Thank you so much for all your replies and suggestions!
My husband is using the “Animas Ping” pump and is on U-500 insulin.
The last few years while I was working and he was on MDI's, I would even load the syringes for him and write down the times that he needed to check his blood sugar and when to take his insulin, but he would forget to check and also forget to take his insulin before eating.
At 5'5 1/2" his weight blossomed up to 215 and he had a heart attack and Congestive Heart Failure in June, 2013. Because of the amount of insulin that he needed, his Dr. put him on U-500 insulin, and then on the pump. Last February he went "blind" in one eye and is unable to read the pump even with glasses; however, his distance vision is still pretty good. He does take his own Blood Sugar readings when I remind him to. Sometimes he'll eat first before checking and bolusing and then I'll find out later and that makes things complicated. Generally, it’s all I can do to get him to wait for even 10 minutes after “pinging” him before eating.
To make a long story short, I had to quit my job to stay home and care for him. Since getting the pump in June of 2014, he has lost around 26 pounds and his blood sugars (instead of being in the 300's and 400's are now mostly in the range between 80 - 115 except when he had the occasional low. Also his A1C has come down from a 10.1 to around 6.5.
I very much agree with you that he should be taking charge and managing his own pump (and I would love to see that happen) but he has difficulty seeing the pump screen as well as having memory problems. I was trying to show him how to do the audio bolus but even that's too difficult for him as he's also hard of hearing. My concern is that if something happens to me and I'm not able to be with him, that he'll end up with renal failure, stroke, or another heart attack and be totally incapacitated. He already has very painful Neuropathy and has difficulty with walking.
I’m really thankful for the “Ping” remote because it enables me to give him a bolus without using a syringe.
Does anyone know if there's a magnifier that could fit over his pump screen? At present I’ll try to show him something simple like hitting the “OK” button to turn off the “Low cartridge” alarm and he cannot see the “Confirm” on the pump.
With the U-500 insulin, we were told that he should bolus 30 minutes before eating. However, we weren’t told what to do if he goes ahead and eats something without checking his blood sugar and then I find out 15, 30, or even 60 or more minutes later. What is the proper procedure for that situation? If it’s only 15 minutes, do we bolus him for both carbs and a correction bolus if needed? If it’s 30 or more minutes, should we only give a correction bolus? Or should we reduce the carb bolus by half of the suggested amount and also give the correction bolus? I realize that the correct answer is not to allow this to happen in the first place, but unfortunately this happens quite often and it would really help to have some sort of criteria to go by in deciding what to do.
We’ve tried experimenting with small amounts of insulin and carbs to come up with a pattern; however, the more weight he loses the more sensitive he is to insulin. So each time we think we’ve got it figured out, and then he loses a few pounds, we have to reduce his basals again. By the time we get a hold of his Endo and then she gets back to us with his new adjustments, he needs to have them adjusted again. At present his numbers are doing okay since he’s reached a plateau in weight loss.
Dave, what do the initials “TAG” stand for where you mentioned “partial TAG strategy”? We’ve done some 4-hour testings during the day (without hubby eating anything) and during that period just the basal is keeping him in the 80‘s or 90’s. Is this ok? Like you mentioned, he hardly needs any basal during the night. Before going on the U-500 and the pump, he would wake up with high numbers (200 or above) but that’s really changed now for the better. Also he was taking up to 240 total daily Units of U-100 NovoLog and Levemir and that’s also drastically changed with using the U-500 since now he’s only pumping 8.55 Units daily of basal and between 1 and 1.5 units daily for carb boluses.
Please forgive the rambling and somewhat disjointed thoughts.
Again, thank you in advance for your help. :)