Omnipod! Wanting To Throw In The Towel

carak1987

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I'm starting to feel depressed, my bms are rarely below 12. I carb count correctly, but only been on it 9 days today. I knew I was to expect a rough time with high bms but it's ridiculous. I feel like just ripping it off and giving in. My background is being increased. Which I did again today to 1.3mmols p/hr. I've got a constant head ache. My ketones are perfect thank God but I just thought that I would start to see some difference. Am I expecting something too soon, I feel like I'm failing and that I don't deserve this pump. Please help with any advice on how you was when first starting on the pump. Tia
 

GrantGam

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Of course you deserve the pump. You've clearly been recommended by a HCP for whatever reason and should see this as a golden opportunity, so stick with it!

When you were initially diagnosed and went on MDI for the first time, it would have taken a long time to get everything under control? I guess your situation now is no different. It will take constant adjustment of insulin dosing to get you where you want to be. Apparently this can take a few weeks, but don't get disheartened so soon. It's all new and a case of learning as you go.

You'll get through it:)

Grant
 
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catapillar

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Don't give up! I've been on omnipod a month and it is an adjustment. Don't be so hard on yourself and don't expect miracles.

Think of the things you can achieve on a pump that would be much harder on MDI:

- you can perfectly bespoke your basal rate to suit you. Yes this does take a bit of work and is a frustrating process. Could you afford a libre for a couple of weeks to ease the process or get a trial one from hospital?
- you can micro bolus for correction, tiny bits of carbs, protein - you can give 0.05 unit increments and aren't forced to round up to 0.50 or 1 unit.
- you can dual wave bolus - hello lasagne/pizza!

Have you read pumping insulin - it is so very worth it to make the most of the pump. And also to realise it's not you, it does just take a bit of hard work to get used to.

Take a breath, have a chat to your DSN about the best way to bring it down. Flick through the omnipod user manual so that you know how to adjust basal settings, ratios, correction factor, insulin duration etc.

You can do it :)
 
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carak1987

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I'm just so frustrated. My bms are currently 24.7mmols. An hour after my dinner. I have 12 units IOB plus 3 units extended bolus remaining. My head is splitting
 

noblehead

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@carak1987 it looks like your basal rates still need some adjustment, why don't you ring your clinic up tomorrow and ask if you can go in and speak with your pump DSN, appreciate it's frustrating but it should all come together in the end.

As @catapillar says do purchase the book Pumping Insulin as it is an excellent read and is full of useful tips & advice on how to get the best from a pump.
 
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catapillar

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So, think about how you got to 24.

Did you count carbs correctly? Is your insulin to carb ratio set correctly?

What were your blood sugars before you ate? Did you have to correct? Is your correction factor set correctly?

What did you eat? Why did you decide to use an extended bolus for that meal?

When did you bolus in relation to eating? If you were correcting, did you wait for that to work before eating?

Have you done basal testing to check your basal rate is correct for this time of day on a weekend? Could you do with an increased TBR?

Sorry, all those questions will probably not help with the frustration! But hopefully they will show that if you systematically work through it, you will find a solution to work for you.

Drink lots of water. Check for ketones. Check no leaky pump site.
 
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carak1987

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So, think about how you got to 24.

Did you count carbs correctly? Is your insulin to carb ratio set correctly?

What were your blood sugars before you ate? Did you have to correct? Is your correction factor set correctly?

What did you eat? Why did you decide to use an extended bolus for that meal?

When did you bolus in relation to eating? If you were correcting, did you wait for that to work before eating?

Have you done basal testing to check your basal rate is correct for this time of day on a weekend? Could you do with an increased TBR?

Sorry, all those questions will probably not help with the frustration! But hopefully they will show that if you systematically work through it, you will find a solution to work for you.

Drink lots of water. Check for ketones. Check no leaky pump site.


