I am a Type 1 that's new to pumping...I started in September on the Ping. Of course at first I was all excited because my sugars seemed to be significantly lowered since starting on the pump. My A1c went down almost a whole point to 6.4 and I was really excited.
Now I am really frustrated. Sugars are always in the 200s a few hours after I eat, they go from good (90-116 or so) when I wake up, bolus 2 units before disconnecting to shower for 20 minutes and then by the time I am going to eat breakfast an hour or so later I am back into the 200s. By lunch I am close to normal levels but it's after lunch that things go high.
I know I need to do a true basal test and start from there, but my instincts are telling me that its the carb counting that's off since my wake-up levels are for the most part good. I did try raising my daytime basal rate a tad (.25)and will test that out for a week or so to see if that has any effect.
I have two carb-counting apps I use, (Calorie King and myfitnesspal)and each one shows different carb numbers for similar items...varying by up to 20-25 grams! How am I supposed to utilize these things if the variability between them is so freaking high?
Sorry to vent but I am frustrated and wanting to throw the damn pump out the window because it seems way too overwhelming and difficult to adjust all these things for optimal control. How do you know if it's your basal rate, your carb-factor, your insulin sensitivity, etc. ect. that needs adjustment? I am driving myself nuts thinking about all the possible changes I can make but don't make any of them because I'm a afraid to do so. I have both "Pumping Insulin" as well as "Think like a Pancreas" and to be honest my head is spinning from them haha.
Most people will tell you to basal test first. I don't disagree but if you are seeing highs two hours after meals you might also want to work on your I:C ratios. If you are feeling insure of your carb counts I would do two things: Pick the listing you are most confident of and just use that one. Then keep records of what you eat and how many carbs and what your two hour pps are. That way you can see if your carb counts are accurate. I cook more from scratch than use prepared ingredients so I only use calorie king occasionally but my cookbooks are marked up with carb counts I know to be accurate.
More important is to tweak your I:C if you are high two hours after meals on a regular basis. If you are using 1:15 and are always high, try going to 1:12 for a few days. Bear in mind that different meals may have different I:C ratios (mine are 1:6, 1:10 and 1:15). Another thought: If you are in the 200s before your meal the only place you can go is up. Are you adding in correction to your meal bolus? If you have an accurate ISF you can do this to keep from going yet higher. Some people also correct and wait to eat until they are somewhat lower.
Yes, it is a lot of work and it takes awhile to get it all balanced. Sounds like you might have had a good ride for a while when you first got on your Ping but now need to tweak some numbers. For me it took a couple months at least to get it all going right. Now I occasionally head off course again and need to revise things but it's never as hard as it was initially. I'm pretty good now at pinpointing exactly what needs tweaking and it's never everything at once. For me, my I:C numbers are incredibly stable over time but my basal needs periodic tweaks. I don't basal test, but simply do some small tweaks two hours before the problem time and it seems to settle down quickly.
You say that you have normal numbers before eating in the morning but your numbers rise into the 200s by breakfast time. That means that your morning basal rates need adjusting. I know that this can seem complicated and there are many factors in play. But your ability to solve problems like this is critical to your long term success.
Maybe you need the help of a certified diabetes educator that has successfully helped others like you to straighten out a basal/bolus program. I used Gary Scheiner to help me a few years ago. He consulted on a long distance basis using the phone and Skype. You can find him by searching for Integrated Diabetes. Once I went through the process with him, I gained the insight and skills necessary to make additional changes myself.
Be aware that these kind of challenges will continue. Successful diabetes insulin therapy is based on ever changing insulin needs. It is well worth learning how to do this yourself! There is no one set perfect profile for each person with diabetes. There’s not a week that goes by that I don’t make some kind of change to my pump settings.
Don’t be intimidated with the seeming complexity. It does get harder before it gets easier, if that makes any sense to you! Get help if you need it and realize that most doctors cannot give the detailed and sustained advice that you’ll need to get going. I’ll echo Zoe here, “Good luck and don’t give up!” There is a good solution for you.
