I had a pump long before a CGM was available – and even then it was far superior to MDI.
For me, it was important to establish correct basal rates first. After that I could focus on bolus amounts and duration, knowing my observations were not skewed by an incorrect basal dose.
To determine my basal rate, I skipped meals and watched what my BG did without food. I averaged many results so as to minimize the variability of stress and other factors. During the night, I began tweaking the early bedtime basal rates first since waking up to check my BG would elevate any later nighttime BG values. After getting a CGM, adjusting nighttime basal was a 1000x easier since I could just check my graph in the morning to see when I needed to make a change.
A CGM was also a huge asset in adjusting the meal bolus timing – both how long before the meal to inject and how long after the meal the insulin needed to last. Basically, l never got bolus timing optimized until I got a CGM because the optimal timing varies so much based on the meal content (steak vs donuts).
One hugely important thing to keep in mind is the insulin absorption curve. Generally, you want to make changes to timing so the peak of insulin absorption aligns with the time you want the biggest change in BG result. This is particularly so when setting basal rate. What to lower your BG at 5AM? Then increase the basal dose at 4AM.
In the advice realm, but not specifically to your points, get really obsessive about changing your infusion sites every 3 days and using different parts of the body (aka, rotate your sites).
Your body doesn’t like having something stuck in it for days on end, so each time you put in a new site, give the old area time to heal. I have a routine where I basically go 21 days before I place an infusion set in the same basic body area.
Welcome to pumping. Unlike @Helmut, if pressed I would give up my CGM long before my pump, but each gets to place their own value on the technology.
As @Terry4 said, we’re rapidly approaching a new age w/r/t insulin pumping that will make it way easier to figure out what to do.
I feel like we have gone backwards. They would do this. Why is the sensor such sh!T now compared to how it used to be? Am I the only one having way worse, totally unpredictable sensor error on G6 than G4? WWWWHHHHHHHYYYYYY?!?!?!
Ashley, is your doctor an internist or a general physician rather than an endocrinologist? If so, do not go to that doctor for advice on your diabetes. If he IS an endocrinologist, I would look for a new one in your area. My fantastic Endo that I used for the last 22 years just retired, so last week I met with a new Endocrinologist. I worked with him regarding some lows I have had, and he set up a whole new bolus/basal testing plan for me to “fine tune” my insulin delivery. Even though I have been diabetic for 53 years, I also have an appointment with one of his “diabetic educators” to help me better understand the changes we will make with my OmniPod pump. Your learning about diabetes and how your body responds to food, exercise, stress, and emotions will NEVER end, and that is OK. The more you know, the more power you will have to make educated changes which will help you lead a better, more controlled life.
Check with your local (or county) health department personnel to see if you can find some good endocrinologists and diabetic educators in your area. The person who trained you on your pump was just a technician who knew enough about the pump to give you the basics. I seriously doubt that he or she was really knowledgable in the treatment of diabetes on a daily basis. We here on the forum are not medical professionals, so we cannot completely (or legally) answer all of your questions, but a good medically-trained endocrinologist or diabetes educator can. I agree that I think a CGM is a great idea, but understand that coordinating the CGM and the pump also takes some legitimate training and experience.
Seek professional education, Ashley. You will be so glad that you did.
Glad this works for you, but many can not find patterns because they don’t always exist. I run a pretty flat basal, and tweak with temp basals as needed, which is easy to do now with cgms and pump.
Here is my last 90 days.
Given this time frame, you can obviously see that OVER TIME, I have a higher BG starting at 8pm until about 11pm.
I could obviously increase my basal in this time frame (starting around 7pm, or maybe 7:30pm)
This would be SAFE to increase a small amount at a time until I smooth this out. And by the graph, it would be SAFE to do so because it never even gets on the low side even with outliers.
I know this works, because I have done this over time a few times. I have had to adjust it a few times as well.
This isn’t a BIG pattern, and would only require a small tweak, but those are and can be what makes a difference in the long run.
Hmmm…I never set basals this way. Just to get some perspective, what would you do with this data? Bump the basals up? This is running way more of the high side than I am generally comfortable with. I know that the sensor tends to read low. This is mostly open loop. Meal boluses seem to have dramatically increased. Thats often an indication that I need to amp up the basal. Maybe I’ll try that.
