Dr B is not educated on the pumps or the pod. I am a long long time pumper with no issue from scar tissue, have never had insulin degrade from heat (even in the hot summers of Texas where I wore the same res for a week sometimes). And the pod uses a cannula 6mm - not a 28g needle and fine tubing. A 28g needle would hurt like heck! He is as wrong in his 2011 review as he was when his first interview was done.
omnipod comes with a fixed size 9mm cannula. humalog is known to be heat sensitive. i was told to not use humalog while on POD but many people do and have no problem.
from the Omnipod site: The Pod's automated insertion system safely and consistently inserts the soft cannula below the skin to a depth of 6.5 mm and at an angle of about 60 degrees to the skin.
Either way, it is not a needle, and it's way smaller than a 28g one :)
The cannula itself is 9 mm but goes into skin about 6.5 mm. Omnipod - Insult Corp seems to be confused about the angle, customer service says 90 degrees..so, IDK. But, you're welcome to check with them. That's just what they told me as well as my pump nurse.
Hi Sarah,
You wrote: "the basal rates you suggested .25 - .35 does not support any type of insulin resistance." Actually it does in this case, as my wife is a renal failure patient. The studies I've seen show that renal failure patients require half as much insulin as a non-renal failure patient (because they don't eliminate insulin through the kidney very easily).
You also wrote: "There is no substantial benefit in achieving 83 bg's vs. 100 or 120 bgs."
How do you know there is no substantial benefit?
You also wrote: "even a nondiabetic has fluctuations in blood sugars." I'm non-diabetic and my blood sugar remains at 83mg/dL before and after all my meals. I wake up in the morning with 83 or 84, and go to bed with 83 or 84. If I fast, I go down to 74. It's only if eat fruit without exercise that my blood sugar rises.
I realize that's not the norm. I do eat low-carb (50-100g day). But is it not the norm now that people with fluctuating blood sugars are ending up with type-2 diabetes? To say they have no problems, I can't understand. I have a friend who had a fasting blood sugar of 97. He was experiencing many problems with his heart and waistline. Since correcting his blood sugar, he's now experiencing the best health of his life (at 50 years old).
My wife had an A1C of 6.5 for 36 years (more or less) and still developed kidney failure.
I just don't see how 120 mg/dL blood sugar could be considered safe or healthy over the long-term (I'm thinking decades, not years).
You also wrote: " a non diabetic can go up to 180 1 hour after meals." Is not also considered serious metabolic marker for heart disease if you exceed 150 mg/dL 1 hour after a meal?
oh, so sorry to hear about your wife, you didn't mention this because typically a .25 basal rate is pumping with 6 units basal which would be considered insulin sensitive. i've tested family, friends, etc...bg's in 120's...that's still considered a normal blood sugar. many would be happy for a 120. why 83, why not 70 or 90 or 85? Typically, one test for type 2 is a BGTT, if 140 2 hours after a meal a person still is considered non diabetic with a glucose tolerance test:
BGTT Normal Results
Normal blood values for a 75-gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant:
•Fasting: 60 -100 mg/dL
•1 hour: less than 200 mg/dL
•2 hours: less than 140 mg/dL
Hum, many many have had high A1C's especially as children back in the day and have no complications, many with good A1C's have complications..so, who knows. Was kidney failure due to diabetes? Is she a type 1 or type 2? For 35 years she's had A1C's at 6.5%?
I think that the "standards" of 120/ 140, etc. for the BGTT may not be as useful as tighter control. I like to use a lower target because I think that aiming at 140 is sort of like aiming arrows at the side of a barn. You'll hit it but it may not improve your marksmanship, as it were.
I agree that lots of people have pretty minimal complications but all of the complications are so ghastly that I want to do everything possible to avoid them. When I figured I'd probably be dead by 40, I figured it didn't matter but, now that I'm 45, I am thinking about it and feel better running pretty tightly controlled. If I get to 120, I am watching it like a hawk to make sure that's as high as it goes or correcting it and tossing in a few extra carbs if I run low, to balance things out.
Some docs recommend that you keep your A1c below 5 when you are pregnant, because that is healtiest for the fetus. I figure if that is what is best for a developing fetus, that is probably what is best for me.
Definitely not 90 degrees.
@ Sarah -
Where does the rest of the cannula go...the 3.5 that is not in the skin??
@ FHS -
my sets are 9mm and they go in 90 degrees. No problem :)
Karen, missed which pump you use so if you are using and I'm just not familiar with infusion sets, so sorry for the ignorance.