I'm only on day 9 so they are still titrating my basal. Had 2 wraps at 35g each with cheese ham and salad cream which I added an extra 3g for. It added the correction dose itself. And then I extended it 30% dose to begin then extended for 2 hours. I think I will have to stop extending for 1 as this doesn't seem to work for me. I never used to extend. I always test bms work out my carbs then eat. I'm just going with the standard ratios etc that they worked out when setting my pump up except for the basal which has been upped to 1.3 from 1. My ketones are fine at the moment.
 

carak1987

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@carak1987 it looks like your basal rates still need some adjustment, why don't you ring your clinic up tomorrow and ask if you can go in and speak with your pump DSN, appreciate it's frustrating but it should all come together in the end.

As @catapillar says do purchase the book Pumping Insulin as it is an excellent read and is full of useful tips & advice on how to get the best from a pump.


I'm at work tomorrow so I've asked my Dsn to come see me as I work on a diabetic ward lol. I seriously think that my pump is just not tuned to my rates properly which the DSN will have to help me with
 

noblehead

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I'm at work tomorrow so I've asked my Dsn to come see me as I work on a diabetic ward lol. I seriously think that my pump is just not tuned to my rates properly which the DSN will have to help me with

That's handy then working in a hospital.

The DSN will help with your basal adjustments, but also ask if the clinic do any pump training days with the Omnipod rep.
 

catapillar

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I totally get why you are so frustrated and it's not working for you. I have no idea what a standard basal or a standard ratio is and I have no interest, because I'm not standard and nor are you! Of course the "standards" aren't working for you - you're unique and you need your pump settings to be bespoke to you. The DSNs will be able to help in that process.

Personally, I've seen my DSN once since starting pump. I have made all the changes myself when I could see they weren't working for me.

I had read pumping insulin, I had looked at the user guide. I have a dexcom. So I'm perfectly competent to titrate basal myself, adjust my ratios, correction factor, insulin duration, insulin per hour limit (ok I had to call my life for help with that one) and make all the necessary changes without input from DSN. But do discuss this with your DSN and do the learning so that you have the power and ability to, safely, make the changes yourself - hopefully that will reduce the frustration :)

Just because extended bolus is available doesn't mean it has to be used for every meal! I probably wouldn't bother for a wrap. Just for something that's both very carby and very fatty (pizza/lasagne) or something especially low gi (brown rice/lentils/pulses).

I think @noblehead or @tim2000s has a link with information on the benefits of pre blousing. Definitely worth thinking about.

Didn't you mention before you would like to train to be a DSN? Maybe it would help to think of yourself and getting used to the pump as a training project.
 
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carak1987

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I totally get why you are so frustrated and it's not working for you. I have no idea what a standard basal or a standard ratio is and I have no interest, because I'm not standard and nor are you! Of course the "standards" aren't working for you - you're unique and you need your pump settings to be bespoke to you. The DSNs will be able to help in that process.

Personally, I've seen my DSN once since starting pump. I have made all the changes myself when I could see they weren't working for me.

I had read pumping insulin, I had looked at the user guide. I have a dexcom. So I'm perfectly competent to titrate basal myself, adjust my ratios, correction factor, insulin duration, insulin per hour limit (ok I had to call my life for help with that one) and make all the necessary changes without input from DSN. But do discuss this with your DSN and do the learning so that you have the power and ability to, safely, make the changes yourself - hopefully that will reduce the frustration :)

Just because extended bolus is available doesn't mean it has to be used for every meal! I probably wouldn't bother for a wrap. Just for something that's both very carby and very fatty (pizza/lasagne) or something especially low gi (brown rice/lentils/pulses).

I think @noblehead or @tim2000s has a link with information on the benefits of pre blousing. Definitely worth thinking about.

Didn't you mention before you would like to train to be a DSN? Maybe it would help to think of yourself and getting used to the pump as a training project.

Yes I want to be a Dsn. I may be re thinking that right now

It's the standard for my usage from the 5 days before starting the pump. They work out from your usage and not just put of a book

I've just realised tested and it's now flashing at me "HIGH" lol I've never been high like this. I've injected a correction dose of 10 units
 

GrantGam

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Yes I want to be a Dsn. I may be re thinking that right now

It's the standard for my usage from the 5 days before starting the pump. They work out from your usage and not just put of a book

I've just realised tested and it's now flashing at me "HIGH" lol I've never been high like this. I've injected a correction dose of 10 units
I know the expense is the only downside, but have you considered using the Libre?