I could not find a stable pattern either. It would work until it wouldn’t. I attributed it to small changes in weight or activity. Now Loop evens out basal requirement changes. It is very typical that I go to bed at 85 and wake up in the morning at 85. During the night my BG moves around a little bit. I see it moving between 75 and 95.
I would try and slightly increase your basal at about 6:30-7pm until about 2-3am.
Try this for TWO WEEKS, and see what the results are.
You would be surprised at how a small change can affect a lot of events afterwards.
You could also potentially increase a little at around 2pm until 3:30 to 4pm.
These are small changes, and when done safely and monitored, can make a difference over time.
I have found that bringing down my nighttime BGs made the biggest difference for my A1c, but also starting the day off with a good BG makes it a lot easier to manage that day.
Oh yeah, my numbers also show a higher trend with the holidays and large meals in abundance.
This time of year might not be the BEST time to make too many changes
Temporary basals are not a bad idea if you splurge during the holidays, etc.
But why wouldn’t you also consider a change in your evening meal bolusing? What if you skipped dinner some days and found your evening pattern was in range ?
You are exactly right. I just happen to know what you see in my last 90 days is both. I previously had my basal set higher and found it worked great. But after a long stint without my g6, I set my basals a little lower to be safe. And I just haven’t raised then back again.
Personally, when I change my basal,I like to fast to make sure the change is good.
I was able to get my pump settings worked out with my Tandem Training
Rep. and OK’d by my Doctor. Also the Nurse’s at Tandem Clinical Support are of tremendous help. I call and talk about problems I’m having regularly!
Tandem Clinical Support 858-800-4406
My favorite Cgm is eversense and they have a bridge program where you can try it for 6 months for 99 per sensor(one every 3 months)…right now most aetna and blue cross/shields plabs cover it, but all others deem it too experimental. its more accurate, and the only one where the device is removable, but it leaves small 1 inch scars after removal and many people don’t want to bother with the insertion and removal appointments. Dexcom is the favorite and I think it works with the tslim or your pump, but if money is a factor, the libre (usually 70 per month with great benefit style medical insurance)and miaomiao2(about 200), and an android phone, or maybe a slight charge for their app if you have to use apple… I never liked pumps, but have used Cgms off and on for the last 8 years and the difference is immeasurable. Pumps without Cgm=rollercoaster. Cgm=a1c < 7
I have been on a pump for 4 years now. I could not have set my pump settings initially without the help of my diabetic team. It is required to visit them 3 x a year to be on the Alberta Insulin Pump Program. Probably the hardest was setting up my basal program. The big advantage of a pump is being able to adjust your basal during the day something you can not do with Lantis. I now have 6 different basal changes during the day. As a starter you total daily basal dosage should be about 10% lower than your Lantis dosage. I was told that I would use less insulin on a pump which was true. I was told that to determine if your basal rates were set properly you should be able to skip a meal and your BG does not change very much and you don’t go low. This is hard to do during the day because activity has a huge effect on your BG numbers. You are supposed to sit for 4 hours. Night time is easy and I know my night time basal rates are very close.
Insulin to carb ratios are much easier to determine. You do have to accurately measure your carbs though. Learning how to effectively carb count during my pump training was as big a game changer as getting a pump. My team also recommended a 10% reduction in insulin to carb ratio when I started on the pump and it worked well. I have found that my insulin to carb ratio has changed from age but probably because I am about 15 lbs heavier.
I have been using a Libre “CGM” that I am becoming very dependant on. The cost is out of pocket but it is so easy to determine basal rate settings. I have lately been adjusting my temp basal setting both up and down depending on my activity level and the direction my BG is going. Which brings up my final comment. My Endocrinologist wants me to get a Medtronic 670G pump with their CGM. It is a hybrid Loop meaning the CGM / pump control your basal rate up or down based on what you BG is doing, basically what I am now doing manually. I think your Tslim x2 is very close to being FDA approved to do that as well. I am on an Omnipod and don’t want to go back be being connected with a tube. I am hoping Omnipod will also be a hybrid loop. My big problem is I don’t have insurance to cover a CGM and the Medtronic CGM and the Dexcom CGM are quite a bit more expensive than the Libre.