The cannula on the Omnipod extends pretty much directly from the reservior into the skin. It's like the line coming from a fishing rod. 6.5 mm of it is under the skin while the other 3.5 mm extends back out of the skin back into the reservior, like fishing line extending back out of the water into the rod.
@karen
Just to clear up a misunderstanding.
The quote from Bernsteins book says:
"The OmniPod uses both a slimmer needle (28 gauge)..."
Gauge is not the length of the neelde but the thickness. The higher the gauge, the thinner the needle. For example, a 31 gauge needle is thinner than a 28 gauge needle. The lenght of the needle is given in mm.
83 mg/dL was what Bernstein arrived at this average blood sugar for a male 20-40 years old; after running his own tests on blood sugar meter salesman. I've since run my own tests on myself and other healthy adults, and have found the 83 mg/dL to be true.
The family and friends you tested who had 120 mg/dL blood sugars -- was that fasting blood sugars?
I find most people will have 120-150mg/dL after eating carbohydrate rich food. It may be normal, but in my own personal experience I haven't found it healthy. When my blood sugar would spike after meals, I'd suffer both mental and physical problems (brain fog, fatigue) followed by sugar cravings 2-3 hours later.
It seems most people are suffering from this combination of fatigue, brain fog and sugar cravings (not to mention weight gain). While the medical system may claim 150-200mg/dL is okay, I think everybody needs to experience better blood sugars and compare for themselves.
In the end, I think we'd both agree it comes down to symptoms. If someone finds no difference in complications or symptoms with 150 mg/dL post meal blood sugar or a 83 mg/dL, then I guess it doesn't matter.
Yes, her kidney failure is assumed to be caused by diabetes. Through my own research, however, I'm seeing mounting evidence that a lot of "high blood sugar complications" are probably only partly caused by high blood sugar and diabetes. Instead, I suspect complications like kidney failure, are caused by the cause as type-1 diabetes -- autoimmune problems.
Successful cases of reversing diabetes type 1 have involved eliminating foods that cause both high blood sugars and autoimmune imbalances -- so it does make for an airtight win-win scenario.
Yes, my wife is type-1 since childhood. No, her A1C wasn't always 6.5 -- but for the years proceeding her kidney failure it was. Her kidney failure also progress quicker than usual, which makes me also suspect that blood sugar wasn't the sole cause. She had also had perfect blood sugars when the kidney finally did give out and we rushed into ER (when kidneys finally go, I assure it's not pretty).
Since going on a ketogenic diet, she managed to go from 6.5 to 5.0 within 3 months -- with a noticeable reversal of many of her complications.
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I like your "arrows at the barn" metaphor. That's exactly our reasoning. If we aim for 4.7 mmol/L (83 mg/dL), then it never goes higher than 7mmol/L (126 mg/dL) most days; and the worst case is like 10mmol/L (180 mg/dL). Sure better than days she'd be hitting 200 or 300mg/dL.
Thanks, Siri, for clearing that up.
Since I've had the pump (2008) and CGM (2010), I'm always surprised at how very small adjustments, .1G/U bolus ratio or .025U/hr basal will make a significant difference both in the "target" numbers and other, related numbers "downstream" timewise from whatever number I'm "targeting" when I make changes.
A 40 point spike from 80 is 120 but, if you're at 120 to start with, 40 takes you to 160 and, if you're even a bit off insulin or carb-wise, 200+ is right there with you. There's certainly a large element of risk with lower targets but I've found it useful to accept the risk, be familiar w/ hypo sensations and use the CGM to keep an eye on how things are sailing along. I kind of suspect that a lot of the problems people face are because health care providers, being largely clueless, don't have anything to say other than to repeat caution about hypos so they naturally try to aim us higher, so we don't create a lot of paperwork.
I would like to see someone take some initiative to find a group of people who are running A1C in the high 4s/ low 5s and see how their approach differs and try to put it into a "bottle" or Power Point or whatever so that it could become more accessible to everyone. So far, it seems as if there's very little interest in that, except for Dr. Bernstein and his minimalistic diet.
before i went on the pump my a1c was 11+ now it is around 7/8 once i was 6.8.
Love that analogy!
I wish someone would write about using an insulin pump with the levels of detail and thoroughness found in Dr. Bernstein's books. It is much easier to make small corrections and tweak basal doses with the pump. There are also plenty of things that can go wrong. I think there are solutions to be found to most of problems, though. If I build up too much scar tissue and can't pump anymore, I wil still be thankful for having had a few years without shots.
Do you actually find it does a good job at small corrections? We never did.
And as far as large corrections go, the pump really isn't ideal because it's not going to provide an intramusclar shot which is certainly much faster and seems to be more accurate.