90 Days on the Pump

Diabetes Technology Insulin Pumps
1

I wanted to give my initial experience after going from MDI to the Medtronic 530G and Enlite sensor.

A quick bio on me: I was Dx with diabetes when I was 25. The docs thought I was type 2, however after a honeymoon period of metformin and glymiride (sp?), about a year later, I was Dx type 1. I was on twice a day 20 units of lantus, and usually 8 to 12 units of humalog per meal shots.

So after 90 days, here is what I have experienced:

- I wish I had gone to a pump earlier. The control or at least the tools I have to help my diabetes has made me feel more at ease with having this disorder.

- For the first month I was only the pump, so I got to experience how it was "old school" before I got my CGM hooked up. Needless to say, I don't know anyone did before CGM came along.

- I have easily come to terms with pricking myself more often (8 to 10 times a day). Actually it doesn't bother me as much as the fact I tend to run out of strips before my insurance refills the script.

- I am still learning how to deal with "fatty foods" and getting the right percentage of dual wave over the right period of time.

- I have found I am waiting at least 20 to 30 minutes from the moment I give my bolus to starting to eat my meal to get better control of my sugar levels. I am on Humalog, but I am debating making the change to Novolog.

- Also I have gone from using over 60/70 units of insulin per day down to less than 50 on most days. I actually have lost weight from the pump (down about 10 pounds).

- I feel like on the pump, you have to be a master of counting carbs more so than on MDI. Which I have found the hard way, I have a long way to go.

- I find I have become almost OCD with my sensor, constantly looking at the values and trends. I am trying to break myself of this habit, but it is hard.

- Medtronic from a customer support/service experience is out of this world, and I am so happy I chose their pump. Have a tube hooked up to me just doesn't bother me that much.

I have my fist endo appointment in two weeks since I have gone on the pump. My last A1C was 7.3, and based on the reports I ran on CareLink, I should beat that, and possibly below 6.5. My goal from an A1C standpoint, is to just make sure I am going in a downward trend. While I would love to be one of those sub 6.0 people, I am happy staying between 6.0 and 6.5.

I do have a few questions for the community:

1) After being on the pump for a few months, at what point did you feel you went from "learning just to be on the pump" to "tweaking the pump" as if you were no longer a beginner?

2) If you use Carelink, anything specific you look at to see what you should be adjusting?

3) Predictive Lows/Threshold suspend...Do you use predictive lows at all (if so what are your settings) and what do you have your threshold suspend set to? I have heard because of the false alarms people get at night, they set it to somewhere in the mid 60s.

2

- "For the first month I was only the pump, so I got to experience how it was "old school" before I got my CGM hooked up. Needless to say, I don't know anyone did before CGM came along."

- "I find I have become almost OCD with my sensor, constantly looking at the values and trends. I am trying to break myself of this habit, but it is hard."

I have to say I find it a bit absurd to hear a pump referred to as "old school". I also find the first statement hard to coordinate with the second statement. The second statement is why I have no desire for a cgm.

I started out my pump use on day one "tweaking the pump" until I got my numbers where I wanted them. The only learning I had from my trainer was how to insert sets. I've always tweaked my own numbers. I remember they used to suggest people start on pumps and CGm's separately as they each had their own learning curve. But I think that was in the "old days"...maybe about 2-3 years ago.

Snarky? Yeah, sorry. I guess I'm getting frustrated reading threads about a pump and having half of them be about a CGM. Now I understand how the people on MDI feel when we all integrate pump talk with general diabetes/insulin talk. Let alone how the Type 2's on the board feel when the larger number of Type 1's talk as if Type 1 Diabetes is Diabetes.

3

Thanks for the encouraging words....

4

My response had less to do with you than my own frustration. It sounds like you are doing great, and exactly where you want to be. That's what counts!

5

8760 days on the pump! When I got my first pump there was no CGM. And when I did try one it was a total fail, some folks just can't wear them. I bought stock in the strip company I tell ya!! I look for patterns before I make any adjustments. One time high or low is just that sometimes. If that high or low happens every day around that time, or every time I do that thing, or eat that whatever....then yes adjust. Sometimes it's easier to just adjust for that 'thing' rather than add a new setting to your regime. That has been my experience anyway.

