I recently started on an insulin pump, just over a month ago. I have been doing MDIs for over two decades (since I was a tiny kid) and finally gave that up. However, while I have to admit the pump has some fantastic advantages (bolus while standing in line for food, correct even just for a tiny bit of a high, like 135, etc), it has not been an easy transition. I have had ridiculously low and high b/s that I never had with shots. Is this a normal transition? This is not happening due to lack of effort b/c I am checking and recording and going to my endo & DE ALL THE TIME. How long did it generally take everyone to finally find a baseline of basals/boluses that worked? I realize everyone is different, but a month of super hard work to get it right (which it still isn't) seems like a lot, but maybe it's normal?
Yea, its normal. Its a different system that you need to get used to. What worked for you during your 20 years of injections doesnt really translate 100% to pump therapy. Hell, I have been at it 7 months and havent ironed it out yet. Plus, things change, so you will most likely have to alter your regiment a bit as time goes on. The important thing is to keep at it and dont get frustrated.
I went through a similar experience… I even took the pump off at one point and decided that I needed a break. I went back to the familiar injections for a week, then remembered why I decided to try the pump in the first place.
My endo made me promise to stick with it for a year (I was a hesitant pumper at first) and I think that is good advice. You can’t know all the benefits of pumping after a month.
Your pump is only as good as the settings that are programmed in it and those are a pain to get right! Be patient and know that it’s not just you!
(Also, my A1c after starting on the pump went up before it came down… because for me the beginning was a struggle. Others experience immediate drops, but not me.)
Been on the Omnipod for a month, and still fighting to get everything in line… my averages are down a good bit since i got put on it, but they’re still high. I’ve been over 400 twice in the last month on this thing, and usually that happens less than once a year for me. i’ve also gone down to below 40 a few times… both unusual, but i’m getting better control now. It just takes some time to settle in.
I am still learning , even while pumping our bods change , our day to day living changes , maybe less active, than when I was 60 , maybe more active tomorrow , because I will do a 10 k walk , the weather changes ( I need less insulin , when the temp is over 85 degrees) … maybe I like to experiment on some foods, I never tried before pumping, who knows. but the record book . My pump Nurse gave me some wisdom , when I wanted to just forget about pumping and go back to needles : NOTE this on the calender ; 14 days from now, you will feel different …she has been correct on numerous occasions …and this is how it is for me ( pumping since 2001 ) …wish you well SJ !
Ha! NORMAL is my vote too. We not only had all the usual collection of hassles in establishing baselines, we also had to deal with defective insulin cartridges during our first week (the seal was bad and allowed air bubbles in, resulting in frequent ketones and very high BGs). And, if it makes you feel better, Eric’s baseline changes every time he goes through a growth spurt, so even when we do settle on a pattern that works, it changes within a few months. But it’s STILL worth it - his a1c is now at 7.4, lower than it’s ever been since diagnosis.
Do you have the book Pumping Insulin? it was recommended to me when I had my troubles, and it’s great. Look it up on Amazon.
Yup. Normal as normal can be. it’s a big adjustment.
Buy a copy of John Walsh’s Pumping Insulin for some insight on how to get your basal rates under control and a wealth of other information. Besides informing you, it will give your endo and DE a break!
Keep with it. Things will settle down eventually. For me I just had to realize that the pump isn’t a magic bullet. It only does what I tell it to do. It’s also not a substitute for paying attention.
But not TOO much attention. Making frequent changes and adjustments isn’t productive if we don’t take time to let the adjustments take hold and track what happens. By ‘take time’ I mean two or three days. And if you’re changing something, like your carb ratio or your basal rates, change only one thing at a time. Otherwise you won’t know which change is affecting you.
How long did it generally take everyone to finally find a baseline of basals/boluses that worked?
one year. seriously - it’s a major committment. I was a 29 year MDI when I made the change, almost threw the pump out a window on several occaisions… but after the burn-in, it’s been a good thing for me. I am glad I made the change. and it’s been very good to me YMMV.
I went searching this form for the answer and you provided it to me. How often to make change? Your response was one thing at a time.
New question, How soon after starting the pump should an individual be confident enough to make ones own changes. I see a pattern on my carelink and want to make changes. but a little concern that i would make an incorrect change. On the pump for less than a month.
IMO, the key is do the upfront work to calc your baseline insulin needs.
Again, IMO:
Basil rate: First, do a gut check by dividing your typical daily insulin intake by 2 then multiply by .8. If that number is in the ballpark to the long acting insulin you take when on MDI then you headed in the right direction. Start with that / 24 for your hourly basil delivery rate. If you normally ‘swing’ a lot meaning you go low, eat, go high, take a shot, etc then back off from that rate by 20-25% since you should not be swinging as much on the pump and thus eating less in total.
Now, you need to get your BG stable while using the pump and DONT EAT ANYTHING for 8-12 hours. Nothing. No carbs, no meat, nothing. Ok, you can drink water and diet coke, etc. See where your BG goes. If it heads up above normal correct a bit and record your correction. When you are done with the fasting add up your total basil deliver + corrections and calc a new basil rate. Retry the test with the new rate until you are stable for 12 hours.
If you go low, back off on the basil delivery by 10% and retest the next day.
Insulin sensitivity: after fasting for 12+ hours and when in a reasonably normal BG range eat a KNOWN* number of carbs and take an amount of insulin that your experience tells you is about right. Meter BG every hour until your BG is stable again. Lather, rinse, and repeat until you figure out how much insulin is needed to return you to your starting BG in ~3 hours. Divide and you have your carbs/unit ratio locked in.
It is critical that you eat a known number of carbs. Use sliced bread or something similar that does not vary in serving size. Don’t use fruit, etc due to the variation in size and sugar content.
I hope that helps. I did the calcs before I started and it took me about 3 weeks to get things in order after starting the pump but the settings going in were within 25% of the final settings so it was close enough to be safe and did not result in any crazy highs or lows.
