To pump or not to pump....?

[ma5on]

Hi Meela

Thanks for your post!

Well, I started properly yesterday (they gave us homework over the weekend before letting us get connected up!), and while the morning and afternoon went well, after dinner and this morning was not fun!

I've been up every 2 hours to test basal levels through the night (my own choice) and found that to be fairly stable. However, following breakfast (of 25g carbs), my blood sugar has gone from a waking 7.3, to current of 15mmol, despite an additional 5ui correction over the morning (last correction was 3ui).

Basal is defaulted to 1ui/hr at the moment, and while my carb ratio on pens was about 1ui:5g, the hospital told me to cut this to 1ui:10g to start. This seemed a little drastic and after speaking to them this morning they told me to increase to 1.5ui:10g, and I agree but am looking to see where the corrections need to be made to my basal.

I'm typical in that I want it all to be perfect now, but more so as I am now 7 weeks pregnant and am really worried about complications and harming the baby!

(I reckon I need some sleep!!!!)

Will let you know what the hospital say this afternoon as due back there for a progress update at 2pm!

ma5on x

 

[jopar]

Not sure how you used to take your back ground insulin, but it does take a couple of days to filter this out...

When I started on my pump I was on split does, so took my last shot the night before, the ones that had a single night shot of long acting were advised to lower the does I think by about 1/2, and those that took a morning single shot, depending on what time of the morning they were either to adjust the timing slightly the day before, or just take as normal as were all be up and running on our pumps by 11.30am...

There is a forumla that they use to work out your starting points, one is to work out your basal profile, they tend to evenly split this over a 24 hour period, and once you settled your can start changing to suit your needs..

I found it took about 3 days for my Levirmer to stop effecting my blood glucose, but you know when this happens as you can see the changes in control.. You ponder then you know..

The forumla they used to calculate my correction, left them a bit concerned as they do like if possible to start you of with 1 unit of insulin will lower your BG by XX amount, mine worked out at 1 unit would drop me by around 7-8mmol/ml's so I had to be extremely careful to start when correcting..

Hopefully you will have quite a bit of support and contact with your clinic, and we had a emergency mobile number that we could ring day or night for the first couple of weeks, as well as phone the pump nurses dirct through clinic hours..

If you can maintian a reasonable steady BG then hopefully your baby won't know that you are a diabetic and take offence over it,

I know that all the testing etc to start is very time consuming and hard going, but it's well worth the effort you put in, just remember don't try to make too many changes at one go, as you won't know which one worked and which one didn't

Good luck, take care and everything thing shoould pan out well

 

[meela83]

Congratulations on the pump and the bump!! Hope you get things sorted, my sugars were haywire for the first couple of weeks. Let us know if we can help. I am trying to get pregnant at the mo so hopefully will be asking for your advice soon :wink:

 

[ma5on]

Lol, thanks guys!

Last night was better - I was on a split dose of Levemir before (32ui at night and then 12ui when I woke up) as this was the only thing that limited the surge after breakfast. Am sticking with a flat basal of 1ui/hr at the moment and am fasting whilst checking my 1hr glucose levels. Pretty static so far apart from a mini surge into the low teens this morning so think I'll start ramping up the basal then (will check with the hospital first though!)

Also not certain my insulin:carb ratio is correct as sometimes I think I overinjected to compensate for the lack of background/dawn phenomenon. Definitely seem ok on about 1-1.5ui:10g in the evening but in the morning this is probably double....it's all fun and games!

Hope the baby won't take too much offence at all this dallying - it should know it's in his/her best interests

Meela - anything you want to ask, feel free. It's actually hard to find info on here as the forum seems to be geared more for gestational diabetes, and not us pre-exisiting (feel free to correct me if wrong!). I was terrified initially as there seems to be a lot of doom and gloom out there - Don't focus on that! Make sure you get your Folic Acid from the doctor as you need 5mg a day (I would start taking it now as you can never be too careful!), and maybe a pre-conception vitamin.....if anything it just gives you peace of mind that you're doing all you can.

I'm keeping my fingers (and toes!) crossed that everything will be ok, but am a strong believer in fate so putting my faith in the old adage "if it's meant to be..." (just doing all I can to help things along positively!)

Let me know how you get on, am on the Veo too (get the CGM hooked up on Fri at the hospital so that will be enlightening!), and remember (everyone) - anything you want to know, feel free to ask!

ma5on x

 

[meela83]

Glad things are getting settled Ma5on, my basal goes up and down all through the night but seem to have sorted dawn phenomenon out which is good. You are right about very little information for diabetics who get pregnant, although there is lots for gestational! I have been taking the folic acid for about 5 months so covered on that one and have had the go ahead to get pregnant so just need it to happen now! Have been TTC for nearly a year so getting a little impatient now.
Are you self funding the CGM or is it through the NHS? I would love to try one out even it was just for a week. Oh, what infusion sets have they given you?
Meela xx

 

[ma5on]

Unfortunately we have to self-fund the CGM bit. It's funny cos when the reps came to see us to let us choose our pumps, the hospital was all "don't go for this one because of the CGM etc...it's not that reliable, blah, blah, blah...." - Then as soon as I've bought it and they know I'm pregnant, they want to connect me to it immediately! Interesting, eh?!

It usually costs £750 I think, for the kit and the first box of 10 sensors (these are £375 for 10), but I asked if they would do us a deal as ther were 4 of us going for it and so we got it all for £375 each. This is prob a standard thing, but doesn't hurt to ask!

At the moment I'm using easy infusion sets - 6mm x 60cm (they sent me the 6mm x 110cm in error so hoping to swap these out with the rep today - too much tubing!), however she did say that these will be better when I get big (yikes! ) as I have more choice about where to wear my pump.

Had a Chinese last night so experimented with a 'Squarewave' bolus.....AMAZING!!!! Usually after a Chinese I'm good for a couple of hours, then rocket after about the third, so set it to run over 3.5 hours, and my blood sugar remained between 6.9-7.9...I was amazed!!!!!

The only problem I seem to be having now is the creep in the morning. I woke up at 6am and I was 7.9 (not too shabby!), but by 8.30 this was 10.9. Had 30g carbs for breakfast and bolused 4.5ui (ratio at moment is 1.5ui:10g) but just checked and I'm 13.9!!!! Done a correction bolus of 3ui, and had increased by basal to 110% (usual is 1ui/hr...changed to 1.1ui at the moment) at 8.00, but think I need to increase this by more, and earlier. Maybe also, mu morning ratio is more like 2ui:10g so wil experiment with this tomorrow.

Had a LOT of problems with air bubbles (think it's my lack of experience in filling the reservoir!), so had another bash at this yesterday and not had a problem since. So much to learn!!!

Am keeping my fingers crossed for you!!! Hope you get pregnant soon!!! In the meantime though, any questions, just shout!

ma5on x

 

[meela83]

Sounds like you are doing really well Ma5on! I have quicksets and use the long tubing as it is so much easier to sleep with, try both and see how you feel it's really easy to have them changed. With the air bubble thing, I had problems at the beginning and found if I take the insulin out of the fridge at least half an hour before so it is room temperature I hardly get any air bubbles!
I know it's a pain but checking your blood sugar at 2 hour intervals throughout the night can show you if you have basal set right. I have to do this tonight as sugars have been creeping up in the morning again! There shouldn't be more than 1.7 mmol between each result if your basal is correct. Good luck with everything xx