As for the CGM - I don't have any advice. I personally would not wear one that will suspend my insulin because it measured a low. I have read plenty of reports where the sensor is not even accurate, the false alarms can ruin a good night sleep, and then of course if you miss it and the thing shuts off your insulin. BOOM - bad day. This is a question for your trainer, your CDE, or your doc who prescribed the thing. Good luck and yay for successful pumping so far!

6

Hiya ITDiabetic,
Sounds like Zoe is having a bad day. So I'll shift away from that a bit.

I just started the same pump(530g) 6 weeks ago so I know where you are coming from. I've already gotten myself to not fixate on the CGM graph, it just takes time to get used to. I've even reduced the number of times I test to 7-8 per day rather than 10+. I did this once I felt I could trust the current sensor I have inserted. Most times when I would test in between meals I just didn't really need too since I knew generally from my CGM what my BG was doing.

As to your questions:
2) Carelink, I find the "Sensor Overlay by Meal" really handy since I'm in the same boat as you basically relearning how to count carbs with far more accuracy. I think once I get more comfortable with my carb counting is when I'll feel like I'm no longer a "beginner" pump user. I am also using this report to help me understand how the use of Dual-Wave and Square Wave bolus can help me with heavier meals.
3) I use both Predictive Lows and Threshold suspend. I have my Predictive low set to 80, which has helped me ward off even going low at all several times already. Just be sure not to over-correct when you aren't even technically low!
I have my threshold suspend set to 60, this seems to be the logical number since lower would be too low and higher would have it going off when you aren't in danger.

Feel free to add me as a friend if you want to chat more about it. I know what its like to be a technical nerd with a new toy, I think its fun ,but at times can border on obsession.

7

Not bad day, actually, Kevin, just a pet peeve whose time had come!

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1) I think that I got the hang of it pretty quickly. It may have helped that I was in a pretty intense Tae Kwon Do program and wasn't really intimdated by the pump and it worked *way* better than I expected and it really made things fall into place for me. I perceived how the trainer looked at the data and it made a ton of sense. I was also learning about carb counting as I had never done any of that before either (this in 2008...back in the dark ages...) and things just fell into place.

2) when I look at CareLink, the main thing I look at is the pie chart reports. I look for areas that have anomalies, like more lows or highs, as areas that might benefit from some adjustment. I try to fix one spot at a time but if I see a lot of lows after breakfast, I might adjust a bolus ratio a nudge, whatever the smallest increments are, .1G/U I think. Then I let it ride for a few days and see how it goes. A lot of times, fixing one spot will fix the "downstream" spots too.

3) I am still on the 523 so I get predictive alerts but it doesnt' turn my pump off. I'm not that keen on turning things off as I've found that that jacks up my BG. I sometimes will manually turn my basal down (I use 7 or 13%, lucky numbers, Or sometimes 25 or 33%...). I would want my pump to keep pumping if I'm in the 60s at night

I'm glad you like your pump and recognize the benefits of the gizmo! I've found mine awesome!

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you are gonna see the pump/ CGM linkage more as Medtronic is selling them that way hard.

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I've been on for 90 days as well. No CGM for me as I'm type 2 and insurance won't pay for it. It has been life changing for me. I am getting back to the control that I when I was first diagnosed. There is nothing more scary than doing everything right and seeing ZERO results for your actions. That's where I've been prior to the pump. It gives me hope that I can control my diabetes again.

11

just what i was searching for…thanks for your narrative!

12

Congratulations on the excellent results and improved A1c. Those of us using pumps can all relate to the initial learning curve: the uncertainties and the victories. What you're experiencing is entirely normal, and it shouldn't take long before you feel like you're tweaking rather than learning. I think what will give you the most confidence is when you feel you've gotten your basal rates right. Having a CGM helps this process dramatically, and there's nothing wrong with being a little OCD about it at first. I find the data fascinating and enjoy downloading and analyzing it as part of the tweaking process. Continue the good work and all the best!

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Being Obsessive-Compulsive comes with staying alive with T1D, so don't worry about it. The details are important, but you will get more comfortable with time.

My perception is that hypoglycemia awareness can change with closer-to-normal A1c results and pump use over many years -- at least it has for me. Checking BG 8-10 times a day is one way to manage and the results are more accurate at that point in time than CGM.

I'm not using the Minimed system, but if I were setting thresholds for myself, I would aim higher than mid 60s -- maybe 79 - 85, especially since your actual BG might be lower than displayed by the CGM.