As the app is now available on smartphones you would only have the £48 or so outlay for a sensor. That would help to provide you and your DSN with a wealth of info over a 14 day period. I bet it would be a great aid to get you on track:)

Oh, and it'll give your fingers a well deserved rest too. But you'd want to quantify extreme highs and lows with a standard BG test.

Grant
 

carak1987

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I know the expense is the only downside, but have you considered using the Libre?

As the app is now available on smartphones you would only have the £48 or so outlay for a sensor. That would help to provide you and your DSN with a wealth of info over a 14 day period. I bet it would be a great aid to get you on track:)

Oh, and it'll give your fingers a well deserved rest too. But you'd want to quantify extreme highs and lows with a standard BG test.

Grant


They have asked my hospital for people to trial the libre so I've put my name down
 

noblehead

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Just because extended bolus is available doesn't mean it has to be used for every meal! I probably wouldn't bother for a wrap. Just for something that's both very carby and very fatty (pizza/lasagne) or something especially low gi (brown rice/lentils/pulses).

Quite agree, I would only use a dual-wave bolus for meals that have a high-fat content or are low-gi.

Pre-bolusing to reduce postprandial spikes works on a pump just the same as it does on MDI, have a read of the following @carak1987

http://www.diabetesselfmanagement.c...blood-glucose-management/strike-the-spike-ii/
 

GrantGam

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They have asked my hospital for people to trial the libre so I've put my name down
That's good that you've put yourself forward for a potential trial but how long will that be? Could be next week, equally a few months down the line.

Grant
 

himtoo

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why can't everyone get on........
Hi @carak1987
i know this is probably not what you want to hear right now -- but I was EXACTLY the same as you the first week on my omnipod.
I was crying my eyes out and wanted to return to my normally excellent control on MDI.....................but things will get better

time is the hardest thing about it -- cuz you can't speed it up and make things better faster.

another thing to consider with getting such high readings ( if way beyond what you expecting )
are you getting good absorption ? how long has current pod been attached ?
did cannula go in properly -- is there any moisture on adhesive or any smell of insulin.

if you don't drop soon ( 1 or 2 hours ) possibly a pen injection and a pod change

I had to do that yesterday ( change pod ) when my bloods ran between 17.1 to 14 to 10 back to 14 then hit 21 by 2:30pm
bloods were back down to 9.3 pre evening meal and 5.3 before bed
 
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himtoo

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why can't everyone get on........
Hi @carak1987
how have you got on these last 5 hours -- hopefully lower
fingers crossed here
 

carak1987

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Hi @carak1987
how have you got on these last 5 hours -- hopefully lower
fingers crossed here

I'm down to 7.7 and off to bed. I feel ****. I did an injection of 10 units when my bloods hit "high". I've had 1 unit with my tea but barely had carbs. Thankfully keytones have been non existent. My pump defo wasn't working properly in my leg. I had a lump when I took it off this morning. Then put another on and it fell off it bath lol
 

iHs

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Hi @carak1987

A good way to get the basal need for insulin adjusted correctly is to do some basal testing. ....This can be done for 5hrs at a time and some dsns will recommend no eating of carb at all but ok to eat small amount of protein. Other dsns will recommend no eating of carb or protein but protein is usually lost in the presence of carb so people only count carb in their food and not protein as well. Once you get yr basal need adjusted a bit more ok, then apart from
adjusting yr carb ratio and correction factor to also be ok, then bg levels will start to behave a bit better.
Another tip from me is while you are learning the ropes......eat just basic carb of no more than 30g per meal.
Reason .........the higher the carb value of the meal, the higher bg levels will go and unless the basal rates and correction factor is right......then its sky high bg levels you go.

Pumps can take a while to get used to and lots of bg testing needs to be done and unfortunately some bg testing in the night too and matchsticks needed. Have a read of the online basal rate adjustment guide by Gary Scheiner. It's easy to understand.
 
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