Gary helped me immensely in the beginning, too! Recently I had a bunch of highs that were frustrating me to no end, and I reread Pumping Insulin and started all over from the beginning. I spent a weekend analyzing my data and tweaking numbers in my pump using the tables in Pumping Insulin. It was well worth the time. I am so new to this–less than 2 yrs–and the most important thing I have learned is, “Your diabetes may vary–and on a daily basis.” Don’t stress, strive for better, and forget perfect.
When I get out of whack, I'll eat something similar for a few days in a row. I use "Lose It" to count things, which I don't do all the time.
RE the pump, I don't ever "basal test" but if I run high after a meal or meals, I adjust the carb/ insulin ratio a click or two (like .1U/G...) to see what happens. A lot of time, things improve and I'm like "ok, that works...". I think I get better results when I go one thing at a time. I might adjust basal rate and bolus ratio at the same time but I've probably done both before too.
YES! It is normal to feel this way. There are a huge number of variables that play into what's going on with our BG, and it doesn't matter whether you are on MDI or a pump. It sadly is more than just having a state-of-the-art pump and carb counting apps.
Until you get your basals dialed in, you won't be able to accurately get your I:C and correction factors really in place, and you will endure frustration.
Now for some smaller questions. Is your morning basal rate 6 units/hour? I am trying to understand the 2 unit bolus before a 20 minute shower.
I would encourage you to also develop a few meals where you get your carb counts from the food labels.
How about Dawn Phenomenon? I know for me, I had a pretty strong DP until I moved to semi-retirement, where it went away. This one change, more than any other clued me into the need to periodically tweak my basal rates.
OMG, this is how I felt too on the pump. I've tried it a number of times but it just felt so overwhelming and so much work. I read all the books too, it didn't help as one still has to apply all that info individually to their own needs, which, change constantly and one-size doesn't fit all, of course. Are you working with a CDE, pump nurse? How many different basal rates do you have? My feelings about a pump is if you don't have significant DP or need a lot of different basal rates (and pumpers seem to change those all the time, too) and/or not into heavy exercising, what's the point. I always felt like I had no control and the fear of DKA was also there. Although I know I'm going to eventually try it again. Please keep us posted.
In answer to your question about the 2 unit bolus, I am having a HUGE problem with my numbers skyrocketing after I have disconnected and showered. Before shower, decent numbers(110-140)After shower and at work before breakfast, in the 200s. This never fails. I'm starting to think my liver dumps sugar one I'm up and moving about in the morning.
I looked at my numbers using Diasend and it has become clear that my basals are not right...I would say they only make up 35-40% of my TDD, which I understand to be too low...it should be more like 50%. This morning I just went without the 2 unit bolus before my shower because it's not doing any good and instead I've increased my early morning basal rate. I know I should do a real basal test and go from there. I will try to get them in soon...perhaps this weekend since it's a long one with no work.
Thanks to all of you for your input and support. I have no intention of giving up on the pump, as I know once things are more settled my health will be better for it in the long run. One good thing is that I have had almost no low sugars since being on it, when I used to have several a week. Its just these high readings that have got me down. I will keep reading my books and tweaking the settings one at a time each for a week or so until things get better.
Sounds like you are having some Dawn Phenomenon/stress issues. If you are bolusing 2 units with no food and a BG of 110-140, your liver is already dumping glucose. Otherwise, you would go low.
One thing you could try (especially with the long weekend coming up), is to take your shower at night so you don't disconnect in the AM.
I'll be succinct with some simple advice: If you're not having any problems with hypos, start turning things up in small, measured amounts. Increase your basal by 10% for 24 and see what happens. Tweak and tune from there.
Lower your IC and CF by 10% (so that you're taking a little more insulin for carb counts and corrections, given the same inputs). Again, tweak and tune.
Adjust gradually like this until you either get things under acceptable control, or start having lows.
This approach may be easier to manage, and reach success, than trying to figure out what the numbers should be via theory and calculation.
