDI and learnt loads. I've also purchased via Amazon Pumping Insulin via John T. Walsh, which is taking a little longer than I expected for delivery, but hope to receive this in the next couple of days.

I'm sure well get there and still in target at present.

 

[ElkBond]

Thank You @ElkBond.

I've started to pickup again 'Think like a Pancreas' a bit more and could do with re-reading it, as I initially read it whilst on MDI and learnt loads. I've also purchased via Amazon Pumping Insulin via John T. Walsh, which is taking a little longer than I expected for delivery, but hope to receive this in the next couple of days.

I'm sure well get there and still in target at present.

Ahh yes I have read that one too. Pretty good but think like a pancreas was more in depth, in fact if you have researched the basics then you can skip ahead in pumping insulin. He did spent far too long in the beginner and could have done with more advanced pumping techniques. Although I felt a similar feeling with pancreas. Another topic of food and timings would have really added to it.

 

[Julian_Hands]

Now the last 3 days work has paid off, all day yesterday I stayed within target, between 4 and 8, last night I went to bed with a BG of 6.6 and after the best nights sleep I've had in weeks, I've woken up with a BG of 6.2.
It pays to put the work in and test hourly at the start, kept tweaking the insulin bolus and sensitivity ratios and now I think I'm there.
Feel great and loving the pump.

 

[iHs]

Now the last 3 days work has paid off, all day yesterday I stayed within target, between 4 and 8, last night I went to bed with a BG of 6.6 and after the best nights sleep I've had in weeks, I've woken up with a BG of 6.2.
It pays to put the work in and test hourly at the start, kept tweaking the insulin bolus and sensitivity ratios and now I think I'm there.
Feel great and loving the pump.

Pumps are very life changing. It's a bit like being on a roundabout that turns slowly around and arounnd but doesn't actually stop so the work and adjusting basal rates or bolus will be an ongoing thing but we all get used to it so good luck with how life goes for you with a pump.

 

[Julian_Hands]

Now I have my Basal regime sorted I will confess that I do need to get a better understanding of Extended Boluses as Rice and Pasta do throw things into new dimensions. From what I've seen on Forums and websites, everyone is different in how they manage these.
I believe its still worth researching though, as the less spikes we can achieve then the happier life we can lead.

I may need to start a new post for this but is the TuDiabetes TAGgers group, worth pursuing. I like the logic with counting the Protein and Fat content to calculate the percentage offset for the extended bolus, its just then the time factor to deliver that dosage over?

 

[tim2000s]

Hi @Julian_Hands - I'm glad to hear you're enjoying your pump. On the food absorption, whilst those graphs are helpful, it's always worthwhile doing a few experiments on yourself. For example, the late climb that you experienced with the Chilli and Rice is more likely due to the fat and protein combination delaying the rice, rather than the rice itself (for me Brown Rice and White Rice have very little difference in terms of Glycaemic Load - both cause a fairly sharp rise - but we are all different).

It's good to hear that you are experimenting with the various bolus types - it's amazing how few people use them. here was feedback in the recently published REPOSE study that suggests that around 80% of pump users never use the advanced bolus functions.

I tried the TAG detailed approach, but found that in most cases the time it took to go through all the calculations was a royal pain, so reverted to a more basic "assume that I have an insulinrotein ratio of about half my insulin:carb ratio" approach, and included that for the extended bolus, i.e., with an IC ratio of 1u:10g, I have an I ratio of 1u:20g. That works well for me and is far more simple to use. I know of others who use a third as their benchmark. It takes a bit of experimentation.

Keep on keeping on!