How long does it take to get the hang of a pump?

[RobertJ]

I am coming up to the four-week mark for my T-Slim X2, the first pump I've been on in my twenty and a half years with Type 1 diabetes.

The first few days were incredible. I couldn't believe how easy everything was and my average glucose was 6.7.

But for some reason, it got worse after that. Due to the fact that you tend to deal in smaller amounts of insulin on a pump, I have experienced some nasty prolonged highs. A common problem has been my BG rising after a meal and staying at 14-16mmol for three hours. I have also had some nights where it's gone high and the recommended correction from the pump was not enough to get it down by the morning.

The sad reality at the moment is that my results are worse than they were when I was on pens. My time in target was about 80/85% most of this year but has now dropped to 69%. I never let my average glucose go above 7.9 (and it was often lower than that) but it is now 8.4. I was assuming I'd go the other way with the pump, i.e. my results would be better than ever.

Have other people experienced a bumpy start before it eventually results in better long-term control?

 

[Juicyj]

Heya @RobertJ

Sorry it's not great from me news from me, have been on the T-Slim over 2 1/2 years now and am still not getting the results I keep seeing posted by others. I average 60-70 TIR, I tweak my basal ratios based on the Clarity data, but I find when I go high it takes ages to get levels down again, I am reluctant to correct by pen as this would mess up the algorithm and am certain i'd be going low if I did try. the only bonus is that generally night times are good and sleep quality is excellent, my issue seems to be hormone driven more than anything so not applicable to men, however would be worth speaking to your DSN about doing some tweaking now you're settled into the T-Slim as the initial basal rates would need some fine tuning.

 

[Nicola M]

My average TIR is around the 75% mark with hybrid closed loop. I was always told to aim for 70% so 69% isn’t terribly bad although it can be a bit of a shock when you’re so used to a higher TIR. I remember that it was definitely a rocky start for me especially getting my nasal rates right for the entire day. Once you’ve got that sorted everything else sort of falls into place pretty quickly. I would definitely call your DSN to just check in and see if you can make some changes, they’ll probably get you to do some basal testing if you haven’t done so already.

 

[RobertJ]

Thanks, @Juicyj and @Nicola M. Yes, I need to do more basal testing. It's hard work doing the fasting but I will do it.

I know we're told 70% is good but even on pens I reached 95% for a couple of days this year. My norm is about 80% so I thought the pump would be an improvement. I see anything below 80% as cause for concern. I am just talking about 3.9-10mmol by the way.

I am not going low as much as I did on pens, so that's definitely a good thing, but the pump has not been the transformation I was expecting.

I guess the logical way forward is to ensure the basal rates are all correct as you say, @Nicola M .

 

[Deleted member 527103]

When I started pumping, it was like starting again with my diabetes management.
I knew a little more than I did when I was first diagnosed but I now had far more "knobs to twiddle".

So, to answer your question, I would turn it around with "how long did it take to get the hang of MDI?" and the double it.

And that's before you start having to deal with "one offs" such as illness.

 

[RobertJ]

When I started pumping, it was like starting again with my diabetes management.
I knew a little more than I did when I was first diagnosed but I now had far more "knobs to twiddle".

So, to answer your question, I would turn it around with "how long did it take to get the hang of MDI?" and the double it.

And that's before you start having to deal with "one offs" such as illness.

Thanks, I guess that means the first few days (where it went really well) was just dumb luck more than anything else.

The main problem I'm having is long highs, where it rises after a meal (or even little snack) and won't come down unless I override it with corrections.

 

[Deleted member 527103]

Thanks, I guess that means the first few days (where it went really well) was just dumb luck more than anything else.

The main problem I'm having is long highs, where it rises after a meal (or even little snack) and won't come down unless I override it with corrections.

I don't think that is unusual.
When on MDI, we tend to have a basal dose which is the same 24x7 even though our basal needs vary throughout the day. This could mean we have "spare basal" sloshing around at some times of the day on MDI which can "mop up" when our bolus dose is too small. If the basal is correctly setup on a pump, we don't have this "spare basal" which is why we need to be more accurate with our bolus dose. The good news is we have more fine grain dosing to deal with this.
Whilst it is always important to get our foundation correct with basal, when I changed to a pump, it was the bolus that needed more tweaking for me and made me realise how much my long acting basal had been mopping up when I was on MDI.

 

[RobertJ]

I don't think that is unusual.
When on MDI, we tend to have a basal dose which is the same 24x7 even though our basal needs vary throughout the day. This could mean we have "spare basal" sloshing around at some times of the day on MDI which can "mop up" when our bolus dose is too small. If the basal is correctly setup on a pump, we don't have this "spare basal" which is why we need to be more accurate with our bolus dose. The good news is we have more fine grain dosing to deal with this.
Whilst it is always important to get our foundation correct with basal, when I changed to a pump, it was the bolus that needed more tweaking for me and made me realise how much my long acting basal had been mopping up when I was on MDI.

Thanks, @In Response. I hadn't thought about that but it makes sense. I think my bolus ratios are probably wrong, meaning I'm not giving enough to cover what I'm eating. I would say my carb-counting is off but I have been more stringent than ever before, to the point of weighing slices of bread and doing maths constantly.

Things are just not going well at all. I used to go through weeks without seeing a reading of 15mmol. Now that happens every day.

 

[sninge]

Don't despair, you Will definitely get there and it will be worth the effort. Are you using the tslim with dex 6 as closed loop?
Ive been on tslim about 8 months now, Roche pumps for about 17 yrs before that. I still found it a big leap going onto a different pump and system and hated the pump for the first 3-4 weeks.
As already mentioned sorting your basals out is 100% the place to start without that you will just be chasing your tail. It does take a bit of effort but you will get back the effort you put in. Then check your carb counting and carb ratios, they may be different at different times of days and equally important your correction ratio's which again can change depending on time of day. Then as the icing on the cake your active insulin time.
With regards to the time it takes to correct your highs I personally put that down to faults with the pumps set up, it works out your correction but only gives ( or suggests ) 60% of what you need, to cope with that I set the pump up with a ratio of 1-4 although I'm 1-6. The other problem I have is that the pump is set that we have 5hr active insulin time, for me novorapid takes an hr to work and then is pretty much done so for 4 hrs the pump thinks my level will keep dropping. I know my own ratio so I just top up any correction if I feel I need it. I also realise it's easier and definitely quicker to avoid a low than fix a high.
My 90 day time in range is now at 86% and I do get days in high 90s and the odd 100% days too. Stick with it and it will be worth it. Things will always change especially when you think you have cracked it, that's diabetes for you!!!

Sent from my Pixel 7a using Diabetes Forum mobile app

 

[RobertJ]

I should say it's got a bit better over the course of this week. I'm now up to 77% in range.

One area where the pump has noticeably helped is with running.

I used to have huge problems with the dawn phenomenon where I used to wake up high then inject to try and get it down and wait before going for a run. The intricate basal rates with the pump mean I barely experience the dawn phenomenon any more, and the ability to have a temporary lower basal rate means I don't have to worry about going low on (or after) a run either.

So now I can just get up, do a tiny correction if necessary, then set the temporary basal rate to 80% and know things will be stable.

 

[Hopeful34]

That's great, @RobertJ especially when you've started on a pump so recently, well done. It will get easier as time goes on, but as with everything diabetes there are still ups and downs, even with a pump.